Efficacy of respiratory tele-rehabilitation in COPD patients: Systematic review and meta-analysis

Pulmonary rehabilitation (PR) is a proven and effective intervention for chronic obstructive pulmonary disease (COPD). The recent pandemic has raised interest on new services, such as telerehabilitation (Tele-R). The aim of this study was to systematically review the effects of Tele-R in COPD on: 1) exercise capacity evaluated by the 6-minute walk test (6MWT); 2) dyspnea (modified Medical Research Council – mMRC); 3) COPD control (the COPD assessment test - CAT). The analysis compared Tele-R versus no rehabilitation and Tele-R versus center-based rehabilitation. This meta-analysis was undertaken according to PRISMA recommendations. This pair-wise meta-analysis included data obtained from studies that enrolled 758 COPD patients. The tele-R compared to no rehabilitation improved the 6MWT distance of 48 m (CI: 24, 72; p<0.001) and the mMRC of -1.02U (CI: -1.49, -0.59; p<0.001), and the CAT of -5.74U (CI: -7.42, -0.407; p<0.001). The tele-R compared to center-based rehabilitation showed no difference on 6MWT distance (p=0.563), mMRC (p=0.911), and CAT (p=0.85). In COPD patients, Tele-R is effective in improving exercise tolerance and patient-reported outcomes and it seems to be a valid alternative to center-based rehabilitation, but more studies are needed to better understand how to select the right patients and which kind of Tele-R is more appropriate.