Remotely Monitored Home-based Pulmonary Rehabilitation in Idiopathic Pulmonary Fibrosis: Results of a Randomized Controlled Trial

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Abstract

OBJECTIVE: In patients with idiopathic pulmonary fibrosis (IPF) on background antifibrotic therapy, we tested a home-based approach to pulmonary rehabilitation (PR) supported with remotely measured physiological variables. DESIGN: A randomized controlled trial with assessments during and after: Run-in (weeks 0-4), Intervention (weeks 5-16), and Post-intervention (weeks 17-20) periods. SETTING: Recruitment: Hospital-based interstitial lung disease care centers and the greater IPF community of the region. REHABILITATION SETTING: An entirely home-based environment. PARTICIPANTS: Twenty-nine of 32 enrolled patients with IPF met criteria during Run-in for randomization to intervention ('I' n=15) and control ('C' n=14) arms. INTERVENTION: Arm I received a 12-week asynchronously remotely monitored, exercise-focused home PR intervention. Arm C received monitoring only. Smartphone-linked, Bluetooth™-enabled monitoring devices included accelerometer activity/HR monitor and medical-grade fingertip pulse oximeter. OUTCOME MEASURES: Primary: Change from Run-in for daily average moderate-to-vigorous physical activity (MVPA) minutes. Feasibility was assessed as rates of completion, adherence, and adverse events (AEs). KEY SECONDARY: 6-minute walk distance (6MWD), VO2max, quality of life (QoL) psychometrics, plasma brain natriuretic peptide ([BNP]), exercise oxygen saturation, and perceived usability of the remote monitoring platform. RESULTS: Program completion was 100% and workout adherence for I was 92%. Primary outcome MVPA increased by 28% for I but decreased by 35% for C (p=0.001 group*time interaction), with an improvement in I (Δ=49±19 min/week) almost double the reported minimal clinically important difference for IPF. Within group effects were observed for several secondary endpoints in I, including increased 6MWD, decreased [BNP], and preserved VO2max and QoL. No AEs occurred, and intervention usability/satisfaction indicators were high. CONCLUSION: For patients with IPF on maintained background antifibrotic therapy, an entirely home-based, remote monitoring-enabled PR program is feasible and produces meaningful increase in moderate-to-vigorous physical activity. Benefits may additionally include improving exercise tolerance and mitigating deterioration of QoL in this challenging, progressive disease.

Abstract as published, via PubMed.