摘要：We read with great enthusiasm the recent article by Daynes et al. highlighting the encouraging outcomes of COVID-19 rehabilitation (Daynes et al. 2021). Indeed, results for exercise capacity, health related quality of life, anxiety, and depression seemed to improve following 6 weeks of rehabilitation. In chronic respiratory diseases, such as chronic obstructive pulmonary disease (COPD), respiratory rehabilitation (RR) has demonstrated benefits both in terms of respiratory symptoms (Ward et al. 2020) and mental health (Gordon et al. 2019). RR centers are the cornerstone of patient management (Ward et al. 2020). In spite of the known benefits of RR, in reality, patients are not as likely to attend, and complete RR as required. Transportation, hospital capacities, and staffing issues are often overlooked as impediment factors in RR compliance. In fact, some studies have shown that the most common barrier to participation in RR is insufficient transportation to and from hospital-based programs (Wadell et al. 2013; Thorpe et al. 2012). In 2015, the official ATS/ERS Policy Statement on Enhancing Implementation noted that further barriers to RR were highlighted in the delivery of RR (Rochester et al. 2015). Health professionals, payers, patients, and caregivers lack awareness and knowledge of the benefits of RR; the optimal use of RR by suitable patient populations (Jones et al. 2014); and limited training opportunities for RR providers. The use of telerehabilitation is another potential method to overcome the limitations of traditional hospital-based RR (Salawu et al. 2020; Sivan et al. 2020). Using information and communication technologies to provide clinical rehabilitation services over the internet has been classified as telerehabilitation (Kairy et al. 2009). In 2021, it was reported that during the treatment of chronic COPD, the need for continuous treatment and care, and the high costs of medications and RR services led to a heavy financial burden for patients and their families. In contrast, the stress and concern caused by the inability to receive medication and to participate in RR worsened the condition. As a result, RR is often not continued by patients and their families (Sami et al. 2021). A Canadian Economic Analysis, published in 2010, showed that normal care plus RR is 27% more effective than usual care, with incremental cost-effectiveness ratios of Canadian dollar (CAD) 27,924 per additional quality-adjusted life-year gained. The authors also reported that, over a 10-year period, if COPD patients were only treated in moderate and severe cases, then 1505 additional people would receive RR treatment in Canada at an added cost of CAD 1.8 million per year. In the case of a 25% increase in COPD patients needing RR, the cost would rise to CAD 33.9 million. The additional annual cost for all individuals with COPD (100% treatment) who require RR would be CAD 168 million (CADTH 2010)..
