A pulmonary rehabilitation intervention administered by video has demonstrated efficacy and safety in lowering 30-day all-cause readmission rates in patients recently hospitalized for acute exacerbation of chronic obstructive pulmonary disease (COPD), according to a study published in the American Journal of Respiratory and Critical Care Medicine.
This study included 80 participants given telehealth pulmonary rehabilitation who were matched 1:2 with 160 participants not exposed to the video. The study took place at a single academic hospital starting in March 2015. Enrollment in the video program took place at index hospitalization, with the initial session taking place upon return to the COPD clinic in 10±2 days. The intervention included 36 guided exercise sessions. The primary outcome of the study was all-cause readmission rate within 30 days. The chi-squared test was used to compare readmission within 30 days between groups, while Kaplan-Meier and Cox proportional hazards analyses were used to compare time with first readmission.
Those given telehealth pulmonary rehabilitation had significantly lower 30-day all-cause rehabilitation rates than those in the unexposed group (6.2% vs 18.1%; P =.013), as well as lower 30-day readmission due to acute COPD exacerbation rates (3.8% vs 11.9%; P =.040). Those in the intervention arm had longer time to first readmission as well (265 days [95% CI, 235-295] vs 211 days [95% CI, 187-233]; P =.012). There were no adverse events associated with the intervention. A total of 82.5% of participants completed ≥20 telehealth sessions resulting in a 17.5% overall rate of attrition.
Limitations to this study include a lack of randomization, the potential for residual confounding from the LACE index (Length of stay, Acuity of admission, Comorbidities, and ER visits in the previous 6 months), and the potential for missed readmissions among those in the control group.
The study researchers concluded that “a video telehealth [pulmonary rehabilitation] intervention, administered early after hospitalization for an acute exacerbation of COPD, is feasible and safe, and is associated with significantly lower 30-day all-cause readmission rates.”
Bhatt SP, Patel SB, Anderson EM, et al. Video telehealth pulmonary rehabilitation intervention in COPD reduces 30-day readmissions [published online April 12, 2019]. Am J Respir Crit Care Med. doi:10.1164/rccm.201902-0314LE