REAcH: Rehabilitation Exercise At Home. A trial of telerehabilitation for chronic respiratory disease.

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Chronic lung diseases, including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), bronchiectasis and asthma, are characterised by breathlessness, reduced exercise tolerance and impaired quality of life. ‘Flareups’ of chronic lung disease are common in people with this condition and often lead to admission to hospital and decline in lung function, imposing considerable burden on patients and the healthcare system. Pulmonary rehabilitation is known to be effective at improving exercise tolerance and function, and helping to prevent ‘flareups’ particularly for people with COPD. However, it is often difficult for people to access these group exercise training programs due to issues surrounding transport and lack of access to programs, particularly in regional areas of Australia. Advances in internet technology and accessibility have made it possible for people to receive specialist medical care and rehabilitation therapy directly to their home. By using readily available equipment such as an exercise bike and iPad it is possible for people with chronic lung disease to undertake a supervised pulmonary rehabilitation program in their own home. However, whether this kind of training is as effective as hospital-based pulmonary rehabilitation is unknown. This project aims to determine whether pulmonary rehabilitation undertaken at home, using internet-based technology, is at least as effective as centre-based pulmonary rehabilitation in improving quality of life, breathlessness and exercise capacity in people with chronic lung disease. People who agree to take part in the study will be randomly allocated to undertake pulmonary rehabilitation at either a hospital-based group or in their home, with internet-based supervision. At the beginning and end of the 8 weeks of the intervention phase, and at 12months post completion of pulmonary rehabilitation, participants will undergo measurements of health status and exercise capacity. Hospital medical records and GP records will be reviewed to determine the frequency of acute chest infection and to identify hospital admissions and treatment of acute infections. This will be tracked for 12 months for all participants. It is hypothesized that: 1. Home-based telerehabilitation will provide clinically significant improvements in health-related quality of life, exercise capacity and symptoms which are equivalent to those seen in centre-based rehabilitation. 2. Telerehabilitation, delivered using our low cost model, will be more cost-effective from a societal perspective when compared to centre-based pulmonary rehabilitation for chronic respiratory disease.