title: Long-term integrated telerehabilitation of COPD Patients: a multicentre randomised controlled trial (iTrain).
abstract: Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic obstructive pulmonary disease (COPD). However, available resources are often limited, and many patients bear with poor availability of programmes. Sustaining PR benefits and regular exercise over the long term is difficult without any exercise maintenance strategy. In contrast to traditional centre-based PR programmes, telerehabilitation may promote more effective integration of exercise routines into daily life over the longer term and broaden its applicability and availability. A few studies showed promising results for telerehabilitation, but mostly with short-term interventions. The aim of this study is to compare long-term telerehabilitation with unsupervised exercise training at home and with standard care.
  
  
  
  An international multicentre randomised controlled trial conducted across sites in three countries will recruit 120 patients with COPD. Participants will be randomly assigned to telerehabilitation, treadmill and control, and followed up for 2 years. The telerehabilitation intervention consists of individualised exercise training at home on a treadmill, telemonitoring by a physiotherapist via videoconferencing using a tablet computer, and self-management via a customised website. Patients in the treadmill arm are provided with a treadmill only to perform unsupervised exercise training at home. Patients in the control arm are offered standard care. The primary outcome is the combined number of hospitalisations and emergency department presentations. Secondary outcomes include changes in health status, quality of life, anxiety and depression, self-efficacy, subjective impression of change, physical performance, level of physical activity, and personal experiences in telerehabilitation.
  
  
  
  This trial will provide evidence on whether long-term telerehabilitation represents a cost-effective strategy for the follow-up of patients with COPD. The delivery of telerehabilitation services will also broaden the availability of PR and maintenance strategies, especially to those living in remote areas and with no access to centre-based exercise programmes.
  
  
  
  ClinicalTrials.gov: NCT02258646 .
authors.affiliation: Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway. paolo.zanaboni@telemed.no.
authors.forename: Paolo
authors.identifier: 0000-0002-5469-092X
authors.initials: P
authors.lastname: Zanaboni
authors.affiliation: Department of Health Science and Technology, Laboratory of Assistive Technologies - Telehealth & Telerehabilitation, SMI, Aalborg University, Aalborg, Denmark.
authors.forename: Birthe
authors.initials: B
authors.lastname: Dinesen
authors.affiliation: Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway.|Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Audhild
authors.initials: A
authors.lastname: Hjalmarsen
authors.affiliation: Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.|Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Hanne
authors.initials: H
authors.lastname: Hoaas
authors.affiliation: La Trobe University, Melbourne, Australia.|Alfred Health, Melbourne, Australia.|Institute for Breathing and Sleep, Melbourne, Australia.
authors.forename: Anne E
authors.initials: AE
authors.lastname: Holland
authors.affiliation: La Trobe University, Melbourne, Australia.
authors.forename: Cristino Carneiro
authors.initials: CC
authors.lastname: Oliveira
authors.affiliation: Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway.|Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
authors.forename: Richard
authors.initials: R
authors.lastname: Wootton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003362:Cost-Benefit Analysis; D003718:Denmark; D005080:Exercise Test; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D009664:Norway; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy; D000069350:Telerehabilitation / Q000379:methods*
keywords: COPD; Exercise; Home monitoring; Pulmonary rehabilitation; Telemedicine; Telerehabilitation