Long-term Telerehabilitation or Unsupervised Training at Home for Patients with COPD
Bourne 2023 trial design and results
Design
Randomised controlled trial with three arms
Treatment
Long-term telerehabilitation, or unsupervised training at home
Control
Usual care
Population
Patients with chronic obstructive pulmonary disease
Follow-up
1 year
Primary endpoint
Rate of hospital readmission
Result
Readmission rates were 1.18 (95% CI 0.94 to 1.46) with telerehabilitation and 1.14 (0.92 to 1.41) with unsupervised training, versus 1.88 (1.58 to 2.21) with usual care (p<0.001 for both comparisons). Both intervention groups had better health status for a year and reached and maintained clinically significant improvements in exercise capacity.
Secondary endpoints
Health status, exercise capacity, maintenance of improvement
Long-term telerehabilitation and unsupervised training at home in COPD are both successful in reducing hospital readmissions and can broaden the availability of pulmonary rehabilitation and maintenance strategies.
The trial authors, in the published abstract
How it has aged
Attacks the real problem with pulmonary rehabilitation, which is not whether it works but that most eligible patients never access or complete it. That unsupervised home training performed as well as supervised telerehabilitation is the striking and cost-relevant finding.
Publications
Long-term Telerehabilitation or Unsupervised Training at Home for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial
Zanaboni P, Dinesen B, Hoaas H, et al. Long-term Telerehabilitation or Unsupervised Training at Home for Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Am J Respir Crit Care Med 2023 Apr 1;207(7):865-875.
Readmission rate roughly 40% lower than usual care in both intervention arms
Better health status maintained for a year
Unsupervised training performed as well as supervised telerehabilitation