Pulmonary rehabilitation causes less anxiety and depression in patients when it’s done away from hospital, research suggests.
Guiding COPD patients through pulmonary rehabilitation via telehealth does not appear to be more effective than in-patient rehab, but it does reduce anxiety and depression in patients, research suggests.
The Danish researchers compared short-term and long-term responses to rehabilitation, as well as home-based care compared with hospital outpatient treatment on walking capacity, respiratory symptoms, quality of life and muscle strength.
The 134 participants with COPD received either 10 weeks of supervised pulmonary telerehabilitation or 10 weeks of supervised hospital-based pulmonary rehabilitation.
“Maintenance exercising was encouraged but not provided in either group during the 52 weeks follow-up,” the researchers wrote in Thorax.
Three quarters of the participants were former smokers, and they had a mean age of 68.
The primary outcome measure was walking capacity, and the secondary outcome measures were respiratory symptoms, hospital anxiety and depression scores, health-related quality of life and leg muscle endurance.
They found no statistically significant difference in walking capacity between the two groups after 10 weeks or 62 weeks.
Only hospital anxiety and depression scores differed between the two groups, with the telehealth group having half the hospital anxiety and depression than the inpatient group.
Overall, the researchers said there were large uncertainties for all responses. “Thus, any clinically relevant differences between treatments could not be shown.”
The researchers said pulmonary rehabilitation had challenges around uptake and adherence, so recent trials had investigated home-based care.
“However, more recently, RCT studies have been challenged by the lower than anticipated benefits in the PR arms, making superiority, equivalence and non-inferiority analyses difficult to interpret.
“Moreover, it is known from large retrospective cohorts receiving state of the art PR that 40 to 50% of the participants do not achieve the minimal important changes despite being adherent to the traditional PR program.”
