Online vs Face-to-Face Pulmonary Rehabilitation for COPD Patients: A Randomized Controlled Trial

Chronic obstructive pulmonary disease (COPD) is a prevalent condition leading to gradual loss of lung function and increasing symptoms over time. Pulmonary rehabilitation (PR) is a key non-pharmacological intervention aimed at reducing symptoms by improving exercise tolerance and self-management. Traditionally, PR is delivered through face-to-face, structured programs over at least 6 weeks. However, access to these programs can be problematic, leading to suboptimal attendance and high dropout rates.

In response to these challenges, an online PR program, known as myPR, was developed to mirror the components of conventional COPD PR programs. This study conducted a non-inferiority randomized controlled trial to compare the efficacy and safety of the online PR program with the standard face-to-face PR program.

Methods

• Study Design: A prospective, parallel group, single-blind randomized controlled trial was conducted in the UK. Patients were randomized to either the online PR program (myPR) or the standard face-to-face PR program.
• Participants: Eligible patients with COPD, aged 40 years or older, with internet access and the ability to operate a web platform were included. Exclusion criteria included recent exacerbations, participation in a PR program within the last 6 months, and significant comorbidities.
• Interventions: The online PR program consisted of a 6-week incremental exercise program and educational sessions accessible via a web platform. The face-to-face PR program involved supervised sessions in a rehabilitation facility.
• Outcomes: Primary outcomes included the 6-minute walk distance (6MWD) test and the COPD assessment test (CAT) score. Secondary outcomes included quality of life and anxiety/depression levels.

Results The study found no significant difference in the primary outcomes between the online and face-to-face PR programs, demonstrating the non-inferiority of online PR. Both programs showed improvements in exercise capacity and health status, with similar safety profiles.

Discussion The findings suggest that online PR is a viable alternative to traditional face-to-face PR, potentially increasing access and adherence for patients with COPD. The study highlights the importance of exploring innovative delivery models for PR to overcome barriers such as geographical distance, resource limitations, and time constraints.

Conclusion Online PR using the myMHealth platform is non-inferior to conventional face-to-face PR in improving clinical outcomes for patients with COPD. This modality of delivery could complement existing face-to-face services, increasing capacity, reducing costs, and broadening availability to socially or geographically isolated groups. Further studies are needed to explore the long-term utility and health economic benefits of online PR programs.