The Long-Term Maintenance Effect of Remote Pulmonary Rehabilitation via Social Media in COPD: A Randomized Controlled Trial

Abstract

Background: Although the benefits of conventional pulmonary rehabilitation (PR) maintenance are well documented, it is challenged by many difficulties. We investigated whether remote home-based PR maintenance strategy via social media (WeChat) is effective on clinical improvements and reducing the risk for acute exacerbation of chronic obstructive pulmonary disease (COPD).

Methods: The eligible stable COPD patients completing an initial 8-week PR were allocated into three groups randomly. Group A: PR maintenance via social media supervision at home. Group B: PR maintenance at hospital. Group C: Usual care. During a 12-month follow-up, the frequency of acute exacerbation of COPD (AECOPD), 6 minutes walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) were evaluated every 3 months.

Results: At the end of the follow-up, compared to the decline in the usual care group (n = 49), the clinical improvements of 6MWD, CAT, and mMRC were sustained in both the home-based group (n = 47) and the hospital-based maintenance group (n = 44) (p < 0.001), no difference was observed between these two groups (p > 0.05). In multivariate analysis, the home-based PR maintenance and hospital-based PR maintenance were independent predictors of lower risk for AECOPD (incidence rate ratio (IRR) 0.712, 95% CI 0.595-0.841, p < 0.001 and IRR 0.799, 95% CI 0.683-0.927, p = 0.002), respectively.

Conclusion: Remote PR maintenance via social media is effective in reducing the risk for AECOPD and keeping the clinical improvement from decline. Remote PR maintenance via social media might be used to deliver alternatives to conventional PR.

Keywords: chronic obstructive pulmonary disease; exacerbations; home monitoring; maintenance; pulmonary rehabilitation.

Figure 1

Flow chart of the study population.

Figure 2

Kaplan–Meier estimates of the time to next COPD exacerbation. Group A: PR Maintenance at home via WeChat. Group B: PR Maintenance at hospital. Group C: Usual care. The COPD exacerbation refers to all types of acute exacerbation of COPD, including mild, moderate and severe.

Figure 3

Patterns of change of 6MWD, mMRC, CAT (A–C), BDI, SAI, TAI (D–F) over study of 12-month follow-up between groups. Data shown are mean values with error bars representing SE. Circles are values for the home-based PR maintenance via WeChat group (Group A), squares are values for hospital-based PR maintenance group (Group B), triangles are values for usual care group (Group C). Month 0 is the time point when patients completed the initial 8-week PR. *Significant differences of between-group over time (p < 0.05).