Results Summary
What was the research about?
Chronic obstructive pulmonary disease, or COPD, is a lung disease that makes it hard to breathe. It is a common reason for hospital stays. Pulmonary rehabilitation, or rehab, may help patients avoid future hospital stays for COPD. But some patients, including many African-American and Hispanic patients with COPD, have a hard time getting to a clinic for rehab.
In this study, the research team wanted to learn if referral to a telehealth rehab program called TelePR helped patients avoid going back to the hospital. Telehealth provides care to patients remotely using phones, videos, or other devices. The team compared patients referred to TelePR with those referred to in-person rehab at a clinic, or usual care.
What were the results?
Only 85 of the 209 patients in the study completed one or more rehab sessions.
After six months, the study found no difference between patients referred to TelePR and those referred to usual care in
- Going back to the hospital or dying
- Quality of life
- Ability to walk, COPD symptoms, or ease of breathing
- Knowledge about COPD or ability to manage COPD
- Social support, depression, or anxiety
Of patients who completed one or more sessions, patients who took part in TelePR had less fatigue than those in usual care after two months.
Who was in the study?
The study included 209 patients with COPD. Of these, 57 percent were African American, and 43 percent were Hispanic. The average age was 66, and 59 percent were women. All had a hospital stay for COPD at one of nine hospitals in the New York City area.
What did the research team do?
The research team assigned patients by chance to receive a referral to TelePR or in-person care. The referral was for 16 guided rehab sessions with respiratory therapists over eight weeks.
For TelePR, patients received a bike fitted with a Wi-Fi modem, a tablet, and equipment to monitor blood pressure and vital signs during exercise sessions. This equipment allowed therapists to monitor up to three patients at the same time using online technology. Patients could complete the 90-minute rehab sessions remotely at home or at a community center. Patients referred to in-person care completed sessions at one of three clinics. During the sessions, patients in both groups watched videos on topics like oxygen therapy and breathing techniques.
Patients took surveys at the start of the study and again 2, 6, and 12 months later.
Patients, caregivers, and healthcare providers gave input on the study.
What were the limits of the study?
Fewer patients completed rehab sessions than expected. Some patients didn’t take part in sessions because of illness; some had problems getting their doctor’s approval to exercise. Results may differ if more patients took part in sessions.
Future studies could look at how to get more patients to take part in sessions.
How can people use the results?
Doctors can use these results when considering ways to help patients with COPD avoid hospital stays.
Professional Abstract
Objective
To compare the effectiveness of a referral to pulmonary rehabilitation delivered via telehealth versus rehabilitation delivered in person on reducing hospital readmissions and death among African-American and Hispanic adults with chronic obstructive pulmonary disease (COPD)
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 209 Hispanic and African-American patients with COPD hospitalized for a COPD exacerbation |
| Interventions/ Comparators |
|
| Outcomes |
Primary: COPD-related hospital readmission or death Secondary: functional capacity; patient-reported quality of life, knowledge about COPD, social support, self-efficacy, symptom control, dyspnea, depression, anxiety, and fatigue |
| Timeframe | 6-month follow-up for primary outcome |
This randomized controlled trial compared the effectiveness of a referral to a telehealth pulmonary rehabilitation program called TelePR versus a referral to in-person standard pulmonary rehabilitation (SPR) for improving outcomes for patients with COPD. African-American and Hispanic patients are disproportionately affected by social and economic inequalities that affect their access to care for COPD compared with non-Hispanic White patients.
Researchers randomized patients to receive a referral to TelePR or SPR for 16 supervised pulmonary rehabilitation sessions with respiratory therapists over eight weeks. Patients in TelePR received an ergonomic bicycle fitted with a Wi-Fi modem, a tablet computer, and equipment to monitor blood pressure and vital signs during exercise sessions. With this equipment, the respiratory therapist was able to remotely monitor up to three patients at the same time using online conferencing technology. Based on their preference, the patients in TelePR completed the 90-minute sessions remotely either in their homes or at a community center. Patients receiving SPR completed rehabilitation sessions in person at one of three health facilities. During the sessions, patients in both groups watched educational videos on topics such as oxygen therapy and breathing techniques and socialized with each other.
The study included 209 patients with COPD. Of these, 57% were African American, and 43% were Hispanic. The average age was 66, and 59% were female. All patients were hospitalized for COPD at one of nine hospitals in the New York City metropolitan area within two weeks of study enrollment.
Patients completed surveys to assess study outcomes at baseline and again 2, 6, and 12 months later.
A community advisory board made up of patients, caregivers, and healthcare providers gave input on the study, including patient recruitment strategies and interpretation of study results.
Results
Of the 209 patients in the study, 85 completed one or more pulmonary rehabilitation sessions.
After six months, patients referred to TelePR and those referred to SPR did not differ significantly in hospital readmissions or deaths.
Among the patients who completed at least one pulmonary rehabilitation session, patients who participated in the TelePR program reported less fatigue than patients who participated in the SPR program after two months (p<0.05). The two groups did not differ significantly on other secondary outcomes.
Limitations
Fewer patients completed pulmonary rehabilitation sessions than expected due primarily to comorbid illness and barriers to obtaining medical clearance to participate. Results may have differed if more patients had participated in the rehabilitation sessions.
Conclusions and Relevance
This study did not find a significant difference in hospital readmissions or patient-reported outcomes for patients receiving referrals to TelePR versus SPR.
Future Research Needs
Future research could examine strategies to increase participation and retention in pulmonary rehabilitation among African-American and Hispanic adults with COPD.
Final Research Report
View this project's final research report.
Journal Citations
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- Reviewers asked whether the researchers considered using the completion of a course of pulmonary rehabilitation as the primary outcome for the trial. The researchers stated that they had not considered this alternate outcome but noted that completion of a course would be the same as 100 percent adherence. The report does present adherence comparisons between intervention arms to assess the effect of adherence on the chosen primary outcome, six-month hospitalization and death.
- The reviewers asked the researchers to provide justification for consenting participants twice: the researchers consented all participants before randomization to treatment, then participants randomized to the telehealth option provided consent a second time for that experimental condition. The researchers explained that this approach allowed them to collect participants’ consent to receive and complete repeat surveys and have their electronic health data tracked for the study. The researchers did not want to include the telehealth experimental condition in consents going to participants randomized to the standard care group because these participants might feel that they were losing out on the high-tech intervention and refuse to participate in the study.
- One reviewer asked the researchers to provide a better rationale for their hypothesis that telehealth-based pulmonary rehabilitation would have better outcomes than standard pulmonary rehabilitation. The researchers clarified that they actually hypothesized that referral to the telehealth option would have better outcomes than referral to the standard option because patients from Hispanic and African-American communities did not have adequate access to standard, clinic-based pulmonary rehabilitation.
Conflict of Interest Disclosures
Project Information
Patient / Caregiver Partners
- Jose Leon
- Mercedes Leon
Other Stakeholder Partners
- Clara Londono, Urban Health Plan