Delivery of Remote Pulmonary Rehabilitation: COVID-19 Service Evaluation in England

James Ellis,1 Gill Gilworth,2 Toby Morgan,2 Katherine Harris,2 Natalie King,2 Patrick White2 1GKT School of Medical Education, King’s College London, London, UK; 2Department of Population Health Sciences, King’s College London, London, UKCorrespondence: Patrick White, Department of Population Health Sciences, King’s College London, London, UK, Email [email protected]: Recent evidence suggests that remote pulmonary rehabilitation (PR) meeting international criteria may be as effective as traditional in-person PR. During social distancing associated with COVID-19, in-person PR services were suspended in England. We assessed the use of remote PR services during COVID-19 social distancing.Methods: An online questionnaire survey to assess the use of remote PR during the COVID-19 pandemic and the subsequent availability and delivery of remote PR in England was conducted. The characteristics of PR services in England that provided remote PR, and the barriers and facilitators of delivery of remote online PR by videoconferencing were assessed.Results: Sixty-three services took part. Provision of remote PR rose from 17% to 95% for participating PR services during the pandemic. Remote PR was provided by telephone (65% of services), group videoconferencing (56%) and by individual patient videoconferencing (51%). Remote PR continued to be provided by 49 (76%) services following the relaxation of COVID-19-related restrictions on social contact. Barriers to the delivery of remote online PR using videoconferencing included patients’ lack of internet access through inability to use smart phones or computers and perceived preference of patients for in-person provision. Perceived facilitators of remote online PR using videoconferencing were ease of staff delivery and the belief that it would be beneficial to patients.Conclusion: Remote PR was widely used during the social distancing phase of the COVID-19 pandemic in England. Service users’ lack of access to the internet was an important barrier to videoconferencing, the form of remote online PR for which evidence of effectiveness is most compelling. The provision of digital equipment and internet training should be considered to enable more equitable access to remote online PR. Despite no guideline recommendations for its utility at present, remote pulmonary rehabilitation via telephone or online videoconferencing appears to be a safe and feasible alternative when in-person pulmonary rehabilitation is unavailable.Keywords: COPD, pulmonary rehabilitation, online, remote, digital access, telehealth, telemedicine