Kim Chul, Choi Hee-Eun, Rhee Chin Kook, Lee Jae Ha, Oh Ju Hyun, Song Jun Hyeong
Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea.
Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea.
Healthcare (Basel). 2025 Feb 3;13(3):308. doi: 10.3390/healthcare13030308.
Home-based pulmonary rehabilitation (PR) is an effective alternative to center-based PR. However, not all participants exhibit sufficient therapeutic improvement, highlighting the need to identify appropriate candidates to maximize cost-effectiveness. This study aimed to identify the factors associated with favorable outcomes in home-based PR, focusing on the role of digital therapeutics (DTx).
This secondary analysis used data from a randomized controlled trial. Participants with chronic respiratory disease (CRD) were divided into responders and non-responders based on a change in 6 min walk distance (6MWD) and patient-reported outcome measures (PROM) representing dyspnea and health-related quality of life. Factors such as baseline 6MWD, DTx use, and pulmonary function were analyzed for their predictive value in improving 6MWD and PROM scores.
Responders, particularly those using DTx, showed significantly greater improvements in 6MWD than non-responders. Participants with a baseline 6MWD under 500 m demonstrated a higher likelihood of exceeding the minimum clinically important difference in 6MWD. DTx use strongly predicted improvements in both 6MWD and PROM scores. The baseline diffusing capacity of the lungs for carbon monoxide was also a significant factor influencing improvements in the modified Medical Research Council scale.
Responders to 8-week program of home-based PR exhibited a relatively lower baseline health status. Encouraging participants with poorer baseline health could improve adherence to PR and enhance cost-effectiveness. Additionally, improvements in 6MWD and PROM scores were associated with the use of DTx. Considering the functions of DTx, proper supervision for home-based exercise may be crucial for achieving optimal outcomes.
家庭肺康复（PR）是中心肺康复的一种有效替代方案。然而，并非所有参与者都表现出足够的治疗改善，这凸显了识别合适的候选者以最大化成本效益的必要性。本研究旨在确定家庭肺康复中与良好结局相关的因素，重点关注数字疗法（DTx）的作用。
这项二次分析使用了一项随机对照试验的数据。根据6分钟步行距离（6MWD）的变化以及代表呼吸困难和健康相关生活质量的患者报告结局指标（PROM），将慢性呼吸道疾病（CRD）参与者分为反应者和无反应者。分析了诸如基线6MWD、DTx使用情况和肺功能等因素对改善6MWD和PROM评分的预测价值。
反应者，尤其是使用DTx的反应者，在6MWD方面的改善明显大于无反应者。基线6MWD低于500米的参与者在6MWD方面超过最小临床重要差异的可能性更高。DTx的使用强烈预测了6MWD和PROM评分的改善。肺一氧化碳弥散量基线也是影响改良医学研究委员会量表改善情况的一个重要因素。
接受8周家庭肺康复计划的反应者基线健康状况相对较低。鼓励基线健康状况较差的参与者可以提高对肺康复的依从性并增强成本效益。此外，6MWD和PROM评分的改善与DTx的使用有关。考虑到DTx的功能，对家庭锻炼进行适当监督可能对实现最佳结局至关重要。
