Telerehabilitation versus face-to-face pulmonary rehabilitation in COPD: A systematic review and meta-analysis of comparative outcomes and delivery characteristics

Abstract

Objective

To compare the effects of pulmonary rehabilitation (PR) interventions delivered via telerehabilitation with face-to-face PR on functional capacity in individuals with chronic obstructive pulmonary disease (COPD). Despite increasing use of telerehabilitation, uncertainty remains regarding its effectiveness and the influence of intervention characteristics.

Methods

Searches of four electronic databases identified studies for a systematic review and meta-analysis comparing telerehabilitation with face-to-face PR interventions. Two independent reviewers screened 2292 records, with 280 full-text articles assessed for eligibility. Methodological quality was evaluated using Cochrane risk of bias 2 (RoB-2). Heterogeneity was accounted for using random-effects models. Subgroup analyses were conducted using mixed-effects models to explore the influence of intervention characteristics, including supervision and delivery mode.

Results

Twenty-eight studies met the inclusion criteria. Eight studies were excluded from within-group meta-analysis (two secondary analyses, two studies with insufficient data, and four studies with high RoB). Insufficient between-group data in two further studies resulted in 18 studies included in the between-group meta-analysis. Telerehabilitation interventions produced significant improvements in functional capacity, with a small pooled effect. Between-group analyses demonstrated that telerehabilitation achieved outcomes comparable to face-to-face PR, although findings should be interpreted in the context of moderate heterogeneity and variability in intervention design. Only one subgroup moderator, type of telerehabilitation support, was statistically significant, suggesting broadly consistent effects across most intervention characteristics.

Conclusion

Findings support the potential integration of telerehabilitation into routine PR delivery, with potential benefits including improved access for rural and underserved populations, greater convenience for individuals living with COPD, and opportunities for cost savings. However, the magnitude of the effect should be interpreted with caution given variability in intervention design and limited statistical power in subgroup analyses, and further high-quality studies are required to optimise intervention design and confirm long-term effectiveness.