Supervised Home-Based Telerehabilitation for Idiopathic Pulmonary Fibrosis: A Pragmatic Service Evaluation in Routine...

In this pragmatic, uncontrolled service evaluation in clinically stable idiopathic pulmonary fibrosis (IPF), we assessed primary service outcomes (feasibility and safety) and prespecified exploratory within-participant changes following a four-week supervised home-based tele-exercise program via the USTEP platform and a four-week detraining period.

Thirteen participants were assessed at three prespecified time points (baseline: T0; post-intervention: T1; post-detraining: T2) using the six-minute walk test (6MWT), SF-36, HADS, and pulse-respiration quotient (PRQ). Primary service outcomes were captured as session attendance/adherence and exercise-related adverse events.

Adherence was 92% (median 11/12 sessions completed) and there were no exercise-related adverse events. The 6MWT distance increased by 8.4% from T0-T1 (Bonferroni-adjusted p=0.004, d=-1.15) but declined towards baseline at T2. SF-36 physical health scores increased at T1 (+5.2%) but decreased at T2 (Bonferroni-adjusted T1-T2 p=0.004, d=1.17). For several exploratory patient-reported outcomes (fatigue, pain and HADS), Bonferroni-adjusted comparisons were non-significant, while unadjusted testing suggested small T0-T1 changes; these are reported as exploratory signals. PRQ changed over time (χ²(2)=8.60, p=0.014), with a shift at T1 and a return to baseline at T2.

In this small uncontrolled service evaluation, the program was feasible and safe and within-participant improvements were observed in 6MWT distance and selected patient-reported and physiological measures. These findings are exploratory and hypothesis-generating and should be confirmed in adequately powered controlled studies that include prespecified maintenance strategies.