Is robotic mobility assistance appropriate as a complement to standard pulmonary rehabilitation for patients with chronic respiratory disease (e.g., COPD, interstitial lung disease, post‑COVID‑19 fibrosis) or post‑thoracic surgery who have resting oxygen saturation ≥ 90 % on room air, are hemodynamically stable, and have no contraindications such as severe osteoporosis, uncontrolled cardiac arrhythmia, or active lower‑extremity musculoskeletal injury, and what protocol should be used?

Robotic Mobility Assistance in Pulmonary Rehabilitation

Robotic mobility assistance is not currently recommended as a standard component of pulmonary rehabilitation for patients with chronic respiratory disease, as current guidelines do not address robotics specifically and the evidence base for robotic applications remains insufficient.

Current Guideline Framework for Technology in Pulmonary Rehabilitation

The American Thoracic Society (2023) provides strong recommendations for pulmonary rehabilitation delivery but does not include robotics as an established modality 1. The guidelines explicitly acknowledge that technologies are "currently being adapted and tested" but do not yet have the robust evidence base of traditional pulmonary rehabilitation 2.

Established Technology-Based Alternatives

• Telerehabilitation is the only technology-based modality with strong guideline support, receiving a strong recommendation (moderate-quality evidence) as an equivalent alternative to center-based pulmonary rehabilitation for adults with chronic respiratory disease 1, 2.
• Telerehabilitation achieves similar clinical outcomes to traditional center-based programs with higher completion rates (93% vs 70%) and no safety concerns 3.
• When compared to in-person rehabilitation, telerehabilitation shows probably little or no difference in 6-minute walk distance (MD 0.06 meters, 95% CI -10.82 to 10.94), quality of life, or breathlessness 3.

Clinical Context for Mobility Assistance Devices

While robotics specifically lack evidence, respiratory assist devices (distinct from robotic mobility aids) have been studied to unload work of breathing and enhance exercise performance in patients with advanced lung disease 4. However, these devices focus on respiratory mechanics rather than mobility assistance 4.

Critical Implementation Requirements If Considering Novel Technologies

Any technology-based intervention must deliver all core pulmonary rehabilitation components, not serve as a standalone mobility aid 2:

• Exercise training: Structured, progressive, and individually tailored protocols are mandatory 2.
• Education: COPD self-management education must be integrated alongside exercise training 2.
• Behavioral support: Patient-tailored behavior change strategies are required program elements 2.
• Multidisciplinary coordination: Healthcare professionals from multiple disciplines must coordinate care 2.

Common Pitfalls to Avoid

• Do not substitute technology for comprehensive pulmonary rehabilitation—technology should deliver all core components (exercise training, education, behavioral support, nutritional assessment), not just exercise monitoring or mobility assistance 2.
• Avoid using any single-modality device as a standalone intervention without comprehensive exercise training 2.

Patient Selection Criteria for Standard Pulmonary Rehabilitation

For the specified patient population (chronic respiratory disease with resting oxygen saturation ≥90% on room air, hemodynamically stable, no contraindications):

• Strong recommendation for pulmonary rehabilitation in adults with stable COPD (moderate-quality evidence) 1.
• Strong recommendation for pulmonary rehabilitation in adults with interstitial lung disease (moderate-quality evidence) 1.
• Strong recommendation for pulmonary rehabilitation after hospitalization for COPD exacerbation (moderate-quality evidence) 1.

Practical Recommendation for Current Practice

Until robotic mobility assistance demonstrates equivalent outcomes in rigorous trials, offer patients the choice between center-based pulmonary rehabilitation or telerehabilitation 1, 2. Telerehabilitation should be deployed for patients who cannot access center-based programs due to transportation barriers, rural location, or mobility limitations 2. Recent evidence demonstrates telerehabilitation produces significant improvements in functional capacity (41.3 m or 15.7% increase in 6-minute walk distance), functional mobility (9.94% faster Timed Up and Go), and quality of life (27.9% improvement in SGRQ) over 12 weeks 5.

Protocol Considerations for Technology-Based Delivery

• Weekly 120-minute sessions delivered via secure video platforms achieve 86% retention rates 5.
• Programs should include progressive lower-body strength training, functional mobility exercises, and upper limb conditioning 6, 5.
• Maintenance rehabilitation after completing initial programs may be beneficial (conditional recommendation, low-quality evidence) 1.