Effectiveness of telerehabilitation for chronic obstructive pulmonary disease on exercise capacity, breathlessness and health-related quality of life compared to centre-based (outpatient) pulmonary rehabilitation
Näytönastekatsaukset
4.11.2026
Level of evidence: C
Pulmonary rehabilitation delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre-based pulmonary rehabilitation, with no safety issues identified.
There was probably little or no difference between telerehabilitation and in-person pulmonary rehabilitation for exercise capacity measured as 6-Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) -10.82 m to 10.94 m; 556 participants; four studies; moderate-certainty evidence); or quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD -1.26, 95% CI -3.97 to 1.45; 274 participants; two studies; low-certainty evidence); or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI -0.13 to 0.40; 426 participants; three studies; low-certainty evidence). No adverse effects of telerehabilitation were reported.
The certainty of the evidence is downgrated by inconsistency due to heterogeneity in telerehabilitation models, imprecision because of the small numbers of studies and participants and width of confidence intervals, and possible publication bias.
The results of the review are applicable in Finland in accordance with regional practices.
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias «Additional comments for included studies»2 |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 »1 | SR/MA | 15 studies with 1904 adults with chronic respiratory disease of any disease severity (99% of patients with COPD in stable health (i.e. not experiencing an exacerbation). Exclusion criteria were a diagnosis of cystic fibrosis and a primary diagnosis of a neuromuscular disease. | Telerehabilitation included exercise intervention with variety of delivery modes (videoconferencing, telephone only, website with telephone support, mobile application with feedback, centralized hub for people to come together). In-person exercise test was performed at health centre prior to rehabilitation. Comparisons: Centre-based (outpatient) pulmonary rehabilitation. | Exercise capacity measured with 6-Minute Walking Distance (6MWD) Breathlessness measured with Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score Quality of life measured with the St George's Respiratory Questionnaire (SGRQ) | Moderate |
| Reference | Comments |
|---|---|
| «Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 »1 | Performance bias detection bias, attrition bias, and reporting bias were identified. No high-quality studies. 3 studies were controlled studies, and non-RCTs were assessed for bias using ROBINS-I tool but are not included in meta-analysis. |
Results
| Reference | Number of studies and number of patients | Follow-up time | Anticipated absolute effects (95% CI) C | Anticipated absolute effects (95% CI)* I | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| «Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 »1 | 4 RCTs/ 556 patients | End of rehabilitation (range 6 weeks to 12 weeks) | The change in 6MWD in the control groups ranged from 11 m to 29 m | Mean change in 6MWD was 0.06 m higher in the telerehabilitation groups (11 lower to 11 higher) | MD 0.06 (-10.82 to 10.94 |
| Level of evidence: moderate The quality of evidence is downgraded due to (study limitations, inconsistency, imprecision, publication bias possible (funnel-plot not available). | |||||
| Reference | Number of studies and number of patients | Follow-up time | Anticipated absolute effects (95% CI) C | Anticipated absolute effects (95% CI)* I | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| «Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 »1 | 3 RCTs, 394 | End of rehabilitation (range 8 weeks to 11 weeks) | The mean change in CRQ dyspnoea in the control groups was 0.7 points | The mean change in CRQ dyspnoea was 0.13 points higher in the telerehabilitation groups (0.1 points lower to 0.4 higher) with higher scores indicating improvement | MD 0.13 (-0.13 to 0.40) |
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, indirectness, imprecision, publication bias). | |||||
| Reference | Number of studies and number of patients | Follow-up time | Anticipated absolute effects (95% CI) C | Anticipated absolute effects (95% CI)* I | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| «Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 »1 | 2 RCTs, 274 patients | End of rehabilitation (range 6 weeks to 8 weeks). | The change in SGRQ in the control groups ranged from -6.3 to 1.6 points | The mean change in SGRQ score was 1.3 points lower in the telerehabilitation groups (4 points lower to 1 point higher) (Lower scores indicating better quality of life) | MD -1.26 (-3.97 to 1.45) |
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, imprecision, publication bias possible (funnel-plot not available). | |||||
| Reference | Number of studies and number of patients | Follow-up time | Anticipated absolute effects (95% CI) C | Anticipated absolute effects (95% CI)* I | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval; * The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | |||||
| «Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 »1 | 2 RCTs, 224 patients | End of rehabilitation (range 6 weeks to 12 weeks). | The change in CAT in the control groups ranged from -1.1 to -0.3 point | The mean change in CAT score was 1.4 points lower in the telerehabilitation groups (3 points lower to 0.4 points higher) with lower scores indicating better health status | MD 1.37 (-3.1 to 0.36 |
| Level of evidence: low The quality of evidence is downgraded due to (study limitations, inconsistency, imprecision, publication bias possible (funnel-plot not available). | |||||
References
- Cox NS, Dal Corso S, Hansen H, ym. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021;1(1):CD013040 «PMID: 33511633»PubMed