Cox Narelle S, McDonald Christine, Burge Angela T, Hill Catherine J, Bondarenko Janet, Holland Anne E
Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, VIC, Australia; Institute for Breathing and Sleep, Melbourne, VIC, Australia.
Institute for Breathing and Sleep, Melbourne, VIC, Australia; Department of Respiratory and Sleep Medicine, Melbourne, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
Chest. 2025 Apr;167(4):1003-1011. doi: 10.1016/j.chest.2024.11.001. Epub 2024 Nov 9.
Response to pulmonary rehabilitation is not equal for all participants and may vary across health outcomes for any one individual. Alternative methods of pulmonary rehabilitation delivery, for example, telerehabilitation, may improve program access, but also could affect response to rehabilitation.
What is the rate of clinical response to home-based telerehabilitation compared with center-based pulmonary rehabilitation, and are any participant baseline characteristics associated with pulmonary rehabilitation response relative to the model of delivery?
In this secondary analysis of 2 randomized controlled trials, participants were categorized as responders or nonresponders according to achievement of the minimal important difference (MID) for each outcome of interest at end rehabilitation and after the 12-month follow-up (change from baseline). Outcomes of interest were functional exercise capacity (6-minute walk distance; MID, 30 m), health-related quality of life (chronic respiratory disease questionnaire: MID, 2.5, 2, 3.5, and 2 points for the dyspnea, fatigue, emotion, and mastery domains, respectively; CRQ total score MID, 10 points); and symptoms (modified Medical Research Council: MID, -1 point).
Two hundred sixty-six individuals with COPD were included in the analysis. The proportion of responders was not different between center-based pulmonary rehabilitation and home-based telerehabilitation at either end rehabilitation or 12-month follow-up for any outcome (range, 39%-62%). In a binary logistic regression analysis, baseline outcome values, but not participant demographic characteristics, were associated most commonly with responder status. The relative risk of program noncompletion in the center-based group was nearly 4 times greater than for telerehabilitation (center-based pulmonary rehabilitation: n = 79 [58%] vs home-based telerehabilitation: n = 116 [90%]; relative risk, 3.89; 95% CI, 2.28-6.63).
In this study, responder status to pulmonary rehabilitation was not different between center-based and home-based telerehabilitation. The ability to identify patient characteristics that confer greater potential for rehabilitation response or better suitability for a particular model of rehabilitation remains a challenge.
并非所有参与者对肺康复的反应都相同，而且任何个体的健康结局反应可能存在差异。肺康复的替代实施方法，例如远程康复，可能会改善项目的可及性，但也可能影响康复反应。
与基于中心的肺康复相比，家庭远程康复的临床反应率是多少，相对于康复模式，是否有任何参与者的基线特征与肺康复反应相关？
在这两项随机对照试验的二次分析中，根据康复结束时和12个月随访后（相对于基线的变化）每个感兴趣结局达到最小重要差异（MID）的情况，将参与者分为反应者或无反应者。感兴趣的结局包括功能运动能力（6分钟步行距离；MID，30米）、健康相关生活质量（慢性呼吸系统疾病问卷：呼吸困难、疲劳、情绪和掌握领域的MID分别为2.5、2、3.5和2分；CRQ总分MID，10分）；以及症状（改良医学研究委员会：MID，-1分）。
266例慢性阻塞性肺疾病患者纳入分析。对于任何结局，在康复结束时或12个月随访时，基于中心的肺康复和家庭远程康复之间反应者的比例没有差异（范围为39%-62%）。在二元逻辑回归分析中，最常与反应者状态相关的是基线结局值，而非参与者的人口统计学特征。基于中心的组中项目未完成的相对风险比远程康复组高近4倍（基于中心的肺康复：n = 79 [58%] 对家庭远程康复：n = 116 [90%]；相对风险，3.89；95% CI，2.28 - 6.63）。
在本研究中，基于中心的肺康复和家庭远程康复之间肺康复的反应者状态没有差异。识别赋予更大康复反应潜力或更适合特定康复模式的患者特征的能力仍然是一项挑战。
