key: cord-0736118-rz35dbd6 authors: Jácome, C.; Marques, A.; Oliveira, A.; Rodrigues, L.V.; Sanches, I. title: Pulmonary telerehabilitation: An international call for action date: 2020-06-24 journal: Pulmonology DOI: 10.1016/j.pulmoe.2020.05.018 sha: 5a78797a5a7a2a71b5f465381b964981700f2373 doc_id: 736118 cord_uid: rz35dbd6 nan telehealth, this definition still encompasses a large diversity of procedures within the realm of rehabilitation, where PR can be included. 13 However, pulmonary telerehabilitation is far from being a reality yet. For example in Portugal, in the most recent characterisation of PR, from the 24 centres delivering PR programmes, none was telehealth supported. 4 Although efforts to increase access to PR have been made recently (primary care centres were advised to implement programmes in well-selected patients), 14 telerehabilitation guidance was never provided. The use of telehealth is increasingly included in national health services. 12 In Portugal there has been a TeleHealth National Centre dedicated to the development and implementation of telehealth solutions since 2016. 15 This centre has produced guidance for teleconsultation, teleradiology, teledermatology and remote patient monitoring. Yet, guidelines for telerehabilitation are still missing. A similar scenario is present in several countries worldwide and therefore guidelines for telerehabilitation are urgently needed but should be broad enough to adapt to all types of rehabilitation. A fundamental pillar of PR programmes is its multidisciplinary nature to address the needs of patients with chronic respiratory diseases and therefore, to standardise pulmonary telerehabilitation, a joint effort by national organisations, scientific and professional societies is required. This effort should also be developed in articulation with the most relevant international societies in the area of respiratory medicine, such as the European Respiratory Society (ERS) and the American Thoracic Society (ATS). Despite the recognised difficulties, e.g., ATS has publicly acknowledged not being able to endorse a specific approach to PR during the current challenges, 16 it is urgent to find alternatives to conventional PR, whilst seeking to increase access to a higher number of patients who can benefit. In the process of developing guidelines for telerehabilitation, it could be of interest to start by analysing the available examples of PR programmes already being delivered remotely to patients with chronic respiratory diseases. 17---19 The available literature reports telerehabilitation to be as effective as onsite-PR programmes and with potential for successful implementation even with few resources in patients' homes. 20 Combining this previous knowledge with the experience gathered from the implementation of telerehabilitation in patients with COVID-19 is now required. 9 Pulmonary rehabilitation, even if delivered remotely must preserve its cornerstone components, i.e., exercise training, education, and behaviour change but, a serious debate about the selection criteria, outcome measures, emergency plans, intervention design and equipment/technology is needed. The discussion should also involve technological specialists to aid healthcare providers in selecting and combining cost-benefit and friendly-user telemonitoring technology such as respiratory monitors, pulse oximeters, activity trackers, environmental sensors, monitors of physiological variables (e.g., heart rate, blood pressure, temperature) and communication systems. 23 Concerns about sharing data and meeting General Data Protection Regulation (GDPR) requirements when using the different telemonitoring systems also need to be addressed. Additionally, a significant effort may be needed to try to preserve the social component of PR the role of which is indusputable during on-site programmes but may be lost during telerehabilitation. Different discussions involving all relevant stakeholders in PR, from patients and families to healthcare providers, policy makers and scientists are urgently needed to shift PR from conventional to telerehabilitation and increase access to this fundamental intervention. Telerehabilitation can be a sustainable solution to the increasing burden of chronic respiratory diseases worldwide. COVID-19: FASE DE MITIGAÇÃO Cuidados de Reabilitação e Respiratórios Domiciliários Clinical guide for the management of respiratory patients during the coronavirus pandemic An Official American Thoracic Society/European Respiratory Society Policy Statement: enhancing implementation, use, and delivery of pulmonary rehabilitation Relatório de análise da capacidade instalada de reabilitação respiratória nos hospitais do serviço nacional de saúde Observatório Nacional das Doenças Respiratórias. 13 • Relatório do Observatório Nacional das Doenças Respiratórias Pan American Health Organization. Rehabilitation considerations during the COVID-19 outbreak Report of an ad-Hoc International task force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors Recommendations for respiratory rehabilitation in adults with COVID-19 Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chron Dis Transl Med Embracing digital technology in chronic respiratory care: surveying patients access and confidence Telehealth: analysis of third global survey on eHealth based on the reported data by countries Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study Orientação Clínica 014/2019 Programas de Reabilitação Respiratória nos Cuidados de Saúde Primários Pulmonary rehabilitation resources in a complex and rapidly changing world PC 190. First steps on home-based pulmonary telerehabilitation by Centro Hospitalar Universitário Lisboa Norte Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial Telehealth pulmonary rehabilitation: a review of the literature and an example of a nationwide initiative to improve the accessibility of pulmonary rehabilitation Home-based maintenance telerehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits Staying active in isolation: telerehabilitation for individuals with the severe acute respiratory syndrome coronavirus 2 infection