Abstract
BACKGROUND: Given limited access to center-based, in-person pulmonary rehabilitation (PR), alternative delivery strategies are needed. RESEARCH QUESTION: We compared a virtual PR program with a conventional center-based one with respect to safety, feasibility/acceptability, and geographic catchment (primary outcomes). We explored efficacy by examining changes in functional outcomes (secondary outcomes). STUDY DESIGN AND METHODS: This single-center observational real-world report included patients enrolled from July 30, 2020, through June 30, 2023, who attended one or more PR class. Patients undergoing virtual PR exercised in their homes under direct supervision via two-way audiovisual teleconferencing. Baseline demographic information and adverse events were extracted from electronic medical records. Google Maps estimated distance and drive time from residential addresses to the PR center. Intake and exit evaluations for secondary (functional) outcomes and feedback questionnaires were completed in a subset. RESULTS: A total of 120 (52 in-person and 68 virtual) patient enrollments were examined; 84% of patients had COPD. Mean age, FEV(1) and FVC % predicted, and baseline 6-min walk test distance were similar between groups. For safety, the overall rate of PR-related adverse events was 1.2 per 1,000 person-days of observation, with no between-group differences. For feasibility, the average number of exercise classes completed (12.4 ± 6.2 vs 13.0 ± 6.1) and proportion of patients completing ≥ 70% of classes (61.5% vs 67.6%) was comparable between the in-person and virtual groups, respectively. For acceptability, among those who completed the virtual PR feedback questionnaire (n = 30), 100% felt safe exercising at home, 97% endorsed clear internet connection, and 90% agreed education sessions were easy to understand. For geographic catchment, patients in virtual PR lived farther (median, 34.1 miles; interquartile range, 16.6-45.1 vs median, 10.3 miles; interquartile range, 5.6-20.6 miles; P < .001) and had longer drive times (mean 86.0 ± 31.6 vs 51.4 ± 31.9 min; P < 0.001) than patients in in-person PR. In the subset with both intake and exit evaluations, similar improvements were observed in functional outcomes and dyspnea in both groups. INTERPRETATION: This study suggests that two-way audiovisual teleconferenced PR is safe, feasible/acceptable, and significantly expands geographic catchment.