Prior to commencing a telerehabilitation program for pulmonary rehabilitation all participants should undertake a comprehensive assessment. In accordance with the core components of pulmonary rehabilitation as outlined by the American Thoracic Society [ Holland et al 2021], a comprehensive pulmonary rehabilitation assessment is ideally undertaken at a centre/healthcare facility, and includes:
- Assessment of functional capacity via an exercise test (which may comprise a field exercise test conducted according to standard protocols)
- Evaluation of quality of life
- Assessment of dyspnoea
- Evaluation of nutritional status and occupational status
Detailed information regarding initial pulmonary rehabilitation assessment, including examples of assessment tools can be found here.
How to complete a pulmonary rehabilitation assessment where an in-person visit is not possible?
In recent years, physical distancing and isolation requirements in response to the COVID-19 pandemic impacted on the ability to deliver centre-based pulmonary rehabilitation services and capacity to undertake in-person assessments. While increasing evidence indicates it is possible to deliver effective pulmonary rehabilitation programs directly to people in their own home [Holland et al 2017; Hansen et al 2020; Cox et al 2021; Cox et al 2022], and such programs achieve outcomes similar to traditional centre-based pulmonary rehabilitation programs, clinical trials of telerehabilitation models have still required patients to attend the hospital for an initial assessment.
During the first year of the COVID-19 pandemic, healthcare professionals primarily sought information on how to implement remote pulmonary rehabilitation programs, and specifically how to complete assessments of exercise capacity remotely [unpublished data]. In a survey of 263 healthcare professionals, representing 24 countries, who were invited to complete a survey regarding their experiences of remote pulmonary rehabilitation delivery during the COVID-19 pandemic; conducting an in-person initial assessment and performing a field exercise test were able to be undertaken by not more than 5% of respondents [Cox & Holland 2022].
Home-based and remote exercise tests for people with chronic respiratory disease
A recent review [Holland et al 2020] evaluated:
- Which functional exercise tests have been conducted in the home setting in people with chronic lung disease?
- Which functional exercise tests have been conducted remotely in people with chronic lung disease?
- What are the clinimetric properties of tests that have been conducted at home or remotely?
- Can these functional exercise tests be used to assess safety and prescribe exercise intensity, either in-person or remotely?
The review found that sit-to-stand, step and time-up-and-go tests:
- can be performed in the home, with in-person supervision
- remote supervision may be possible in selected patients, but few data are available
- are useful to quantify outcomes of home-based pulmonary rehabilitation programs, but they do not reveal the full extent of desaturation evident on walking; and
- validated methods to prescribe exercise intensity are only available for the Modified Incremental Step Test (MIST) when conducted in-person at home [Burge et al 2021]. Instructions and procedures for in-person administration of the MIST can be found here.
It has been demonstrated that, when conducted at home, the 6-minute walk test underestimates exercise capacity in chronic obstructive pulmonary disease, primarily due to a shorter track length available in the home environment.
