Evaluation of Program Adherence and Health Outcomes When Patients Self-Select to Either In-Person or Virtual Pulmonary Rehabilitation
Bibliographic record
Abstract
Abstract Rationale: In-person pulmonary rehabilitation (PR) has long been the gold standard, fostering direct clinician-patient interactions and facilitating a supportive group environment. However, geographical limitations, mobility issues, and scheduling conflicts can hinder accessibility for some patients. Virtual PR delivered within patient's homes has emerged as a promising alternative, offering flexibility and convenience. Randomized-controlled trials as well as cohort studies conducted during the pandemic demonstrate similar outcomes derived from in-person vs. Virtual PR. A real-world limitation of this previous work is that patients were not given the choice of what type of program to attend. The purpose of this study was to compare adherence and health outcomes from virtual PR versus in-person PR when patients were able to self-select their preferred delivery modality of PR. Methods: Patients enrolled in the Breathe Easy PR Program (n=572) self-selected in-person (n=374) or virtual (n=198) PR. Both groups attended a standardized curriculum of 16 PR sessions consisting of group education and supervised exercise. Program adherence was determined via program completion and participant attendance. Health outcomes were assessed before and after PR and consisted of 6-minute walk distance (6MWD), 30-second sit-to-stand (30-sec STS), grip strength, COPD assessment test (CAT), and EQ5D health score. Results: More females self-selected virtual PR versus in-person PR (61% vs. 41%; p<0.001). At baseline, 6MWD (305±122m vs. 363±110m; p<0.001) and 30-sec STS (9.7±3.2 vs. 10.5±3.7; p=0.024) were significantly lower in virtual PR. Program completion rates were similar between virtual PR and in-person PR (79% vs. 72%; p=0.07). The primary reason for non-completion (health reasons, time or logistical constraints, or lack of interest), did not differ between groups (p=0.748). The virtual PR group attended more sessions compared to the in-person PR group (12/16 vs. 11/16; p=0.04). Both groups demonstrated similar statistically significant within-group improvements in 6MWD, 30-sec STS, CAT and EQ5D with PR, however, there were no time-by-program interactions. Conversely, a time-by-program interaction was observed for grip strength showing that in-person PR led to greater improvements in grip strength compared to virtual PR. Conclusions: More women self-select virtual PR vs. in-patient PR. Virtual PR facilitated greater program attendance, but completion rates were similar between the two programs. Self-selected virtual PR is an effective alternative to in-person PR, resulting in similar improvements in health outcomes and program adherence. Greater improvements in grip strength were observed during the in-person program, suggesting that in-person participation may facilitate greater strength benefits compared to virtual 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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".