Pulmonary rehabilitation improves symptoms, exercise capacity, and quality of life in people with chronic obstructive pulmonary disease (COPD), but access and participation may be limited by travel, organizational, logistical, and personal barriers. Home-based pulmonary telerehabilitation may reduce some of these barriers, although not all eligible individuals accept this mode of care. Identifying the characteristics associated with acceptance or refusal of this model is therefore essential to better define the population most likely to benefit from this approach, tailor the program's delivery and content, and identify potential remaining barriers in order to improve access to care. This retrospective study will use existing data from adults with COPD who were screened at ADIR Association between May 2024 and April 2025 for an 8-week home-based pulmonary telerehabilitation feasibility study. Of 50 potentially eligible individuals, 21 accepted participation and 29 declined. Demographic, clinical, functional, psychological, and geographic characteristics will be compared between individuals who accepted and those who declined participation. Documented reasons for refusal will be described, and factors associated with refusal will be explored using logistic regression.
ACCEPT-TELEREHAB is a single-center retrospective observational cohort study based on data collected during screening for the TELEREHAPP feasibility study (ClinicalTrials.gov identifier NCT05314686). The source cohort comprises all individuals with COPD who were screened and considered potentially eligible for an 8-week home-based pulmonary telerehabilitation program at ADIR Association between May 2024 and April 2025. Participants will be classified according to the decision recorded at screening: acceptance or refusal of the proposed telerehabilitation program. Data will be extracted from the original screening file, medical records, and information available from the pulmonary rehabilitation referral and assessment. Variables of interest include age, sex, body mass index, COPD severity, comorbidities, available pulmonary function and exercise-test data, long-term oxygen therapy, dyspnea, quality of life, psychological status, functional exercise capacity, previous pulmonary rehabilitation, and the setting of any previous pulmonary rehabilitation program. When a reason for declining participation was documented, it will be coded retrospectively into descriptive categories; more than one category may be assigned to a single participant. Home-to-center distance and estimated travel time will be derived using a standardized mapping procedure. The residential address available at screening will be used to calculate the fastest car journey to ADIR Association for a standardized arrival time of 9:00 AM on a working Tuesday outside public holidays and school vacations. Continuous variables will be summarized using means and standard deviations or medians and interquartile ranges, as appropriate. The acceptance and refusal groups will be compared using independent-samples t tests or Wilcoxon-Mann-Whitney tests for continuous variables and chi-square or Fisher exact tests for categorical variables. Differences will be reported with 95% confidence intervals. Refusal to participate will be the dependent variable in univariable and multivariable logistic regression models. Results will be reported as odds ratios with 95% confidence intervals.
Study Type
OBSERVATIONAL
Enrollment
50
None for the present retrospective study.
ADIR Association
Rouen, Normandy, France
Participation Decision Regarding Home-Based Pulmonary Telerehabilitation
The participation decision recorded at screening will be classified as acceptance or refusal of the proposed 8-week home-based pulmonary telerehabilitation program. The number and percentage of participants in each category will be reported.
Time frame: At screening, before initiation of the proposed 8-week telerehabilitation program
Documented Reasons for Refusal of Home-Based Pulmonary Telerehabilitation
Reasons for refusal documented in the screening file or medical record will be coded retrospectively into descriptive categories and reported as numbers and percentages among participants with an available reason. More than one category may be assigned to a participant.
Time frame: At screening, when the participation decision was documented
Distance From the Participant's Residence to the Pulmonary Rehabilitation Center
Distance from the residence recorded at screening to ADIR Association will be calculated using a standardized mapping procedure and expressed in kilometers. The derived value will be compared between participants who accepted and declined telerehabilitation.
Time frame: At the time of screening
Estimated Travel Time From the Participant Residence to the Pulmonary Rehabilitation Center
The estimated duration of the fastest car journey from the residence recorded at screening to ADIR Association will be calculated using a standardized mapping procedure and expressed in minutes. The derived value will be compared between participation-decision groups.
Time frame: At the time of screening
Age At Screening
Age in years at screening will be compared between participants who accepted and declined telerehabilitation.
Time frame: At the time of screening
Sex Distribution
The number and percentage of female and male participants will be reported for each participation-decision group.
Time frame: At the time of screening
Body Mass Index At Screening
Body mass index will be calculated as weight in kilograms divided by height in meters squared and compared between groups.
Time frame: At the time of screening
Chronic Obstructive Pulmonary Disease Severity
COPD severity available in the medical record, including Global Initiative for Chronic Obstructive Lung Disease (GOLD) spirometric grade when documented, will be reported by participation-decision group.
Time frame: At the time of screening
Long-term oxygen Status
The number and percentage of participants receiving long-term oxygen therapy will be reported for each group.
Time frame: At the time of screening
Modified Medical Research Council Dyspnea Scale Score
Functional dyspnea will be assessed using the modified Medical Research Council (mMRC) dyspnea scale. Scores range from 0 to 4, with higher scores indicating greater dyspnea-related disability.
Time frame: At the time of screening
Visual Simplified Respiratory Questionnaire Score
Respiratory quality of life will be assessed using the Visual Simplified Respiratory Questionnaire (VSRQ). Scores range from 0 to 80, with higher scores indicating better respiratory quality of life.
Time frame: At the time of screening
Saint George's Respiratory Questionnaire
Respiratory quality of life will be assessed using the Saint George's Respiratory Questionnaire (SGRQ). Scores range from 0 to 100, with lower scores indicating better respiratory quality of life.
Time frame: At the time of screening
Hospital Anxiety and Depression Scale Anxiety Subscale Score
Anxiety symptoms will be assessed using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A). Scores range from 0 to 21, with higher scores indicating more severe anxiety symptoms.
Time frame: At the time of screening
Hospital Anxiety and Depression Scale Depression Subscale Score
Depressive symptoms will be assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). Scores range from 0 to 21, with higher scores indicating more severe depressive symptoms.
Time frame: At the time of screening
Six-Minute Walk Distance
Functional exercise capacity will be expressed as the distance walked during the 6-minute walk test, in meters.
Time frame: At the time of screening
Six-Minute Stepper Test Performance
Functional exercise capacity will be expressed as the number of steps completed during the 6-minute stepper test.
Time frame: At the time of screening
One-Minute Sit-to-Stand Test Performance
Functional exercise capacity will be expressed as the number of complete repetitions performed during the 1-minute sit-to-stand test.
Time frame: At the time of screening
Peak Oxygen Uptake During Cardiopulmonary Exercise Testing
Peak oxygen uptake (VO2peak), when available, will be extracted from the most recent cardiopulmonary exercise test and compared between groups.
Time frame: At the time of screening
Previous Participation in Pulmonary Rehabilitation
The number and percentage of participants who had previously participated in a pulmonary rehabilitation program will be reported for each group.
Time frame: At the time of screening
Setting of Previous Pulmonary Rehabilitation
When available, the setting of previous pulmonary rehabilitation will be classified as center-based, home-based, telerehabilitation, private physiotherapy practice, hybrid or mixed, other, or unknown.
Time frame: At the time of screening
Pulmonary Function at Screening - Forced Expiratory Volume in 1 Second
The most recent forced expiratory volume in 1 second (FEV1) available at the time of screening for the initial telerehabilitation study will be extracted from the medical record. FEV1 will be reported as an absolute volume in liters and as a percentage of the predicted value. Values will be compared between participants who accepted and those who declined participation in the home-based pulmonary telerehabilitation program.
Time frame: At the time of screening
Pulmonary Function at Screening - Forced Vital Capacity
The most recent forced vital capacity (FVC) available at the time of screening for the initial telerehabilitation study will be extracted from the medical record. FVC will be reported as an absolute volume in liters and as a percentage of the predicted value. Values will be compared between participants who accepted and those who declined participation in the home-based pulmonary telerehabilitation program.
Time frame: At the time of screening
Pulmonary Function at Screening - FEV1/FVC Ratio
The most recent ratio of forced expiratory volume in 1 second to forced vital capacity (FEV1/FVC) available at the time of screening for the initial telerehabilitation study will be extracted from the medical record. The FEV1/FVC ratio will be reported as a percentage. Values will be compared between participants who accepted and those who declined participation in the home-based pulmonary telerehabilitation program.
Time frame: At the time of screening
Pulmonary Function at Screening - Residual Volume
The most recent residual volume (RV) available at the time of screening for the initial telerehabilitation study will be extracted from the medical record. RV will be reported as an absolute volume in liters and as a percentage of the predicted value. Values will be compared between participants who accepted and those who declined participation in the home-based pulmonary telerehabilitation program.
Time frame: At the time of screening
Pulmonary Function at Screening - Total Lung Capacity
The most recent total lung capacity (TLC) available at the time of screening for the initial telerehabilitation study will be extracted from the medical record. TLC will be reported as an absolute volume in liters and as a percentage of the predicted value. Values will be compared between participants who accepted and those who declined participation in the home-based pulmonary telerehabilitation program.
Time frame: At the time of screening
Pulmonary Function at Screening - Slow Vital Capacity
The most recent slow vital capacity (VC) available at the time of screening for the initial telerehabilitation study will be extracted from the medical record. VC will be reported as an absolute volume in liters and as a percentage of the predicted value. Values will be compared between participants who accepted and those who declined participation in the home-based pulmonary telerehabilitation program.
Time frame: At the time of screening
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