Graduate School, Xinjiang Medical University, Urumqi, 830001, China.
Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91 Tianchi Road, Tianshan District, Urumqi, 830001, China.
BMC Pulm Med. 2022 Jul 24;22(1):284. doi: 10.1186/s12890-022-02077-w.
Pulmonary tele-rehabilitation can improve adherence to pulmonary rehabilitation. However, there are few reports on home based pulmonary tele-rehabilitation. We assessed the effectiveness of home based pulmonary tele-rehabilitation under telemedicine system in patients with chronic obstructive pulmonary disease (COPD).
This cohort study enrolled 174 patients with COPD who received home based pulmonary tele-rehabilitation under telemedicine system. The follow-up time was 12 weeks. Patients were grouped according to pulmonary rehabilitation weeks, number of rehabilitation times and total duration time, and when these three data were inconsistent, the two lowest values were grouped: control group (total rehabilitation weeks < 1 week, total number of rehabilitation times < 5, total duration time < 150 min, n = 46), pulmonary rehabilitation group 1 (PR-1) (1 week ≤ rehabilitation weeks < 4 weeks, 5 ≤ total number of rehabilitation times < 20, 150 min ≤ total duration time < 1200 min, n = 31), pulmonary rehabilitation group 2 (PR-2) (4 weeks ≤ rehabilitation weeks < 8 weeks, 20 ≤ total number of rehabilitation times < 40, 600 min ≤ total duration time < 2400 min, n = 23), pulmonary rehabilitation group 3 (PR-3) (8 weeks ≤ rehabilitation weeks < 12 weeks, 40 ≤ total number of rehabilitation times < 60, 1200 min ≤ total duration time < 3600 min, n = 40) and pulmonary rehabilitation group 4 (PR-4) (rehabilitation weeks = 12 weeks, total number of rehabilitation times = 60, total duration time = 3600 min, n = 34). The clinical data before and after rehabilitation were collected and evaluated, including dyspnea symptoms, 6-min walk distance (6MWD), diaphragmatic mobility, anxiety and depression.
There was no significance difference between control group and PR-1 group. PR-2 group after rehabilitation had significantly decreased CAT and HAMA scores than control (P < 0.05). Compared with control, PR-3 group and PR-4 group after rehabilitation had significantly higher 6MWD and diaphragmatic motility during deep breathing, but significantly lower CAT score, mMRC score, HAMA score, and HAMD score (P < 0.05). Compared with before pulmonary rehabilitation, in PR-3 and PR-4 groups, the 6MWD and the diaphragmatic motility during deep breathing were significantly higher, while CAT score, mMRC score, HAMA score, and HAMD score (for PR-4 only) were significantly lower after pulmonary rehabilitation (P < 0.05). There was no significant difference between PR-3 group and PR-4 group (P > 0.05). In the 12-week pulmonary rehabilitation program, patients who completed at least 8 weeks, namely those in the PR-3 and PR-4 groups, accounted for 42.5% of the total number. Education, income and response rate to telemedicine system reminders were the main risk factors associated with home based pulmonary tele-rehabilitation.
Home based pulmonary tele-rehabilitation under telemedicine system for more than 8 weeks can significantly improve the dyspnea symptoms, 6MWD, diaphragmatic mobility during deep breathing, and negative emotions of patients with moderate to severe stable COPD.
This study was registered at Chinese Clinical Trial Registry under registration number of ChiCTR2200056241 CTR2200056241 .
远程肺康复可以提高肺康复的依从性。然而，关于家庭为基础的远程肺康复的报道很少。我们评估了远程医疗系统下家庭为基础的远程肺康复在慢性阻塞性肺疾病（COPD）患者中的有效性。
这项队列研究纳入了 174 名接受远程医疗系统下家庭为基础的远程肺康复的 COPD 患者。随访时间为 12 周。患者根据肺康复周数、康复次数和总持续时间进行分组，如果这三项数据不一致，则取两个最低值进行分组：对照组（总康复周数 < 1 周，总康复次数 < 5 次，总持续时间 < 150 分钟，n = 46）、肺康复组 1（PR-1）（1 周 ≤ 康复周数 < 4 周，5 ≤ 总康复次数 < 20 次，150 分钟 ≤ 总持续时间 < 1200 分钟，n = 31）、肺康复组 2（PR-2）（4 周 ≤ 康复周数 < 8 周，20 ≤ 总康复次数 < 40 次，600 分钟 ≤ 总持续时间 < 2400 分钟，n = 23）、肺康复组 3（PR-3）（8 周 ≤ 康复周数 < 12 周，40 ≤ 总康复次数 < 60 次，1200 分钟 ≤ 总持续时间 < 3600 分钟，n = 40）和肺康复组 4（PR-4）（康复周数 = 12 周，总康复次数 = 60 次，总持续时间 = 3600 分钟，n = 34）。收集并评估康复前后的临床资料，包括呼吸困难症状、6 分钟步行距离（6MWD）、膈肌移动度、焦虑和抑郁。
对照组和 PR-1 组之间无显著性差异。与对照组相比，PR-2 组康复后 CAT 和 HAMA 评分显著降低（P < 0.05）。与对照组相比，PR-3 组和 PR-4 组康复后 6MWD 和深呼吸时膈肌移动度显著增加，但 CAT 评分、mMRC 评分、HAMA 评分和 HAMD 评分显著降低（P < 0.05）。与肺康复前相比，在 PR-3 和 PR-4 组中，6MWD 和深呼吸时膈肌移动度显著增加，而 CAT 评分、mMRC 评分、HAMA 评分和 HAMD 评分（仅对 PR-4 组）在肺康复后显著降低（P < 0.05）。PR-3 组和 PR-4 组之间无显著性差异（P > 0.05）。在 12 周的肺康复计划中，完成至少 8 周的患者，即 PR-3 和 PR-4 组的患者，占总人数的 42.5%。教育、收入和对远程医疗系统提醒的反应率是与家庭为基础的远程肺康复相关的主要危险因素。
远程医疗系统下超过 8 周的家庭为基础的远程肺康复可以显著改善中重度稳定期 COPD 患者的呼吸困难症状、6MWD、深呼吸时的膈肌移动度和负面情绪。
本研究在中国临床试验注册中心注册，注册号为 ChiCTR2200056241。
