What are the challenges of incorporating robotics into rehabilitation programs for older adults with Chronic Obstructive Pulmonary Disease (COPD) and comorbid conditions such as heart disease, diabetes, and hypertension?

Challenges for Incorporating Robotics into Rehabilitation Programs for Older Adults with COPD

The primary challenges for incorporating robotics into rehabilitation programs for older adults with COPD and comorbidities include technology access barriers (equipment costs, internet connectivity, digital literacy), physiological monitoring limitations requiring close supervision, and the need for resource-intensive infrastructure that remains largely unproven in real-world implementation.

Technology Access and Digital Divide

The most significant barrier to technology-based rehabilitation is the digital divide affecting older adults with COPD:

• 31% of people with COPD have never accessed the internet, creating an immediate exclusion from technology-assisted programs 1
• Older age, lower household income, Black race, Latinx ethnicity, and female sex are associated with lower use of video technology for healthcare in a large U.S. cohort of 148,042 participants 1
• Equipment requirements (phone, tablet, computer), reliable internet access, and associated costs create substantial barriers for many patients 1
• Digital skills required to operate equipment and technology represent a significant hurdle, particularly for older adults who may lack technical proficiency 1

Physiological Monitoring and Safety Concerns

Older adults with COPD and multiple comorbidities require careful monitoring that robotics may not adequately provide:

• Special consideration is required for individuals with vision or hearing impairment, balance issues, or those requiring close physiological monitoring 1
• Patients lacking home caregiver support face additional safety risks with remote or robotic rehabilitation 1
• Comorbid conditions including heart disease, diabetes, and hypertension (the most frequently reported comorbidities in 51% of COPD rehabilitation patients) may reduce rehabilitation outcomes and require closer supervision 2
• Lower-intensity supervision in remotely supported programs necessitates robust service audit and benchmarking processes to ensure program efficacy 1

Resource and Implementation Barriers

The feasibility of implementing resource-intensive robotic programs remains largely unproven:

• Real-world applications have primarily described low-cost programs requiring few resources, while feasibility of programs requiring specialist equipment, infrastructure, web support, or smartphone application development has not been widely described 1
• No studies exist on resource requirements (costs) for telerehabilitation specific to the U.S. healthcare context 1
• No data are available regarding costs for establishing and sustaining remote programs that require higher resources, such as advanced technology like videoconferencing 1
• Robotic programs must follow well-defined intervention procedures that adhere to essential components of pulmonary rehabilitation, including proper patient assessments before program commencement 1

Functional and Mobility-Specific Challenges

Older adults with COPD prioritize functional independence, which robotics may not adequately address:

• Functional status and mobility issues, particularly related to supplemental oxygen, emerged as patient-prioritized challenges in a multiphase study of older adults with COPD 3
• Supplemental oxygen challenges emerged as a critical problem that complicates technology-based rehabilitation 3
• Transportation, psychological morbidity, and general frailty are frequent barriers to post-hospitalization rehabilitation that must be addressed 4
• While robotics showed better recovery in strength, balance, endurance, and coordination, there was no significant improvement in speed or agility in elderly patients with degenerative diseases 5

Program Efficacy and Standardization Issues

Ensuring robotic rehabilitation maintains the same efficacy as traditional programs presents challenges:

• Robust service audit and benchmarking processes are needed because some models of remotely supported programs may result in lower-intensity supervision and exercise training 1
• Programs must include both upper and lower extremity training components at adequate intensity to achieve physiological benefits, which may be difficult to ensure with robotic systems 4
• Exercise training should be conducted for 6-12 weeks, with longer programs producing greater sustained benefits, requiring sustained engagement with technology 4
• Benefits typically decline gradually over 12-18 months, necessitating maintenance strategies that may be challenging to implement through robotic platforms 4

Common Pitfalls to Avoid

• Failing to screen patients for technology access, digital literacy, and home support systems before enrolling them in robotic rehabilitation programs 1
• Not providing alternative options for patients with sensory impairments (vision, hearing) or balance issues who cannot safely use robotic systems 1
• Implementing high-resource robotic programs without evidence of cost-effectiveness or real-world feasibility in the specific healthcare context 1
• Neglecting to ensure adequate physiological monitoring for patients with multiple comorbidities (heart disease, diabetes, hypertension) who may have reduced rehabilitation outcomes 2
• Overlooking patient-prioritized needs for independence and supplemental oxygen management when designing robotic interventions 3