Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: a systematic review

J Physiother. 2021 Jan;67(1):27-40. doi: 10.1016/j.jphys.2020.12.006. Epub 2020 Dec 24.

Abstract

Questions: How effective is home-based exercise therapy delivered using advanced telehealth technology (ATT-ET) for people with chronic obstructive pulmonary disease (COPD) compared with: no exercise therapy (ET), in/outpatient ET, and home-based ET without ATT?

Design: Systematic review and meta-analysis of randomised trials.

Participants: People with stable COPD referred for ET.

Intervention: ATT-ET.

Outcome measures: Exercise capacity, quality of life, functional dyspnoea, cost-effectiveness and various secondary outcomes.

Results: Fifteen eligible trials involved 1,522 participants. Compared with no ET, ATT-ET improved exercise capacity (four studies, 6-minute walk test MD 15 m, 95% CI 5 to 24) and probably improved quality of life (four studies, SMD 0.22, 95% CI 0.00 to 0.43) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had a similar effect as in/outpatient ET on functional dyspnoea (two studies, SMD -0.05, 95% CI -0.39 to 0.29) and a similar or better effect on quality of life (two studies, SMD 0.23, 95% CI -0.04 to 0.50) but its relative effect on exercise capacity was very uncertain (three studies, 6-minute walk test MD 6 m, 95% CI -26 to 37). ATT-ET had a similar effect as home-based ET without ATT on exercise capacity (three studies, 6-minute walk test MD 2 m, 95% CI -16 to 19) and similar or better effects on quality of life (three studies, SMD 0.79, 95% CI -0.04 to 1.62) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had effects on most secondary outcomes that were similar to or better than each comparator.

Conclusion: ATT-ET improves exercise capacity, functional dyspnoea and quality of life compared with no ET, although some benefits may be small. Its benefits are generally similar to in/outpatient ET and similar to or better than home-based ET without ATT.

Registration: PROSPERO CRD42020165773.

Keywords: COPD; Exercise; Meta-analysis; Pulmonary rehabilitation; Telehealth; Telerehabilitation.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Exercise Therapy
  • Exercise Tolerance
  • Humans
  • Pulmonary Disease, Chronic Obstructive* / therapy
  • Quality of Life
  • Technology
  • Telemedicine*