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

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.