Characteristics of Virtual Pulmonary Rehabilitation Programs in the United States: Results from a National Electronic Survey

Abstract

Rationale: Understanding virtual pulmonary rehabilitation (VPR) in the United States would inform clinicians and patients, guide healthcare systems to ensure quality and safety, and inform payers on reimbursement issues. Objectives: To characterize United States VPR programs. Methods: A 40-question online survey was developed by the American Thoracic Society PR Reimbursement Working Group to assess delivery methods, program content, and outcome assessments. United States VPR programs were identified from the Live Better database, the internet, and scientific publications. Veterans Affairs (VA) sites were identified from an email sent to medical service chiefs asking whether their site offered VPR. The survey was sent to 53 programs using SurveyMonkey. Responses were summarized as percentages of available data. The 2010 Rural-Urban Commuting Area Codes were used to characterize rurality. Results: Twenty-five sites currently and five previously offered VPR; 23 were offered by an outpatient hospital department (7 non-VA, 16 VA), 5 were commercial, 1 was physician office-based, and 1 was independent. Eighty-four percent of VPR programs (16 of 19) offered by outpatient hospital departments concomitantly provided in-person PR, as did 25% of commercial sites (1 of 4). The delivery method was "live" two-way videoconferencing for 88% of sites (22 of 25); 47% of VA sites (7 of 15) also used telephone-based delivery, and 60% of commercial entities (3 of 5) also used prerecorded videos or website/mobile applications. Ninety-two percent of programs (23 of 25) provided exercise prescription and resistance training, and 96% (24 of 25) provided aerobic training. Nearly one quarter of respondents did not describe exercise progression. Seventy-four percent of all programs (17 of 23) provided exercise equipment, with 54% of VA programs (7 of 13) using pedometers. Thirty-five percent of outpatient hospital department sites (6 of 17) conducted outcome assessments only in person, 12% (2 of 17) conducted them only virtually, and 53% (9 of 17) provided both options, whereas 100% of commercial programs (5 of 5) did so virtually. The 6-minute-walk test was the most common measure of exercise performance, used by 76% of outpatient hospital department sites (13 of 17) and 20% of commercial programs (1 of 5). All VPR addresses were categorized as metropolitan or "micropolitan"; none were small-town or rural. Conclusions: VPR in the United States is heterogeneous. Although most facilities delivered the broad components of PR, there is a lack of in-person assessments, in-person standardized exercise testing, and plans for exercise progression, most notably by commercial programs.

Keywords: exercise prescription; exercise progression; exercise training; tele-pulmonary rehabilitation; virtual pulmonary rehabilitation.