Telerehabilitation Interventions That Improve Adherence to Pulmonary Rehabilitation in Patients With Chronic Respiratory Diseases: A Realist Review

AIM: To explore how, under what circumstances and why telerehabilitation can improve adherence to pulmonary rehabilitation in patients with chronic respiratory diseases. DESIGN: A realist review. DATA SOURCES: Embase, MEDLINE, CINAHL, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to 2 July 2024 to identify relevant literature. METHODS: Initial programme theory was developed through research team meeting, informal literature reading and the use of Capability, Opportunity, Motivation, Behaviour model. After completing the literature search, key evidence was appraised, extracted and synthesised into context-mechanism-outcome configurations. RESULTS: The review included 23 studies. Seven context-mechanism-outcome configurations were identified. Accessibility and convenience of pulmonary rehabilitation; social interaction and support; technical support; individuality and flexibility of program; getting feedback and seeing results; real-time monitoring of diseases; and diverse motivational incentives were found to be critical for telerehabilitation to improve adherence to pulmonary rehabilitation in patients with chronic respiratory diseases. CONCLUSIONS: This review explains the key mechanisms by which telerehabilitation improves adherence to pulmonary rehabilitation in patients with chronic respiratory diseases, which may contribute to the development and improvement of future pulmonary telerehabilitation interventions. IMPACT: The program theory developed in this study may guide researchers and clinical staff in the development or improvement of pulmonary telerehabilitation interventions to improve patients' adherence to pulmonary rehabilitation and further support better pulmonary rehabilitation outcomes. REPORTING METHOD: This study adheres to The RAMESES reporting standards. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRIAL REGISTRATION: Open Science Framework (https://osf.io/). DOI: https://doi.org/10.17605/OSF.IO/YWMQ8.