S98 Effectiveness of home maintenance tele-rehabilitation on COPD exacerbations

Abstract

Acute exacerbations are cardinal events in the natural history of chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. Tele-monitoring interventions are a relatively new field in COPD research and management. Furthermore, the effect of home tele-rehabilitation on COPD exacerbation has not been thoroughly studied. Therefore, we set out to investigate whether a home tele-rehabilitation program would be as beneficial as an outpatient maintenance rehabilitation program, in the context of COPD exacerbations, following completion of a 3-month course of supervised pulmonary rehabilitation. We studied 137 Caucasian, ambulatory COPD patients. Forty seven patients were assigned to home maintenance tele-rehabilitation (FEV1,%pred = 50 +/- 22, mean+/-SD). Fifty patients were assigned to twice weekly hospital-based maintenance rehabilitation (FEV1,%pred = 52 +/- 17). Forty COPD patients (FEV1, % pred = 52 +/- 21), were not assigned to any rehabilitation program and served as controls. Tele-rehabilitation included home exercise reconditioning, self-management techniques, dietary, and psychological advice. Patients were provided with tablets and wireless devices to record and transmit data, related to symptoms, lung function, and vital signs, to a tele-health platform. Patients were followed up for 12 months. At baseline there were no significant differences amongst the tele-rehabilitation (3.3 +/- 3.1), hospital-based rehabilitation (3.4 +/- 1.9), or control (3.3 +/- 1.6), groups in terms of COPD exacerbations. After 12 months, COPD exacerbations in the group of home tele-rehabilitation were significantly reduced to 1.7 +/- 1.7. In the group of hospital-based rehabilitation COPD exacerbations were also significantly reduced to 1.8 +/- 1.4. In contrast, in the control group COPD exacerbations remained unchanged (3.5 +/- 1.7). There were significant difference amongst the two rehabilitation groups (tele-rehabilitation and hospital-based) and the control group in terms of COPD exacerbations (p < 0.001). In conclusion, ongoing home tele-rehabilitation with the use of tele-monitoring could significantly reduce COPD exacerbations and seems to be as beneficial as an outpatient hospitalbased maintenance rehabilitation program in the context of COPD exacerbations. Thus, tele-rehabilitation may constitute a satisfactory alternative rehabilitative strategy to diminish health care costs.