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

Access to pulmonary rehabilitation is particularly challenging in rural settings. Tele-pulmonary rehabilitation (tele-PR) is a promising solution, but it is unclear if the supporting evidence includes the populations it is aimed to serve. This review aimed to determine if individuals with chronic obstructive pulmonary disease from rural communities are recruited for tele-PR randomized controlled trials (RCTs).

A systematic review of Medline, CINAHL, Embase, Web of Science, and Compendex was conducted for RCT on tele-PR from 1995 to March 2025. Data were extracted and synthesized to evaluate the inclusiveness of rural populations.

A total of 41 RCTs were included. Most studies (83%) were conducted in urban areas, with only 17% specifying the inclusion of both urban and rural populations. Based on the available data, rural participants represented less than 3% of the total 4142 participants. Furthermore, 78% of the reviewed tele-PR programs required at least 1 mandatory in-person visit for assessment or follow-up, which likely creates a significant barrier to participation for rural residents. Therefore, despite its potential for rural populations, tele-PR research appears to drastically underrepresent these individuals. This limits the generalizability of current findings and hinders the goal of equitable access to care. Researchers must intentionally recruit, report, and design studies considering the principles of equity and diversity.