Real-time telerehabilitation for chronic respiratory disease and post-COVID-19: A systematic review and meta-analysis

Introduction: Telerehabilitation may facilitate access and adherence to pulmonary rehabilitation. Given the heterogeneity in existing telerehabilitation studies, it is still necessary to identify the most effective, safe, and cost-efficient strategy for clinical implementation, as well as the necessary level of supervision during telerehabilitation. The aim of this review was to determine the effectiveness and safety of real-time telerehabilitation for chronic respiratory diseases and post-COVID-19 compared to no-rehabilitation, center-based rehabilitation or asynchronous telerehabilitation. Methods: A comprehensive search was conducted in six databases until 30 April 2023. Clinical trials of real-time telerehabilitation supervised via videoconference in adults with diagnosis of any chronic respiratory disease or post-COVID-19 were included. Results: Twelve studies with 1540 participants were included. Very-low to moderate certainty evidence showed no difference between real-time telerehabilitation and center-based pulmonary rehabilitation. Studies included in this review reported high adherence rates to real-time telerehabilitation and completion rate, with no difference compared to center-based pulmonary rehabilitation. When compared to no-rehabilitation, the results of this review provide low-certainty evidence that real-time telerehabilitation may have a potential effect on exercise capacity at the end of the intervention, with no better results in others outcomes. No studies comparing real-time telerehabilitation with asynchronous telerehabilitation were found. Conclusion: Real-time telerehabilitation is safe and it seems to promote similar effects to center-based pulmonary rehabilitation. However, the certainty of this evidence ranged from very-low to moderate. Therefore, real-time telerehabilitation offers an alternative to center-based pulmonary rehabilitation models. This review provides a clear definition of real-time telerehabilitation, facilitating results interpretation and clinical applicability.