Underrepresentation of Rural Populations in Tele-Pulmonary Rehabilitation Trials: A Systematic Review.
Débora M Petry Moecke, Baneesha K Gill, Olivia M Zawadiuk et al.
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In 30 seconds
This systematic review assessed whether people with chronic obstructive pulmonary disease from rural communities were represented in tele-pulmonary rehabilitation (tele-PR) randomised controlled trials. It included 41 trials published from 1995 to March 2025. Most studies (83%) were conducted in urban areas, while 17% specified inclusion of both urban and rural populations. Rural participants accounted for less than 3% of the total 4142 participants, based on available data. The review also found that 78% of programs required at least one in-person visit, potentially limiting rural participation and the generalisability of the evidence.
Key findings
- Of 41 tele-PR randomised controlled trials, 83% were conducted in urban areas and 17% specified inclusion of urban and rural populations.
- Rural participants represented less than 3% of the total 4142 participants, based on available data.
- In 78% of reviewed programs, at least one in-person assessment or follow-up visit was mandatory.
Why it matters
Tele-PR is proposed as a way to address access barriers for rural communities, yet the evidence base largely reflects urban populations. Limited rural representation may constrain how confidently trial findings can be applied to these communities. In-person requirements may also impede participation, underscoring the importance of considering access and population inclusion when designing and reporting future studies.
What to keep in mind
Rural representation was estimated from available trial data; the abstract does not specify how consistently rural residence was defined or reported.