Design and delivery of home-based telehealth pulmonary rehabilitation programs in COPD: A systematic review and meta-analysis

RATIONALE: Home-based telehealth pulmonary rehabilitation (HTPR) for chronic obstructive pulmonary disease (COPD) is increasingly common partly due to the COVID-19 pandemic. However, optimal HTPR programming has not been described. This review provides a comprehensive overview of the design, delivery, and effects of HTPR for people with COPD. METHODS: Relevant databases were searched to July 2021 for studies on adults with COPD utilizing information or communication technology to monitor or deliver HTPR. A meta-analysis was performed on a subset of randomized controlled trials. RESULTS: Of 3124 records retrieved, 38 studies evaluating 1993 individuals with stable COPD (age 54-75 and FEV₁ 31-92% predicted) were included. Program components included exercise and education (n = 17) or exercise alone (n = 15) with in-clinic baseline assessments commonly conducted (n = 26). Few trials (n = 7) featured synchronous virtual exercise supervision. Aerobic exercise commonly involved walking (n = 14) and cycling (n = 11) and most programs included resistance training (n = 25). Exercise progressions and emergency action plans were inconsistently reported. Meta-analysis demonstrated HTPR was comparable to outpatient PR and had a greater effect than usual care for the modified Medical Research Council dyspnea scale (mean difference [95 %CI]: -0.49 [-0.77, -0.22], p < 0.01) and COPD Assessment Test score (-4.90 [-7.13, -2.67], p < 0.01). Neither HTPR nor outpatient PR impacted sedentary time or step count. Only 6% of studies reported race and no studies reported participant ethnicity. CONCLUSION: This review revealed the heterogeneity of HTPR program designs in COPD. HTPR programs had similar effects to outpatient PR programs and greater effects than usual care for people with COPD.