The Role of Robotics in Pulmonary Rehabilitation
Robotics technology represents an emerging approach in pulmonary rehabilitation that can improve accessibility, adherence, and outcomes for patients with chronic respiratory diseases by providing consistent training, remote supervision, and objective data collection. 1
Current Applications of Robotics in Pulmonary Rehabilitation
Virtual reality (VR) systems are being implemented as innovative methods for pulmonary rehabilitation, allowing patients with COPD to access services remotely and potentially improving compliance among vulnerable patients (MRC 4 or 5) 2
Socially assistive robots in home settings have demonstrated effectiveness in improving medication adherence and increasing rehabilitation exercise frequency for patients with COPD 3
Technology-assisted exercise training, including telehealth and mobile phone-based systems, can remotely monitor endurance exercise training programs completed at home, showing good compliance and significant improvements in clinical outcomes 4
Robotic technology can assist rehabilitation by providing consistent training for extended periods, collecting objective assessment data, and potentially allowing therapists to treat multiple patients simultaneously 1
Benefits of Robotics in Pulmonary Rehabilitation
Robotic interventions can help overcome barriers to traditional pulmonary rehabilitation, including transportation issues, psychological morbidity, and general frailty that often prevent post-hospitalization rehabilitation 5
VR-supported pulmonary rehabilitation has shown significant improvements in physical measures and could help overcome current limitations associated with providing rehabilitation services at scale 2
Home-based robotic systems can improve adherence to medication regimens and increase exercise frequency compared to standard care 3
Technology-assisted rehabilitation can reduce primary care contacts for respiratory issues and potentially decrease acute exacerbations and hospitalizations 4
Integration with Traditional Pulmonary Rehabilitation
The American Thoracic Society recognizes that a "one size fits all" approach to pulmonary rehabilitation is not optimal, given the varying symptoms, disease severity, comorbidities, and impacts of disease among patients with chronic respiratory diseases 4
Telerehabilitation and low-cost, home-based models are emerging program models that aim to improve access and uptake of pulmonary rehabilitation 6
Essential components of pulmonary rehabilitation must be maintained in any program model, including comprehensive patient assessment, appropriate program content, effective delivery methods, and quality assurance 6
Robotics can support the delivery of both upper and lower extremity training components, which are recommended by the American Thoracic Society to achieve comprehensive rehabilitation benefits 5
Implementation Considerations
Successful implementation of robotic technology in pulmonary rehabilitation requires consideration of visualization devices, interaction methods, and feedback systems to ensure feasibility, safety, usability, and positive user experience 7
Health professionals should use clinical judgment to determine which patients are best served by center-based, multidisciplinary rehabilitation programs versus technology-assisted approaches 6
Robust quality-assurance processes are important to ensure that any technology-enhanced pulmonary rehabilitation service delivers optimal outcomes for patients 6
Despite widespread use of telehealth during the COVID-19 pandemic, there is still no set infrastructure in the United States for implementation of novel models of pulmonary rehabilitation such as telerehabilitation 4
Future Directions
Further research is needed to determine the characteristics of patients most likely to succeed with different robotic and technology-assisted program models 6
The success of all pulmonary rehabilitation models, including those incorporating robotics, will be judged on whether they deliver essential components and achieve expected patient outcomes (improved exercise capacity, reduced dyspnea, enhanced quality of life, and reduced hospital admissions) 6
Workforce capacity-building and training should consider the skills necessary for emerging technology-assisted models, many of which are delivered remotely 6
Precision medicine using a "treatable traits" approach in pulmonary rehabilitation could optimize patient outcomes, including determining which type of program model (traditional vs. technology-assisted) is optimal for individual patients 4