The Accessibility, Feasibility, and Safety of a Standardized Community-based Tele-Pulmonary Rehab Program for Chronic Obstructive Pulmonary Disease: A 3-Year Real-World Prospective Study
Bibliographic record
Abstract
Abstract Rationale Few individuals with chronic obstructive pulmonary disease (COPD) are able to access pulmonary rehabilitation (PR) despite its importance. Barriers include increased travel time and lack of resources. Tele-PR has been proposed as a novel solution to overcome such barriers and improve access. Objectives Our study aimed to provide information on implementing a novel province-wide standardized community-based tele-PR program and determine its accessibility, feasibility, and safety. Secondary objectives examined the effectiveness of tele-PR compared with standard PR and if clinical improvements were sustained over time. Methods We conducted a concurrent prospective study of people with COPD enrolled in either standard PR or community-based tele-PR at satellite centers between January 2017 and January 2020. To determine accessibility and feasibility, we recorded the number of participating centers meeting eligibility criteria, centers remaining in the program over 3 years, number of delivered programs, and major adverse events. Participants had a 6-minute walk test (6MWT) and COPD assessment test (CAT) at baseline, immediately after PR and at 1, 3, 6, and 12 months. Descriptive analysis was performed for accessibility, feasibility, and safety. Mixed-effects random models were used to estimate change in 6MWT and CAT. Results Seven tele-sites were recruited into the tele-PR program, with six continuing to participate at 3 years, delivering a total of 58 programs for 177 individuals with COPD. During that same period, the standard PR site delivered 15 programs for 89 individuals with COPD. Over 70% of participants completed each program, and no major adverse events were reported. There were significant improvements in the 6MWT and CAT scores in both groups immediately after PR with no between-group differences. Participants in both programs had persistent 6MWT improvement at 1, 3, 6, and 12 months after PR. Participants in tele-PR, but not those in standard PR, had persistent improvements of CAT scores beyond 1 month after PR. Conclusions This study provides real-world evidence demonstrating successful implementation of tele-PR. The Canadian standardized tele-PR program is an accessible, feasible, safe, and effective model for delivering PR.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".