Will Remotely Based Pulmonary Rehabilitation Water Down Its Effectiveness?

Despite numerous benefits, traditional Pulmonary Rehabilitation (PR) as a resource remains underutilized in chronic lung disease. Less than 3% of eligible candidates for PR attend one or more sessions after hospitalization due to many barriers, including the ongoing COVID-19 pandemic. Emerging alternative models of PR delivery such as home-based PR, tele-rehabilitation, web-based PR, or hybrid models could help address these barriers. Numerous studies have tested the feasibility, safety, and efficacy of these methods, but there is wide variability across studies and methods. We conducted a literature review to help determine if these alternative delivery methods watered down the effectiveness of PR. To evaluate the effectiveness of remotely based PR, the authors performed a literature search for randomized controlled trials (RCTs), cohort studies, and case series using PubMed, CINAHL, and Medline to identify relevant articles through 1 May 2021. Twenty-six applicable studies were found in which 11 compared tele-rehabilitation to conventional clinic-based PR; 11 evaluated tele-rehabilitation using the patient's baseline status as control; and four compared tele-rehabilitation to no rehabilitation. Despite the different technologies used across studies, tele-rehabilitation was found to be both a feasible and an efficacious option for select patients with lung disease. Outcomes across these studies demonstrated similar benefits to traditional PR programs. Thus the existing data does not show that remotely based PR waters down the effectiveness of conventional PR. Use of remotely based PR is a feasible and effective option to deliver PR, especially for patients with significant barriers to conventional clinic-based PR. Additional, well-conducted RCTs are needed to answer the questions regarding its efficacy, safety, cost-effectiveness and who, among patients with COPD and other lung diseases, will derive the maximum benefit.

Comparison of single bout effects of bicycle training versus locomotor training on paired reflex depression of the soleus H-reflex after motor incomplete spinal cord injury.

OBJECTIVE: To examine paired reflex depression changes post 20-minute bout each of 2 training environments: stationary bicycle ergometer training (bicycle training) and treadmill with body weight support and manual assistance (locomotor training). DESIGN: Pretest-posttest repeated-measures. SETTING: Locomotor laboratory. PARTICIPANTS: Motor incomplete SCI (n=12; mean, 44+/-16y); noninjured subjects (n=11; mean, 30.8+/-8.3y). INTERVENTION: All subjects received each type of training on 2 separate days. MAIN OUTCOME MEASURE: Paired reflex depression at different interstimulus intervals (10 s, 1 s, 500 ms, 200 ms, and 100 ms) was measured before and after both types of training. RESULTS: (1) Depression was significantly less post-SCI compared with noninjured subjects at all interstimulus intervals and (2) post-SCI at 100-millisecond interstimulus interval: reflex depression significantly increased postbicycle training in all SCI subjects and in the chronic and spastic subgroups (P<.05). CONCLUSIONS: Phase-dependent regulation of reflex excitability, essential to normal locomotion, coordinated by pre- and postsynaptic inhibitory processes (convergent action of descending and segmental inputs onto spinal circuits) is impaired post-SCI. Paired reflex depression provides a quantitative assay of inhibitory processes contributing to phase-dependent changes in reflex excitability. Because bicycle training normalized reflex depression, we propose that bicycling may have a potential role in walking rehabilitation, and future studies should examine the long-term effects on subclinical measures of reflex activity and its relationship to functional outcomes.

Game-based telerehabilitation.

This article summarizes the recent accomplishments and current challenges facing game-based virtual reality (VR) telerehabilitation. Specifically this article addresses accomplishments relative to realistic practice scenarios, part to whole practice, objective measurement of performance and progress, motivation, low cost, interaction devices and game design. Furthermore, a description of the current challenges facing game based telerehabilitation including the packaging, internet capabilities and access, data management, technical support, privacy protection, seizures, distance trials, scientific scrutiny and support from insurance companies.

Is the functional reach test useful for identifying falls risk among individuals with Parkinson's disease?

OBJECTIVE: To evaluate the effectiveness and validity of the Functional Reach Test (FRT) as a screening tool to identify fallers (persons at risk for falls) among subjects with Parkinson's disease (PD) and control subjects. DESIGN: A case-comparison design with a consecutive sample. Subjects performed 3 consecutive functional reach trials. SETTING: Motor behavior laboratory in a university setting. PARTICIPANTS: Fifty-eight adults (43 subjects with PD, 15 control subjects). Controls were recruited from a Florida hospital and the local community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A falls history was recorded, a mean FRT score attained, and FRT scores were categorized as less than 25.4 cm, the criterion for falls risk, or > or =25.4 cm. RESULTS: Mean FRT scores differentiated subjects with PD and a known history of falls from subjects with PD and no history of falls and from control subjects (P <.001). Tests of validity for the FRT as a screening tool indicated sensitivity as 30%, specificity as 92%, positive predictive value as 90%, and negative predictive value as 36%. CONCLUSIONS: The FRT, using a reach less than 25.4 cm as a criterion for falls risk, is not a sensitive instrument for identifying individuals with PD at risk. However, the percentage of those persons identified as at risk by the FRT are highly likely at risk, and they should be referred for falls risk intervention. Because the FRT does not identify every person at risk, using a test battery addressing other factors contributing to falls risk may increase the sensitivity of a clinician's assessment to identify persons with PD at risk for falls.