BACKGROUND Response to pulmonary rehabilitation is not equal for all participants, and may vary across health outcomes for any one individual. Alternative modes of pulmonary rehabilitation delivery, e.g. telerehabilitation, may improve program access but could also affect response to rehabilitation. RESEARCH QUESTIONS What is the rate of clinical response to home-based telerehabilitation compared to center-based pulmonary rehabilitation? And, are there participant baseline characteristics associated with pulmonary rehabilitation response relative to model of delivery? STUDY DESIGN AND METHODS Secondary analysis of two randomized controlled trials. Participants were categorized as 'responders' or 'non-responders' according to achievement of the minimal important difference (MID) for each outcome of interest at end rehabilitation and after 12-month follow-up (change from baseline). Outcomes of interest were: functional exercise capacity (six-minute walk distance [6MWD], MID 30m); health-related quality of life (chronic respiratory questionnaire [CRQ], MID 2.5, 2, 3.5 and 2 points for the dyspnea, fatigue, emotion and mastery domains, respectively; CRQ total score MID 10 points); and symptoms (modified Medical Research Council [mMRC], MID -1 point). RESULTS 266 individuals with COPD were included in the analysis. The proportion of responders was not different between center-based pulmonary rehabilitation and home-based telerehabilitation at either end rehabilitation or 12-month follow-up for any outcome (range 39% to 62%). In a binary logistic regression analysis, baseline outcome values, but not participant demographic characteristics, were most commonly associated with responder status. The relative risk of program non-completion in the center-based group was nearly four times greater than for telerehabilitation (PR completion: center-based PR n=79 (58%) versus home-based telerehabilitation n=116 (90%); RR 3.89, 95%CI 2.28 to 6.63). INTERPRETATION Responder status to pulmonary rehabilitation was not different between center-based and home-based telerehabilitation. The ability to identify patient characteristics that confer greater potential for rehabilitation response, or better suitability for a particular model of rehabilitation, remains a challenge. Take home points: STUDY QUESTION: What is the rate of clinical response to home-based telerehabilitation compared to center-based pulmonary rehabilitation? And, are participant baseline characteristics, program completion or program location associated with rehabilitation response? RESULTS The proportion of responders to rehabilitation is not different between center-based and home-based telerehabilitation programs; however the risk of program non-completion is 4 times higher for center-based rehabilitation. INTERPRETATIONS Responder status to pulmonary rehabilitation was not different between center-based and home-based telerehabilitation, although rehabilitation completion was higher for home-based telerehabilitation. Identifying participant features that confer greater potential for rehabilitation response, or better suitability for a particular model of rehabilitation, remains a challenge.

中文翻译：

---

COPD 患者基于中心和基于家庭的远程康复后具有临床意义的改善的比较。


背景 并非所有参与者对肺康复的反应都是平等的，并且任何一个人的健康结果可能会有所不同。肺康复治疗的替代模式，例如 远程康复，可能会改善项目可及性，但也可能影响对康复的反应。研究问题 与中心肺康复相比，家庭远程康复的临床反应率是多少？并且，相对于分娩模式，是否存在与肺康复反应相关的参与者基线特征？研究设计和方法两项随机对照试验的二次分析。根据康复结束时和 12 个月随访后 （相对于基线的变化） （相对于基线的变化），参与者根据每个感兴趣的结局的最小重要差异 （MID） 的实现情况被分类为“反应者”或“无反应者”。感兴趣的结局是：功能性运动能力（6 分钟步行距离 [6MWD]，MID 30m）;与健康相关的生活质量（慢性呼吸问卷 [CRQ]，呼吸困难、疲劳、情绪和掌握领域分别为 MID 2.5、2、3.5 和 2 分;CRQ 总分 MID 10 分）;和症状 （改良医学研究委员会 [modified Medical Research Council， mMRC]，MID -1 分）。结果 266 例 COPD 患者被纳入分析。在最终康复或 12 个月随访中，基于中心的肺康复和基于家庭的远程康复之间的反应者比例没有差异（范围为 39% 至 62%）。在二元 logistic 回归分析中，基线结局值（而不是参与者人口统计学特征）最常与反应者状态相关。 以中心为基础的组未完成项目的相对风险几乎是远程康复组的四倍（PR 完成：以中心为基础的 PR n=79 （58%） 与基于家庭的远程康复 n=116 （90%）;RR 3.89,95% CI 2.28 至 6.63）。解释 基于中心和基于家庭的远程康复对肺康复的反应状态没有差异。识别赋予康复反应更大潜力或更适合特定康复模式的患者特征的能力仍然是一个挑战。带回家的分数： 研究问题：与基于中心的肺康复相比，对家庭远程康复的临床反应率是多少？以及，参与者的基线特征、计划完成情况或计划位置是否与康复反应相关？结果 基于中心的远程康复计划和基于家庭的远程康复计划对康复的反应者比例没有差异;然而，对于基于中心的康复，计划未完成的风险要高 4 倍。解释 基于中心的远程康复和基于家庭的远程康复对肺康复的反应状态没有差异，尽管基于家庭的远程康复的康复完成率更高。确定赋予更大康复反应潜力或更适合特定康复模式的参与者特征仍然是一个挑战。