Underrepresentation of Rural Populations in Tele-Pulmonary Rehabilitation Trials: A SYSTEMATIC REVIEW

Area of Science:

• Pulmonary Medicine
• Health Services Research
• Digital Health

Background:

• Access to pulmonary rehabilitation (PR) is a significant challenge for individuals residing in rural areas.
• Tele-pulmonary rehabilitation (tele-PR) offers a potential solution to bridge this accessibility gap.
• However, the extent to which tele-PR research includes its intended rural beneficiaries remains unclear.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) of tele-PR.
• To determine if individuals with chronic obstructive pulmonary disease (COPD) from rural communities are adequately recruited in tele-PR RCTs.
• To assess the generalizability and equity of current tele-PR research findings for rural populations.

Main Methods:

• A comprehensive systematic review of five major databases (Medline, CINAHL, Embase, Web of Science, Compendex) was performed.
• The review covered randomized controlled trials (RCTs) on tele-PR published from 1995 to March 2025.
• Data extraction focused on evaluating the recruitment and inclusion of rural populations in these trials.

Main Results:

• Out of 41 included RCTs, 83% were conducted in urban settings, with only 17% explicitly including both urban and rural populations.
• Rural participants constituted less than 3% of the total 4142 participants across all reviewed studies.
• A significant barrier identified was that 78% of tele-PR programs mandated at least one in-person visit, hindering rural access.

Conclusions:

• Current tele-PR research substantially underrepresents individuals from rural communities, limiting the applicability of findings.
• The findings highlight a critical gap in ensuring equitable access to tele-PR for those in rural settings.
• Future research must prioritize intentional recruitment, transparent reporting, and study designs that embrace diversity and equity for rural populations.