Effect of a telerehabilitation program in sarcoidosis

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José Cerdán-de-las-Heras https://orcid.org/0000-0002-2677-0703
Fernanda Balbino
Daniel Catalán-Matamoros https://orcid.org/0000-0002-3086-6812
Ole Hilberg https://orcid.org/0000-0002-3075-3463
Anders Løkke https://orcid.org/0000-0002-6905-4141
Elisabeth Bendstrup https://orcid.org/0000-0002-4238-6963


Sarcoidosis, Rehabilitation, Telerehabilitation, Virtual agents, Telemedicine


Rehabilitation is recommended in sarcoidosis to improve exercise capacity. Focus on creating flexible rehabilitation options is warranted to keep patients with sarcoidosis employed. Telerehabilitation (TR) might be an alternative. We investigated the effectiveness of TR on exercise capacity in patients with sarcoidosis.  Study included stable patients with sarcoidosis who were enrolled in either a control group where they received the usual standard of care or in the 3 months TR group composed of video and chat-consultations with a physiotherapist and workout sessions with a virtual autonomous physiotherapist agent. 6-minute-walk-test (6MWT), forced-vital-capacity (FVC), diffusion-capacity-of-the-lung-for- carbon-monoxide (DLCO), isometric-voluntary-contraction (MVC), 7 days pedometry, Saint-George-Respiratory-Questionnaire for interstitial lung disease (SGRQ-I), The King's-Brief Interstitial-Lung-Disease-Questionnaire (KBILD) and General-Anxiety-Disorder-7-Questionnaire (GAD7) were tested before and after 3 months of TR, and after 3 and 6 months follow-up. Patient-satisfaction was measured with a 5-point scale and adherence was calculated as percent of tasks and time spent training. Thirty patients aged 53.9±13.5 years, male 63.3%, FVC% 88.9±18.8, DLCO% 65.2±16.0, 6MWT 513.1±141.3 were included. Fifteen patients were randomized to TR and 15 patients to the control group. Differences in meters walked (6MWTD) between groups was at baseline (-28.9 m (p=0.58)), after 3 (+25.8 m (p=0.57)), 6 (+48.4 m (p=0.39)) and 9 months (+77.3 m (p=0.18)) follow-up in favor of TR. No differences were observed in other variables. Exercise adherence in the intervention group was 64% with an average of 28 minutes per exercise session during the first 3 months. Patient-satisfaction scored 3.8 ± 0.7. No adverse events were reported. TR did not result in any change. A statistically non-significant trend for improved 6MWTD was observed during follow-up. TR was safe, had high patient-satisfaction and acceptable adherence.


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1. Cerdán-de-las-Heras J, Balbino F, Løkke A, Catalán-Matamoros D, Hilberg O, Bendstrup E. Tele-rehabilitation program in idiopathic pulmonary fibrosis—A single-center randomized trial. Int J Environ Res Public Health. 2021 Sep 23;18(19):10016.
2. Diagnosis and Detection of Sarcoidosis: An Official ATS Clinical Practice Guideline Implementation Tools [Internet]. [cited 2021 Jan 10]. Available from: https://www.thoracic.org/statements/guideline-implementation-tools/diagnosis-and-detection-of-sarcoidosis.php
3. Thillai M, Atkins CP, Crawshaw A, Hart SP, Ho L-P, Kouranos V, et al. BTS Clinical Statement on pulmonary sarcoidosis. Thorax. 2021 Jan;76(1):4–20.
4. Baughman RP, Valeyre D, Korsten P, Mathioudakis AG, Wuyts WA, Wells A, et al. ERS clinical practice guidelines on treatment of sarcoidosis. Eur Respir J [Internet]. 2021 Jun 17; Available from: http://dx.doi.org/10.1183/13993003.04079-2020
5. Hunninghake GW, Costabel U, Ando M, Baughman R, Cordier JF, du Bois R, et al. ATS/ERS/WASOG statement on sarcoidosis. American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and other Granulomatous Disorders. Sarcoidosis Vasc Diffuse Lung Dis. 1999 Sep;16(2):149–73.
6. Sweiss NJ, Korsten P, Baughman RP. Chapter 117 - Sarcoidosis. In: Firestein GS, Budd RC, Gabriel SE, McInnes IB, O’Dell JR, editors. Kelley and Firestein’s Textbook of Rheumatology (Tenth Edition). Elsevier; 2017. p. 1983–96.
7. Marcellis RGJ, Lenssen AF, Kleynen S, De Vries J, Drent M. Exercise Capacity, Muscle Strength, and Fatigue in Sarcoidosis: A Follow-Up Study. Lung. 2013;191(3):247–56.
8. Strookappe B, Saketkoo LA, Elfferich M, Holland A, De Vries J, Knevel T, et al. Physical activity and training in sarcoidosis: review and experience-based recommendations. Expert Rev Respir Med. 2016 Oct;10(10):1057–68.
9. Strookappe B, Elfferich M, Swigris J, Verschoof A, Veschakelen J, Knevel T, et al. Benefits of physical training in patients with idiopathic or end-stage sarcoidosis-related pulmonary fibrosis: a pilot study. Sarcoidosis Vasc Diffuse Lung Dis. 2015 Jun 22;32(1):43–52.
10. Marcellis R, Van der Veeke M, Mesters I, Drent M, De Bie R, De Vries G, et al. Does physical training reduce fatigue in sarcoidosis? Sarcoidosis Vasc Diffuse Lung Dis. 2015 Jun 22;32(1):53–62.
11. Moor CC, Kahlmann V, Culver DA, Wijsenbeek MS. Comprehensive Care for Patients with Sarcoidosis. J Clin Med Res [Internet]. 2020 Feb 1;9(2). Available from: http://dx.doi.org/10.3390/jcm9020390
12. Peretti A, Amenta F, Tayebati SK, Nittari G, Mahdi SS. Telerehabilitation: Review of the State-of-the-Art and Areas of Application. JMIR Rehabil Assist Technol. 2017 Jul 21;4(2):e7.
13. Cox NS, Dal Corso S, Hansen H, McDonald CF, Hill CJ, Zanaboni P, et al. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev. 2021 Jan 29;1:CD013040.
14. Drent M, Elfferich M, Breedveld E, Vries JD, Strookappe B. Benefit of Wearing an Activity Tracker in Sarcoidosis. J Pers Med [Internet]. 2020 Aug 22;10(3). Available from: http://dx.doi.org/10.3390/jpm10030097
15. Moor CC, Gür-Demirel Y, Wijsenbeek MS. Feasibility of a Comprehensive Home Monitoring Program for Sarcoidosis. J Pers Med [Internet]. 2019 May 5;9(2). Available from: http://dx.doi.org/10.3390/jpm9020023
16. Diagnosis and Detection of Sarcoidosis: An Official ATS Clinical Practice Guideline Implementation Tools [Internet]. [cited 2021 Jan 10]. Available from: https://www.thoracic.org/statements/guideline-implementation-tools/diagnosis-and-detection-of-sarcoidosis.php
17. VAPA [Internet]. [cited 2020 Aug 18]. Available from: https://www.eurostars-eureka.eu/project/id/10287
18. Cerdán de Las Heras J, Tulppo M, Kiviniemi AM, Hilberg O, Løkke A, Ekholm S, et al. Augmented reality glasses as a new tele-rehabilitation tool for home use: patients’ perception and expectations. Disabil Rehabil Assist Technol. 2020 Aug 4;1–7.
19. Cerdan J, Catalan-Matamoros D, Berg SW. Online communication in a rehabilitation setting: Experiences of patients with chronic conditions using a web portal in Denmark. Patient Educ Couns. 2017 Dec;100(12):2283–9.
20. Solution [Internet]. [cited 2020 Sep 20]. Available from: https://optimov.com/?page_id=3006
21. Products - Optimov [Internet]. [cited 2020 Sep 20]. Available from: https://optimov.com/?page_id=1879
22. Kabitz H-J, Lang F, Walterspacher S, Sorichter S, Müller-Quernheim J, Windisch W. Impact of Impaired Inspiratory Muscle Strength on Dyspnea and Walking Capacity in Sarcoidosis. Chest. 2006;130(5):1496–502.
23. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1384–7.
24. Hecht A, Ma S, Porszasz J, Casaburi R. Methodology for Using Long-Term Accelerometry Monitoring to Describe Daily Activity Patterns in COPD the COPD Clinical Research Network. COPD. 2009 Apr;2:121–9.
25. Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs. 2000 Jun;26(3):216–22.
26. microFET®2 – Hoggan Scientific [Internet]. [cited 2021 Mar 13]. Available from: https://hogganscientific.com/product/microfet2-muscle-tester-digital-handheld-dynamometer/
27. Prior TS, Hoyer N, Shaker SB, Davidsen JR, Yorke J, Hilberg O, et al. Validation of the IPF-specific version of St. George’s Respiratory Questionnaire [Internet]. Vol. 20, Respiratory Research. 2019. Available from: http://dx.doi.org/10.1186/s12931-019-1169-9
28. Prior TS, Hilberg O, Shaker SB, Davidsen JR, Hoyer N, Birring SS, et al. Validation of the King’s Brief Interstitial Lung Disease questionnaire in Idiopathic Pulmonary Fibrosis [Internet]. Vol. 19, BMC Pulmonary Medicine. 2019. Available from: http://dx.doi.org/10.1186/s12890-019-1018-0
29. Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092–7.
30. Karadall MN, Bo nak-Guclu M, Camc o lu B, Kokturk N, Turkta H. Effects of Inspiratory Muscle Training in Subjects With Sarcoidosis: A Randomized Controlled Clinical Trial. Respir Care. 2016 Apr 1;61(4):483–94.
31. Sample Size Calculator [Internet]. [cited 2018 Oct 16]. Available from: http://clincalc.com/Stats/SampleSize.aspx
32. McCoy CE. Understanding the Intention-to-treat Principle in Randomized Controlled Trials. West J Emerg Med. 2017 Oct;18(6):1075–8.
33. Holland AE, Hill CJ, Conron M, Munro P, McDonald CF. Small changes in six-minute walk distance are important in diffuse parenchymal lung disease. Respir Med. 2009 Oct;103(10):1430–5.
34. Guber E, Wand O, Epstein Shochet G, Romem A, Shitrit D. The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature. Respiration. 2021 Mar 30;100(5):423–31.
35. Wallaert B, Kyheng M, Labreuche J, Stelianides S, Wemeau L, Grosbois JM. Long-term effects of pulmonary rehabilitation on daily life physical activity of patients with stage IV sarcoidosis: A randomized controlled trial. Respir Med. 2020 Mar;77:1–7.
36. Froidure S, Kyheng M, Grosbois JM, Lhuissier F, Stelianides S, Wemeau L, et al. Daily life physical activity in patients with chronic stage IV sarcoidosis: A multicenter cohort study. Health Sci Rep. 2019 Feb;2(2):e109.
37. Li Y, Qian H, Yu K, Huang Y. Nonadherence in Home-Based Pulmonary Rehabilitation Program for COPD Patients. Can Respir J. 2020 Jan 7;2020:5146765.
38. Fischer MJ, Scharloo M, Abbink JJ, van ’t Hul AJ, van Ranst D, Rudolphus A, et al. Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respir Med. 2009 Oct;103(10):1564–71.

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