Introduction
Pulmonary or respiratory rehabilitation is an effective therapeutic approach for individuals with chronic respiratory disorders, including COPD (chronic obstructive pulmonary disease), bronchiectasis, and interstitial lung disease (ILD). However, some individuals do not attend or complete rehabilitation programs due to health issues and logistics problems associated with travel and transport. Respiratory rehabilitation is usually delivered in person at a hospital or other healthcare centers on an outpatient basis. Home-based delivery of pulmonary rehabilitation with the use of telehealth is the new approach. Telerehabilitation improves the accessibility to various rehabilitation services.
What Is Telerehabilitation?
Telerehabilitation refers to the remote delivery of respiratory rehabilitation services through information and communication technology. Telerehabilitation programs include patient assessment, setting of goals, supervision of exercise training programs, education, and self-management training, and physiological signals monitoring. Telerehabilitation is an excellent therapeutic measure where patients can exercise at home while experts monitor these rehabilitation sessions from tertiary centers in remote places. However, a comprehensive report on the clinical efficacy and safety of telerehabilitation services or their ability to improve access to rehabilitation services for individuals with chronic respiratory diseases has not been established.
What Is the Difference Between Hospital-Based Pulmonary Rehabilitation and Telerehabilitation?
Traditionally, pulmonary rehabilitation involves a hospital-based rehabilitation system for patients with chronic respiratory disorders. Hospital-based pulmonary rehabilitation reduces breathlessness and improves exercise tolerance and overall quality of life in patients with chronic respiratory diseases. Hospital-based rehabilitation involves supervised exercise training programs in a group setting and fewer self-management methods. It combines respiratory exercises, strength training, aerobic exercises, and stretching exercises for the disease with an educational program. However, 8 to 50 percent of individuals do not attend the program due to hospital admissions as it is an in-patient system and due to other problems, such as transportation problems, lack of support, worsening of the condition, and follow-up programs.
Telerehabilitation was introduced to support pulmonary rehabilitation for patients with chronic respiratory disorders. It refers to the delivery of rehabilitation services remotely to people in their homes or other environments. The primary goal of this system is to provide equitable access to rehabilitation services. Studies have shown that telerehabilitation is equally effective as hospital-based pulmonary rehabilitation programs. It has several advantages, including the cost involved, ease of caregiver burden, expertise in monitoring physical activities, and ease of transportation.
What Is the Role of Telerehabilitation in Respiratory Rehabilitation?
Pulmonary telerehabilitation involves reinforcement of exercise intervals, follow-ups, physical activities, and nutritional and psychological support through information and communication technology. It also involves activity monitors that communicate with the central hospital servers and video conferences with patients. Initially, several social media platforms were used as a part of telerehabilitation services to improve compliance to exercise programs. With advancements in technology, real-time video conferencing, and accelerometers and pedometers with in-built global positioning systems, the physical activities and energy expenditure of the patients are monitored. Monitoring the step count, physical activities, physical activity quantification, walking distance, shortness of breath, energy expenditure, the occurrence of adverse events, and functional capacity of the lungs can be measured and archived for the betterment of remote telerehabilitation.
The supervised pulmonary rehabilitation session involves monitoring the intensity of exercises, oxygen saturation, heart rate, and blood pressure. Any adverse events are observed, and exercise or nutritional counseling is given. Exercise adherence is monitored through the number of sessions attended, intensity and frequency of exercise sessions, and their duration. At the end of 8 to 12 weeks of supervised pulmonary telerehabilitation through videoconferencing, the functional and vocational training transfers to the training of real-time household and occupational activities.
Research has shown that telerehabilitation has several benefits similar to hospital-based rehabilitation systems, including a decrease in dyspnea, improvement in functional capacity, reduced morbidity, increased exercise capacity, reduced hospitalizations, improved lung functions, and improvements in the quality of life. Further, the ease of accessibility is the greatest advantage of telerehabilitation.
What Are the Modes of Telerehabilitation?
Telerehabilitation for chronic respiratory disorders is an effective intervention that can be delivered in several ways. Technology helps in the delivery of evidence-based care in a multidimensional proposition that includes education, exercise, and support. The modes of telerehabilitation services are widely classified into
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Center-Based Telerehabilitation involves linking a larger center to smaller centers to support the delivery of respiratory rehabilitation services to a remote site. Video conferencing supports the delivery of exercise training programs and multidisciplinary educational programs from the central center to the local healthcare professionals at the remote site. Studies have shown that patients at these telerehabilitation centers had equivalent improvements in quality of life and exercise tolerance compared to those under standard center-based programs.
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Home-Based Telerehabilitation involves supervised rehabilitation at their homes, using videoconferencing and telemonitoring of physiological signals such as pulse rate and oxyhemoglobin saturation. Patients under supervised training using videoconferencing showed significant development in walking capacity. Home-based telerehabilitation programs are useful and as effective as hospital-based rehabilitation programs.
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Web-Based Telerehabilitation involves the use of web applications and mobile phones to support pulmonary rehabilitation at any place. Studies have shown that online rehabilitation programs have similar benefits to center-based rehabilitation programs.
What Are the Limitations of Pulmonary Telerehabilitation?
Telerehabilitation systems in chronic lung disorders have not yet been researched enough. Also, the studies related to other respiratory diseases are sparse, and it is difficult to determine the outcomes. In addition, studies related to specific rehabilitation programs have not been established. Therefore, the efficiency of telerehabilitation was not extrapolated due to the lack of data. In addition, studies regarding the combination of traditional and tele-pulmonary rehabilitation have not been concluded. Hence, acceptable forms of pulmonary rehabilitation with international guidelines should be provided with attention to the compliance of tele-pulmonary rehabilitation.
Conclusion
Telerehabilitation in pulmonary rehabilitation is a widely accepted therapeutic invention. It improves access to rehabilitation programs for patients with chronic respiratory disorders, including chronic obstructive pulmonary disease, bronchiectasis, and interstitial lung disease. Telerehabilitation profoundly improves the overall quality of life in patients with chronic respiratory diseases with the use of information and communication technologies. Though the aim of telerehabilitation was to deliver home-based rehabilitation services through technology, due to a lack of studies and data, telerehabilitation has to be considered as one of the options for respiratory rehabilitation to improve exercise capacity, depression, anxiety, quality of life, and the impact of the disease on a person’s life.
