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Comparative Study
. 2025 Jan 31:20:231-241.
doi: 10.2147/COPD.S484558. eCollection 2025.

Feasibility, Usability, and Pilot Efficacy Study of a Software-Enabled, Virtual Pulmonary Rehabilitation with Remote Therapeutic Monitoring

Sheryl Flynn  1 , Christopher L Mosher  2   3 , Sharon Cornelison  4 , Erica Rao  2 , Kimberly A Metzler  4 , William Pu  1 , John Davies  2 , Connie Paladenech  4 , Daniel Doyle  3 , Neil MacIntyre  2 , Jill Ohar  5
Affiliations
Comparative Study

Feasibility, Usability, and Pilot Efficacy Study of a Software-Enabled, Virtual Pulmonary Rehabilitation with Remote Therapeutic Monitoring

Sheryl Flynn et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Objective: Fewer than 3% of adults with Chronic Obstructive Pulmonary Disease (COPD) attend in-person, center-based pulmonary rehabilitation (PR) despite demonstrated health benefits and reduction in mortality. This study evaluated the feasibility and usability of a novel home-based, virtual PR (V-PR) intervention compared to center-based PR (C-PR). The virtual PR intervention was supported by remote therapeutic monitoring (V-PR+RTM; Blue Marble Platform, Blue Marble Health, Altadena, CA). Additionally, we collected data on the 6-Minute Walk Test to explore the efficacy of the V-PR compared to C-PR.

Patients and methods: Adults with stable COPD referred for PR were recruited. The participants self-selected C-PR or V-PR and were provided a 6-8-week personalized exercise and COPD self-management educational program. In addition, weekly phone contacts with the V-PR group were made. Feasibility was measured using qualitative analysis of adherence, reasons for withdrawal, and self-reported barriers to using the software at home. Usability was measured with the System Usability Scale (SUS). Efficacy was evaluated with the 6 minute Walk Test (6MWT) and various functional performance and patient-centered health-related quality of life (HRQoL) questionnaires.

Results: Forty-eight participants were enrolled, and 40 (83.3%) completed the intervention, n=17 in the C-PR group and n=23 in the V-PR group. Four participants from each group withdrew due to reasons related to health issues (appendicitis, thrush, COVID, back pain) or the health status of their spouse, no-shows, and time constraints. Adherence to the exercise dose (3x/week) and educational offerings were >80% in both groups. Participants in the V-PR group scored the software as having high usability. In both groups, 6MWT distance improved significantly, as did scores on the CAT and SGRQ. No adverse events were reported in either group.

Conclusion: A software-enabled virtual PR program with remote therapeutic monitoring is feasible, usable, and effective. It could offer an alternative model that increases PR uptake for those unable or unwilling to attend in-person, center-based PR.

Keywords: COPD; chronic obstructive pulmonary disease; education; exercise training; pulmonary rehabilitation; remote therapeutic monitoring; self-management; telehealth; virtual.

Plain language summary

Pulmonary rehabilitation (PR) is a treatment program that improves breathlessness and quality of life for adults with lung diseases such as chronic obstructive pulmonary disease (COPD). Typically, PR is conducted in a clinic, which is often inaccessible for many adults with COPD; only 3% of Medicare-eligible patients with COPD participate in PR. Recently, new telehealth models of PR that do not require transport to a clinic have been shown to be as beneficial as clinic-based PR. This study measured the feasibility, usability, and effectiveness of a virtual home-based program supported by a remote therapeutic monitoring software platform and a weekly phone call from the clinician to the patient compared to traditional clinic-based PR. We found that both PR models were effective and that the virtual, home-based model supported by a remote monitoring software platform was feasible and usable.

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Conflict of interest statement

SF is the founder and CEO of Blue Marble Health. SF did not participate in the data collection of this study. CLM reports grants from Blue Marble Rehab, Inc, during the conduct of the study; research funding unrelated to this project from the American Lung Association, The Lang Family COPD Research Fund, Patient-Centered Outcomes Research Institute, AstraZeneca, and the National Institute on Aging/National Institutes of Health from R03AG082878-01 (GEMSSTAR award); grants from RofLumilast or Azithromycin to preveNt COPD Exacerbations (RELIANCE) (PCORI funded), A Phase III, Multicentre, Randomised, Double-blind, Chronic Dosing, Parallel Group, Placebo Controlled Study to Evaluate the Efficacy and Safety of Two Dose Regimens of MEDI3506 (AstraZeneca); personal fees from COPD Foundation, International Consulting Associates, Inc., Guidepoint, Physicians Education Resources, LLC, Wellinks, GlaxoSmithKline; travel reimbursement and honoraria from Respiratory Care Foundation, outside the submitted work. JO has received research funding from BI, TEVA, The Moore Foundation, The COPD Foundation, and NIH-Spiromics, as well as consulting fees from Theravance, Viatris, Chiesi Pharma, Astra Zeneca, Verona, Mylan, Genetech, and several law firms. NM reports personal fees from Inogen and Insprx. JD has received consulting fees from Medline Industries and educational fees from MedBridge. All remaining authors received funding from the NIH/NHLBI grant. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Consort diagram showing participant flow through the study.
Figure 2
Figure 2
Bar graphs depicting mean (SE) 6MWT distance pre- and post-intervention for each group. Significance is depicted for change in 6MWT in each group and no significance is depicted between groups post-6MWT scores.
See this image and copyright information in PMC

References

    1. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13–64. doi:10.1164/rccm.201309-1634ST - DOI - PubMed
    1. Stefan MS, Pekow PS, Priya A, et al. Association between initiation of pulmonary rehabilitation and rehospitalizations in patients hospitalized with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2021;204(9):1015–1023. doi:10.1164/rccm.202012-4389OC - DOI - PMC - PubMed
    1. Lamberton CE, Mosher CL. Review of the evidence for pulmonary rehabilitation in COPD: clinical benefits and cost-effectiveness. Respir Care. 2024;69(6):686–696. doi:10.4187/respcare.11541 - DOI - PMC - PubMed
    1. Lindenauer PK, Stefan MS, Pekow PS, et al. Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among medicare beneficiaries. JAMA. 2020;323(18):1813. doi:10.1001/jama.2020.4437 - DOI - PMC - PubMed
    1. Ryrso CK, Godtfredsen NS, Kofod LM, et al. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med. 2018;18(1):154. doi:10.1186/s12890-018-0718-1 - DOI - PMC - PubMed

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