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Online pulmonary rehabilitation not inferior to face-to-face rehab

May 23, 2017

ATS 2017, WASHINGTON, DC -- Online pulmonary rehabilitation for patients with chronic obstructive pulmonary disease (COPD) was found to be as effective as face-to-face rehabilitation programs at improving patients' exercise capacity and symptom control, according to new research presented at the 2017 American Thoracic Society International Conference.

"For many patients, attending in-person classes isn't easy and we know that attendance rates are variable," said lead author Tom Wilkinson, MA, Cantab, MBBS, PhD, FRCP, of the Southampton University Faculty of Medicine at Southampton General Hospital, United Kingdom. "This study challenges the paradigm that pulmonary rehabilitation needs to be delivered using a conventional face-to-face class-based approach."

The study involved 90 patients with moderate COPD who were referred for pulmonary rehabilitation. Study participants were assigned randomly to either online or face-to-face rehabilitation. Patients were well-matched between treatment arms for age, disease severity and smoking status. Approximately twice as many (n=64) study participants were assigned to the online group as were assigned to in-person classes (n=26). The researchers were blinded to which group each person was in.

Those in the face-to-face group participated in six-week group sessions at a local rehabilitation center, while online subjects logged in to the MyPR application from their home computers. MyPR, which is part of the larger MyCOPD software application (app), is the first to be supported in the UK by the National Health Service Innovation and Technology Tariff, and is free for UK patients with advanced COPD.

Outcome measures for the study were patients' six-minute walking distance and scores on the COPD Assessment Test (CAT). At the completion of the study, the walking distance for online participants was not significantly less than for face-to-face study subjects. Improvements in pulmonary rehabilitation scores on the CAT were higher for the online group in all domains. (See study abstract below for statistical analyses.)

"This study has shown that MyPR is non-inferior to usual pulmonary rehab for key improvements in exercise capacity and symptom control," said Professor Wilkinson. "This effect was seen with minimal clinician involvement in the online arm, demonstrating that digitally supported pulmonary rehabilitation is both safe and effective."

Prof. Wilkinson added: "Further studies are needed to explore how, during implementation, the platform can be best used in blended digital services. Research should also examine the benefits of use of MyPR over the long term, as the app, unlike face-to-face classes, can deliver maintenance pulmonary rehabilitation at minimal cost."
-end-
Contact for Media: Tom Wilkinson, MA, PhD, t.wilkinson@soton.ac.uk

FOR MORE INFORMATION, CONTACT:

Dacia Morris
dmorris@thoracic.org
ATS Office 212-315-8620 (until May 17)
Cell Phone 917-561-6545

Session: C17 Advances in Physical Activity, Pulmonary Rehabilitation and Exercise Training
Abstract Presentation Time: Tuesday, May 23, 10 a.m. ET
Location: Liberty Ballroom M-P (Level M4), Marriott Marquis Washington

Abstract 775

Online Versus Face to Face Pulmonary Rehabilitation for Patients with COPD: A Randomised Controlled Trial

Authors: T. Wilkinson1, S. Bourne2, R. DeVos3, M. North1, A. Chauhan3, B. Green3, T. Brown3, V. Cornelius4; 1University of Southampton - Southampton/GB, 2MyMHealth Ltd - Bournemouth/GB, 3Portsmouth Hospital NHS Trust -Portsmouth/GB, 4Imperial College - London/GB; TROOPER

Introduction: Pulmonary rehabilitation is an established intervention for patients with COPD that forms an important aspect of routine care. Delivery of PR using conventional face-to-face classes is resource intensive and often limits accessibility for patients due to difficulties with transportation and timing of conventional sessions. Therefore we sought to obtain evidence whether a novel online pulmonary rehabilitation (PR) programme 'My-PR' is non-inferior to a conventional face-to-face PR in improving physical performance and symptom scores in patients with COPD.

Design and Methods: A two-arm parallel single-blind, randomised controlled trial. A six week PR programme organized either as group sessions in a local rehabilitation facility, or online PR via log in and access to 'MyPR' in their own homes.

Participants: 90 patients with a diagnosis of COPD, modified MRC score of 2 or greater referred for PR, randomised in a 2:1 ratio to online(n=64) or face-to-face PR(n=26). Participants unable to use an internet-enabled device at home were excluded. Subjects had moderate COPD and were well matched for age, disease severity and smoking status betweentreatment arms.

Main Outcome Measures: Co-primary outcomes were six-minute walking distance and the COPD Assessment Test (CAT) score at completion of the programme.

Results: The adjusted mean difference for the 6MWT between groups for the ITT population was 23.8m with the lower 95% CI well above the non-inferiority threshold of -40.5m at -4.5m with an upper 95%CI of +52.2m. This result was consistent in the PP population with a mean adjusted difference of 15m (-13.7 to 43.8). The CAT score difference in the ITT was -1.0 in favour of the online intervention with the upper 95% CI well below the non-inferiority threshold of 1.8 at 0.86 and the lower 95% CI of -2.9. The PP analysis was consistent with the ITT with the direction of effect in favour of online PR for all domains.

Conclusion: A six week programme of online supported PR was not-inferior to a conventional model delivered in face-to-face sessions in terms of effects on six minute walk test distance, and symptom scores and was safe and well tolerated in the context of this study. This mode of PR delivery offers the opportunity to extend the provision of this evidence based and guideline mandated intervention for patients with COPD with functional limitation as part of routine car

American Thoracic Society

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