Effect of Internet-Based Rehabilitation Programs for patients with chronic obstructive pulmonary disease: A Meta-analysis of Randomized Controlled Trials (Preprint)

UNSTRUCTURED Background Chronic obstructive pulmonary disease (COPD) is characterized by limiting of airflow, pulmonary rehabilitation proved to significantly improve the statement of patients. While most people fail to obtain face-to-face pulmonary rehabilitation. This meta-analysis was to investigate the effect of Internet-based rehabilitation versus face-to-face rehabilitation programs on physical capacity and health-related quality of life. Search methods We identified randomized controlled trails (RCTs) from Pubmed, Embase, Cocharane Library, China national knowledge infrastructure (CNKI), and WANFANG Data, from databases inception to December 2021. Selection criteria We selected random-control trails on pulmonary rehabilitation of COPD patients in which invention group received rehabilitation via smart technology such as iPhone, iPad, Andriod tablets and so on, control group received face-to-face rehabilitation or usual care with no intervention. Date collection and analyses Two authors checked articles on the basis of eligible criteria, one author assessed the risk of bias. Mean and standard differences were calculated using a random-effects model, forest plots were used to present data visually. We used standard methods as recommended by The Cochrane Collaboration. Main results There were 14 studies and total of 1590 randomized patients were included in this study. Most intervention programs last for 12 months with an overall range from 1 month to 14 months. All the forest plots showed the same result that Internet-based rehabilitation and face-to-face rehabilitation has the same effect in physical capacity and health-related quality of life. Nine studies reported six-minute walk distance (6MWD) or six-minute walk test (6MWT), (mean difference [MD] 4.93, 95%CI -8.13 to 17.98, P= .46). Five studies reported St George’s Respiratory Questionnaire (SGRQ), (MD 1.20, 95% CI -1.74 to 4.14, P= .42). Four studies reported steps/per day, (MD -226.38, 95%CI -704.22 to 251.46, P= .35). Five studies reported COPD assessment test (CAT), (MD 0. 01, 95% CI -1.29 to 1.30, P= .99). Three studies reported modified Medical Research Council scale (mMRC), while one study was excluded due to high heterogeneity (MD 0.13, 95%CI -0.09 to 0.36, P= .25). There’s no significant heterogeneity between studies (Chi2=6.28, P= .71; I2=0%, Chi2=1.12, P= .89; I2=0%, Chi2=2.44, P= .49; I2=0%, Chi2=5.11, P= .28, I2=22% and Chi2=1.15, P= .28; I2=13%, respectively). Authors’ Conclusions Pulmonary rehabilitation (PR) has been proved to improve the quality of COPD patients’ life, while because of much of limitation, many patients fail to receive PR. Our study find that Internet-based rehabilitation has the same effect in COPD patients compared with face-to-face rehabilitation which was similar to previous studies. While their has some limitations in our study. One study stopped early due to multiple challenge faced in Internet-based rehabilitation group reminds us that further study should focus on the feasible of it. Furthermore, our study only include 14 studies, which is insufficient. Further studies about it should be included.