Comparison of Clinically Meaningful Improvements After Center-Based and Home-Based Telerehabilitation in People With COPD

Background: 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.

Research question: 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?

Study design and methods: 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 [CRQ]: 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 [mMRC]: MID, -1 point).

Results: 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).

Interpretation: 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.