Telemedicine in patients with COPD: Feasibility and benefit of regular exercise testing via remote patient monitoring

Purpose: The six-minute walk test (6MWT) is used clinically to assess prognosis in patients with COPD. This study evaluates the feasibility of remote patient monitoring by placing hospital based function tests into a home based setting. We assessed if weekly self-administration of the 6MWT offers additional benefits in terms of clinically outcome.

Methods: In this RTC patients with COPD are placed either into the telemedicine group (TG) or a control group (CG). Patient recruitment is currently on going with total study duration of 12 months. Remote patient monitoring includes weekly 6MWT recorded via accelerometry, subjective well being scale (CAT) and lung function testing via spirometer (peak flow = PEF). The accelerometer used in this study is customized especially for the 6MWT with a “start 6MWT” button and automatic end of data recording after 6 min. All data is transmitted via PDA system from the patient's home to the telemedicine center. Group differences between baseline (BL) and 9 month follow-up (9 M) are evaluated and compared.

Results: So far 40 patients have been recruited for this study from which 29 patients completed 9 M of follow-up (TG: N = 14; CG: N = 15). In intra-group analyses, a significant increase in 6MWT distance from BL to 9 M could be observed in the TG (383 ± 92.9 vs. 464 ± 117, respectively; P= 0.04), a slight increase in FEV1% (BL: 50.2 ± 15.0; 9 M: 52.2 ± 16.7; P= 0.16) as well as a marked but non-significant decrease in CAT score (BL: 19.0 ± 6.9; 9 M: 15.2 ± 5.6; P= 0.07). No significant changes from BL to 9 M were found in the CG. Here, an increasing trend in CAT score could be seen, however non-significant (BL: 17.6 ± 5.0; 9 M: 19.5 ± 6.9; P= 0.06). In inter-group analyses, the TG showed markedly lower exacerbation frequency from BL to 9 M compared to the CG (2 vs. 11; P= 0.08), 20% and 19% lower visits to the primary care physician and lung specialist, respectively.

Conclusion: Continuous patient monitoring in form of Telemedicine seems to be feasible and beneficial for exercise capacity, lung function and wellbeing in COPD patients. The improvements seen in the TG are most likely attributable to an underlying training effect acquired by the weekly 6MWT. This training effect seems to expand to disease specific outcome such as exacerbation rate. These findings are preliminary and have to be confirmed in a larger patient number.