Innovating in rehabilitation: Challenges and Solutions
Speaker: Prof Anne Holland, Australia
In summary: Pulmonary rehabilitation improves patient outcomes and helps keep patients out of the hospital, but very few COPD patients go through with pulmonary rehabilitation programs. Offering such programs remotely may help remove some obstacles for participation, but must still contain the same key components as traditional pulmonary rehabilitation. Moving forward, quality standards are needed to ensure added value of innovations in pulmonary rehabilitation.
A cornerstone in COPD treatment but difficult to make happen.
Pulmonary rehabilitation (PR) plays a crucial role in the treatment of COPD especially after hospitalization due to an exacerbation. However, globally, only 16% of patients are referred to a PR program1. In addition, few of the referred patients complete a PR program. Data from the UK suggest that one-third of the patients referred to a PR program never attend their initial assessment, and only around 40% complete the program2.
Despite its benefits, PR faces significant implementation challenges. There are environmental obstacles, such as patient travel or transport, lack of resources in the healthcare system, or the administrative burden of the referral process. For example, if HCPs lack understanding of the referral process, it could influence the likelihood of referring patients3.
Telerehabilitation: rehabilitating remotely could be as effective as in person
Telerehabilitation is a promising tool to break down some of the barriers and scale up access to PR worldwide. There are various ways to deliver telerehabilitation, including direct supervision via video calls, app-based PR, websites and e-books to increase knowledge, and telephone-supported PR. But is telerehabilitation as effective as traditional PR? In a Cochrane review (a comprehensive summary of the current literature), the effect of telerehabilitation was suggested to be comparable to traditional PR regarding health-related quality of life and exercise capacity, with no safety concerns associated with remote supervision. Both traditional PR and telerehabilitation showed clinically significant improvements in outcomes related to exercise capacity and health-related quality of life. However, only a few heterogeneous studies exist on the subject, and more research is needed to draw final conclusions4.
More finishers in remote setting
An important differentiation between traditional PR and telerehabilitation is seen in completion rates. For telerehabilitation, the completion rate is around 90%, whereas for center-based PR, the completion rate is only 70%.4 These completion rates could be related to the fact that patients report telerehabilitation as a positive experience.
What about cost-effectiveness?
Is telerehabilitation less resource-demanding than center-based PR? A recently published study showed that the direct cost of telerehabilitation programs was similar to that of center-based PR programs5. Professor Holland highlights that this is an important finding because the common understanding is that remote PR is cheaper than center-based PR. However, in telerehabilitation, costs related to the development of digital infrastructure may be significant, whereas personnel resources are the main expense in traditional center-based PR. The real cost-effectiveness, however, lies in the reduction of hospital admissions due to worsening symptoms says Prof. Holland. To ensure successful PR programs, we must tailor interventions to individual needs.
If you want to deliver remote PR, there are various free resources available on how to build such an intervention, for example, www.homebasedrehab.net.
Accessible rehab of good quality will improve patient outcomes
In summary, there is strong evidence supporting both telerehabilitation and traditional PR models, demonstrating significant benefits for patients and healthcare systems alike. Healthcare professionals, must actively advocate for PR programs, ensure accessibility, and uphold quality standards. Looking ahead, continued evaluation and innovation in PR delivery will be key to maximizing patient outcomes and reducing hospital admissions. HCPs should be confident that delivering PR improves outcomes that are important for both patients and healthcare systems. However, any new model must include the essential components of PR, and all emerging models need to be evaluated against standards to ensure that the key ingredients are being delivered to patients. Quality standards will be critically important in the coming years to ensure that patients receive the full benefits of PR.
Emil Bojsen-Møller
Medical Advisor, Chiesi Nordic
References
- Milner SC, Boruff JT, Beaurepaire C, Ahmed S, Janaudis-Ferreira T. Rate of, and barriers and enablers to, pulmonary rehabilitation referral in COPD: A systematic scoping review. Respiratory Medicine. 2018 Apr;137:103–14.
- British Thoracic Society. BTS/RCP Pulmonary Rehabilitation Audit. 2016.
- Cox NS, Oliveira CC, Lahham A, Holland AE. Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: a systematic review using the Theoretical Domains Framework. Journal of Physiotherapy. 2017 Apr;63(2):84–93.
- Cox NS, Dal Corso S, Hansen H, McDonald CF, Hill CJ, Zanaboni P, et al. Telerehabilitation for chronic respiratory disease. Cochrane Airways Group, editor. Cochrane Database of Systematic Reviews [Internet]. 2021 Jan 29 [cited 2025 Mar 5];2021(1). Available from: http://doi.wiley.com/10.1002/14651858.CD013040.pub2
- Burge AT, Cox NS, Holland AE, McDonald CF, Alison JA, Wootton R, et al. Telerehabilitation Compared with Center-based Pulmonary Rehabilitation for People with Chronic Respiratory Disease: Economic Analysis of a Randomized Controlled Clinical Trial. Annals of the American Thoracic Society. 2024 Dec 30;
ID 13864-11.03.2025