Pulmonary Rehabilitation Reduces COPD Exacerbations
Exacerbations of COPD are one of the most common causes of hospital admission and readmission, creating a significant burden for health services. In the UK, over 140,000 annual admissions for COPD exacerbation resulted in over 1 million bed days last year.
Exacerbation events are managed in the hospital, where care focuses on the rapid return of patients to their home environment once the symptoms have been controlled. Consequently, there is very little time for clinicians to address the underlying drivers to exacerbations which, contrary to prior understanding, are both predictable and modifiable.
One of the most cost-effective treatments for COPD patients is pulmonary rehabilitation. This is an essential component for every COPD patient's treatment plan and according to NICE one that should be available within every respiratory pathway in the UK.
NHS England and NHS Improvement aims to increase referral rates to pulmonary rehabilitation from 13% to 60% by 2023.
The Challenges of Delivering Pulmonary Rehabilitation
With an ever-increasing COPD population, growing numbers of referrals to meet QOF and PCRS targets, reduced NHS resources and the COVID-19 pandemic impacting health services across the country - not to mention the risks involved for COPD patients in attending these sessions - the challenges for delivering pulmonary rehabilitation by traditional face-to-face classes are clear.
Due to these challenges, patients are being forced to wait for traditional pulmonary rehab, with 20% waiting longer than 90 days. And of those who are eligible for pulmonary rehab, only a small proportion go on to complete their programme due to the suspension of face-to-face sessions and inaccessibility of classes.
The UK is facing another major health crisis, but this time we already have the solution in our hands.
Digitally Enhanced Pulmonary Rehabilitation (DEPR)
myCOPD has been developed by a multidisciplinary team of respiratory clinicians and people living with COPD. The myCOPD app is set apart from other digital interventions as it is the only multi-faceted online self-management app platform comprising of education programmes, a 6 week, gated, online pulmonary rehabilitation programme, inhaler technique videos and environmental alerts of weather and pollution.
myCOPD has been designed from the ground-up to improve patient access to digital pulmonary rehabilitation, to improve medication adherence and increase health service capacity.
The comprehensive 6-week safety gated and graduated home rehabilitation programme has been shown to delivery parity of care with face-to-face delivery. And when used as part of a digitally enhanced service delivery model can result in an increased service capacity, and increased completion rates, whilst maintaining parity of care and providing increased service resilience.
myCOPD has achieved NICE and GOLD Endorsement. The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) works with health care professionals and public health officials around the world to improve prevention and treatment of COPD. To receive an endorsement from both NICE and GOLD means myCOPD has been rigorously tested against very specific criteria and meets the high standards required to satisfy these respected institutions.
Digitally Enhanced Pulmonary Rehabilitation Evaluation Study
Results published on bmj.com proved that a 6-week programme of digitally enhanced pulmonary rehabilitation is non-inferior to a traditional PR class delivered via face-to-face sessions.
The study was a two-arm parallel single-blind, randomised controlled trial. The online arm used the myCOPD pulmonary rehabilitation programme to perform pulmonary rehabilitation in their own homes and the face-to-face arm received conventional face-to-face rehabilitation in a local facility.
90 patients referred for pulmonary rehabilitation, with a confirmed diagnosis of COPD and a modified Medical Research Council (MRC) score of 2 or greater were enrolled into the study. Patients were randomised, in a 2:1 ratio to receive online pulmonary rehabilitation using myCOPD and 26 received conventional face-to-face pulmonary rehabilitation. The main outcomes measured were 6-minute walk distance test and the COPD assessment test (CAT) score at completion of the programme.
The adjusted mean difference for the 6 min walk test (6MWT) between groups for the intention-to-treat (ITT) population was 23.8 m with the lower 95%CI well above the non-inferiority threshold of −40.5 m at −4.5 m with an upper 95%CI of +52.2 m. This result was consistent in the per-protocol (PP) population with a mean adjusted difference of 15 m (−13.7 to 43.8). The CAT score difference in the ITT was −1.0 in favour of the online intervention with the upper 95%CI well below the non-inferiority threshold of 1.8 at 0.86 and the lower 95%CI of −2.9. The PP analysis was consistent with the ITT.
Digitally Enhanced Pulmonary Rehabilitation Pathway
Pulmonary rehab delivered via the myCOPD app can be a blended or completely home-based experience. There are benefits to both approaches and we encourage you to discuss all options with your patients.
Here is our recommended pathway: