Pulmonary Telerehabilitaion for Patients with Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, with pulmonary rehabilitation forming a cornerstone of management. However, traditional programs are often limited by accessibility barriers. Telerehabilitation (TR) has emerged as a potential alternative, but its clinical effectiveness remains variably reported. Objective: This study aimed to evaluate the efficacy of pulmonary telerehabilitation in improving exercise capacity, dyspnea, QoL, and healthcare utilization in adults with COPD. Methods: Six databases (PubMed, Scopus, PEDro, CENTRAL, VHL, and Web of Science) were searched for randomized controlled trials (RCTs) comparing TR to usual care or center-based PR in adults with COPD. Inclusion criteria followed the PIOCS framework. Two reviewers independently screened studies, extracted data, and assessed methodological quality using the PEDro scale. Levels of evidence were classified using the Modified Sackett Scale. Meta-analyses were conducted only where clinical and statistical homogeneity existed. Otherwise, narrative synthesis was performed. Results: Nine RCTs (n=624) were included, with seven eligible for meta-analysis. TR programs varied in format, including video conferencing, smartphone apps, and web-based modules. Exercise capacity improved significantly, with a pooled standardized mean difference (SMD) of 0.37 [95% CI: 0.14–0.60]; moderate heterogeneity (I²=48%). Dyspnea did not show a significant pooled effect initially (SMD = −0.16), but sensitivity analysis revealed a significant improvement (SMD = −0.37; I²=21%). Health related Quality of life (HRQoL), measured by CAT, also improved significantly (SMD = −0.63), with adjusted analysis confirming robustness. Several studies reported reduced hospitalizations. Study quality was high in 6/9 trials (PEDro ≥6). Evidence levels were: Level I for exercise capacity, Health related quality of life, and hospitalizations; Level II for dyspnea, HRQoL, and self-efficacy. Conclusion: Pulmonary telerehabilitation significantly improved exercise capacity and HRQoL in patients with COPD and demonstrated a meaningful reduction in dyspnea severity upon sensitivity analysis. These findings support telerehabilitation as an effective and accessible alternative to conventional rehabilitation, particularly for patients facing barriers to in-person care.