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Rutkowski S. Management Challenges in Chronic Obstructive Pulmonary Disease in the COVID-19 Pandemic: Telehealth and Virtual Reality. J Clin Med 2021; 10:1261. [PMID: 33803853 PMCID: PMC8003143 DOI: 10.3390/jcm10061261] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 12/23/2022] Open
Abstract
For the treatment of chronic obstructive pulmonary disease (COPD), early diagnosis and unconditionally correct management at the initial stage of the disease are very important when the symptoms are not yet too worrying. In this way, the progress of the disease can be slowed down, as can the occurrence of late, life-threatening symptoms. Pulmonary rehabilitation is an essential component of the management of COPD. The selection of appropriate exercises, which are determined during the classification of patients into a suitable improvement program, is of key importance in the process of rehabilitation. The coronavirus disease 2019 (COVID-19) pandemic has resulted in major limitations to public health care. Health systems were largely unprepared for an outbreak of this magnitude. Searching for new, attractive technologies that help patients with chronic diseases seems to be justified. This may be driven by telehealth platforms, likewise with the use of virtual reality (VR). Analysis of the available literature indicates promising effectiveness, high patient acceptance, and high motivations to undertake physical activity with the use of such a solution. Thus, the management of patients with COPD during the COVID-19 pandemic should include options for remote delivery of pulmonary rehabilitation, including home-based, telerehabilitation, and computer-based virtual programs.
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Affiliation(s)
- Sebastian Rutkowski
- Department of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
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Galdiz JB, Gómez A, Rodriguez D, Guell R, Cebollero P, Hueto J, Cejudo P, Ortega F, Sayago I, Chic S, Iscar M, Amado C, Rodríguez Trigo G, Cosio BG, Bustamante V, Pijoan JI. Telerehabilitation Programme as a Maintenance Strategy for COPD Patients: A 12-Month Randomized Clinical Trial. ACTA ACUST UNITED AC 2021. [DOI: 10.1016/j.arbr.2020.03.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sabahi A, Hosseini A, Emami H, Almasi S. Telemedicine Services in Chronic Obstructive Pulmonary Disease: A Systematic Review of Patients' Adherence. TANAFFOS 2021; 20:209-220. [PMID: 35382079 PMCID: PMC8978036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/13/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND The current systematic review aimed to determine the effect of telemedicine services on adherence in patients with chronic obstructive pulmonary disease (COPD) and to describe the type of adherence and applied devices and modules. MATERIALS AND METHODS We reviewed PubMed, Scopus, Web of Science, and Embase databases to identify relevant studies from the time of inception of these databases to March 10, 2019, using three groups of keywords. The first group comprised words describing COPD, the second group included words describing types of telemedicine interventions, and the third group contained words describing adherence. The reference list of identified articles was also hand-searched to retrieve possibly relevant articles. RESULTS In total 21 articles were included, in which 13 reported a positive effect for telemedicine on patients' adherence. Adherence to treatment was classified under six categories. The highest frequency belongs to the adherence to performing exercises and participation in training sessions, using the system, using devices, measuring (like blood pressure, oxygen saturation, heart rate, weight, temperature, sputum volume) and reporting symptoms and the results of measurements, completing tasks, and medication. CONCLUSION This study demonstrated the effectiveness of telemedicine services on adherence to treatment plans in patients with COPD. The following factors contribute to the effectiveness of telemedicine services: patient support by healthcare professionals and easy access to them, uninterrupted execution of telemedicine programs, follow-up and supervision of providers, creating and maintaining motivation in patients, and provision of different self-management modules.
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Affiliation(s)
- Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, South Khorasan, Iran
| | - Azamossadat Hosseini
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Hosseini A, Address: Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
| | - Hasan Emami
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Almasi
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rassouli F, Germann A, Baty F, Kohler M, Stolz D, Thurnheer R, Brack T, Kähler C, Widmer S, Tschirren U, Sievi NA, Tamm M, Brutsche MH. Telehealth mitigates COPD disease progression compared to standard of care: a randomized controlled crossover trial. J Intern Med 2021; 289:404-410. [PMID: 33428219 PMCID: PMC7986739 DOI: 10.1111/joim.13230] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND We showed excellent adherence and satisfaction with our telehealth care (TC) approach for COPD. Here, the results of a consecutive randomized controlled trial are presented. METHODS Patients were randomly assigned to TC or standard care (SC). During TC, patients answered six daily questions online, and focused on the early recognition of exacerbations, in addition to SC. RESULTS The mean increase in COPD assessment test (CAT) was 1.8 vs. 3.6 points/year in the TC and SC groups, respectively (P = 0.0015). Satisfaction with care (VAS) at baseline was 8.2; at the end of SC, 8.5 (P = 0.062); and after TC, 8.8 (P < 0.001). We detected significantly more moderate exacerbations during TC. CONCLUSION Whilst receiving TC, the slope of the CAT increase - an indicator of the naturally progressive course of COPD - was reduced by 50%. Satisfaction with care increased with TC. The higher number of detected moderate exacerbations probably indicates a higher diagnostic sensitivity than without TC.
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Affiliation(s)
- F Rassouli
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - A Germann
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - F Baty
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - M Kohler
- Clinic for Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - D Stolz
- Clinic for Pulmonology, University Hospital Basel, Basel, Switzerland
| | - R Thurnheer
- Clinic for Internal Medicine, Cantonal Hospital Münsterlingen, Münsterlingen, Switzerland
| | - T Brack
- Clinic for Internal Medicine, Cantonal Hospital Glarus, Glarus, Switzerland
| | - C Kähler
- Clinic for Pulmonology, Waldburg-Zeil-Kliniken, Wangen, Germany
| | - S Widmer
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - U Tschirren
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - N A Sievi
- Clinic for Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - M Tamm
- Clinic for Pulmonology, University Hospital Basel, Basel, Switzerland
| | - M H Brutsche
- From the, Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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55
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Cox NS, Dal Corso S, Hansen H, McDonald CF, Hill CJ, Zanaboni P, Alison JA, O'Halloran P, Macdonald H, Holland AE. Telerehabilitation for chronic respiratory disease. Cochrane Database Syst Rev 2021; 1:CD013040. [PMID: 33511633 PMCID: PMC8095032 DOI: 10.1002/14651858.cd013040.pub2] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pulmonary rehabilitation is a proven, effective intervention for people with chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD) and bronchiectasis. However, relatively few people attend or complete a program, due to factors including a lack of programs, issues associated with travel and transport, and other health issues. Traditionally, pulmonary rehabilitation is delivered in-person on an outpatient basis at a hospital or other healthcare facility (referred to as centre-based pulmonary rehabilitation). Newer, alternative modes of pulmonary rehabilitation delivery include home-based models and the use of telehealth. Telerehabilitation is the delivery of rehabilitation services at a distance, using information and communication technology. To date, there has not been a comprehensive assessment of the clinical efficacy or safety of telerehabilitation, or its ability to improve uptake and access to rehabilitation services, for people with chronic respiratory disease. OBJECTIVES To determine the effectiveness and safety of telerehabilitation for people with chronic respiratory disease. SEARCH METHODS We searched the Cochrane Airways Trials Register, and the Cochrane Central Register of Controlled Trials; six databases including MEDLINE and Embase; and three trials registries, up to 30 November 2020. We checked reference lists of all included studies for additional references, and handsearched relevant respiratory journals and meeting abstracts. SELECTION CRITERIA All randomised controlled trials and controlled clinical trials of telerehabilitation for the delivery of pulmonary rehabilitation were eligible for inclusion. The telerehabilitation intervention was required to include exercise training, with at least 50% of the rehabilitation intervention being delivered by telerehabilitation. DATA COLLECTION AND ANALYSIS We used standard methods recommended by Cochrane. We assessed the risk of bias for all studies, and used the ROBINS-I tool to assess bias in non-randomised controlled clinical trials. We assessed the certainty of evidence with GRADE. Comparisons were telerehabilitation compared to traditional in-person (centre-based) pulmonary rehabilitation, and telerehabilitation compared to no rehabilitation. We analysed studies of telerehabilitation for maintenance rehabilitation separately from trials of telerehabilitation for initial primary pulmonary rehabilitation. MAIN RESULTS We included a total of 15 studies (32 reports) with 1904 participants, using five different models of telerehabilitation. Almost all (99%) participants had chronic obstructive pulmonary disease (COPD). Three studies were controlled clinical trials. For primary pulmonary rehabilitation, there was probably little or no difference between telerehabilitation and in-person pulmonary rehabilitation for exercise capacity measured as 6-Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) -10.82 m to 10.94 m; 556 participants; four studies; moderate-certainty evidence). There may also be little or no difference for quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD -1.26, 95% CI -3.97 to 1.45; 274 participants; two studies; low-certainty evidence), or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI -0.13 to 0.40; 426 participants; three studies; low-certainty evidence). Participants were more likely to complete a program of telerehabilitation, with a 93% completion rate (95% CI 90% to 96%), compared to a 70% completion rate for in-person rehabilitation. When compared to no rehabilitation control, trials of primary telerehabilitation may increase exercise capacity on 6MWD (MD 22.17 m, 95% CI -38.89 m to 83.23 m; 94 participants; two studies; low-certainty evidence) and may also increase 6MWD when delivered as maintenance rehabilitation (MD 78.1 m, 95% CI 49.6 m to 106.6 m; 209 participants; two studies; low-certainty evidence). No adverse effects of telerehabilitation were noted over and above any reported for in-person rehabilitation or no rehabilitation. AUTHORS' CONCLUSIONS This review suggests that primary pulmonary rehabilitation, or maintenance rehabilitation, delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre-based pulmonary rehabilitation, with no safety issues identified. However, the certainty of the evidence provided by this review is limited by the small number of studies, of varying telerehabilitation models, with relatively few participants. Future research should consider the clinical effect of telerehabilitation for individuals with chronic respiratory diseases other than COPD, the duration of benefit of telerehabilitation beyond the period of the intervention, and the economic cost of telerehabilitation.
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Affiliation(s)
- Narelle S Cox
- Institute for Breathing and Sleep, Melbourne, Australia
- Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
| | - Simone Dal Corso
- Graduate Program in Rehabilitation Sciences, Nove de Julho University, São Paulo, Brazil
| | - Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Christine F McDonald
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Respiratory and Sleep Medicine, Austin Hospital, Melbourne, Australia
| | - Catherine J Hill
- Institute for Breathing and Sleep, Melbourne, Australia
- Department of Physiotherapy, Austin Hospital, Melbourne, Australia
| | - Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jennifer A Alison
- Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Allied Health Research and Education Unit, Sydney Local Health District, Sydney, Australia
| | - Paul O'Halloran
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Heather Macdonald
- Community Rehabilitation, Wimmera Health Care Group, Horsham, Australia
| | - Anne E Holland
- Institute for Breathing and Sleep, Melbourne, Australia
- Physiotherapy, Alfred Health, Melbourne, Australia
- Allergy, Clinical Immunology and Respiratory Medicine, Monash University, Melbourne, Australia
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Niknejad N, Ismail W, Bahari M, Nazari B. Understanding Telerehabilitation Technology to Evaluate Stakeholders' Adoption of Telerehabilitation Services: A Systematic Literature Review and Directions for Further Research. Arch Phys Med Rehabil 2021; 102:1390-1403. [PMID: 33484693 DOI: 10.1016/j.apmr.2020.12.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 12/12/2020] [Accepted: 12/26/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To examine the adoption of telerehabilitation services from the stakeholders' perspective and to investigate recent advances and future challenges. DATA SOURCES A systematic review of English articles indexed by PubMed, Thomson Institute of Scientific Information's Web of Science, and Elsevier's Scopus between 1998 and 2020. STUDY SELECTION The first author (N.N.) screened all titles and abstracts based on the eligibility criteria. Experimental and empirical articles such as randomized and nonrandomized controlled trials, pre-experimental studies, case studies, surveys, feasibility studies, qualitative descriptive studies, and cohort studies were all included in this review. DATA EXTRACTION The first, second, and fourth authors (N.N., W.I., B.N.) independently extracted data using data fields predefined by the third author (M.B.). The data extracted through this review included study objective, study design, purpose of telerehabilitation, telerehabilitation equipment, patient/sample, age, disease, data collection methods, theory/framework, and adoption themes. DATA SYNTHESIS A telerehabilitation adoption process model was proposed to highlight the significance of the readiness stage and to classify the primary studies. The articles were classified based on 6 adoption themes, namely users' perception, perspective, and experience; users' satisfaction; users' acceptance and adherence; TeleRehab usability; individual readiness; and users' motivation and awareness. RESULTS A total of 133 of 914 articles met the eligibility criteria. The majority of papers were randomized controlled trials (27%), followed by surveys (15%). Almost 49% of the papers examined the use of telerehabilitation technology in patients with nervous system problems, 23% examined physical disability disorders, 10% examined cardiovascular diseases, and 8% inspected pulmonary diseases. CONCLUSION Research on the adoption of telerehabilitation is still in its infancy and needs further attention from researchers working in health care, especially in resource-limited countries. Indeed, studies on the adoption of telerehabilitation are essential to minimize implementation failure, as these studies will help to inform health care personnel and clients about successful adoption strategies.
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Affiliation(s)
- Naghmeh Niknejad
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam; Faculty of Information Technology, Duy Tan University, Da Nang, Vietnam; School of Computing, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Waidah Ismail
- Faculty of Science and Technology, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia; Information System Study Program, Universitas Airlangga, Indonesia Kampus C, Mulyorejo, Surabaya, Indonesia.
| | - Mahadi Bahari
- Department of Information Systems, Azman Hashim International Business School, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Behzad Nazari
- Department of Information Systems, Azman Hashim International Business School, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
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Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: a systematic review. J Physiother 2021; 67:27-40. [PMID: 33358547 DOI: 10.1016/j.jphys.2020.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/01/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022] Open
Abstract
QUESTIONS How effective is home-based exercise therapy delivered using advanced telehealth technology (ATT-ET) for people with chronic obstructive pulmonary disease (COPD) compared with: no exercise therapy (ET), in/outpatient ET, and home-based ET without ATT? DESIGN Systematic review and meta-analysis of randomised trials. PARTICIPANTS People with stable COPD referred for ET. INTERVENTION ATT-ET. OUTCOME MEASURES Exercise capacity, quality of life, functional dyspnoea, cost-effectiveness and various secondary outcomes. RESULTS Fifteen eligible trials involved 1,522 participants. Compared with no ET, ATT-ET improved exercise capacity (four studies, 6-minute walk test MD 15 m, 95% CI 5 to 24) and probably improved quality of life (four studies, SMD 0.22, 95% CI 0.00 to 0.43) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had a similar effect as in/outpatient ET on functional dyspnoea (two studies, SMD -0.05, 95% CI -0.39 to 0.29) and a similar or better effect on quality of life (two studies, SMD 0.23, 95% CI -0.04 to 0.50) but its relative effect on exercise capacity was very uncertain (three studies, 6-minute walk test MD 6 m, 95% CI -26 to 37). ATT-ET had a similar effect as home-based ET without ATT on exercise capacity (three studies, 6-minute walk test MD 2 m, 95% CI -16 to 19) and similar or better effects on quality of life (three studies, SMD 0.79, 95% CI -0.04 to 1.62) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had effects on most secondary outcomes that were similar to or better than each comparator. CONCLUSION ATT-ET improves exercise capacity, functional dyspnoea and quality of life compared with no ET, although some benefits may be small. Its benefits are generally similar to in/outpatient ET and similar to or better than home-based ET without ATT. REGISTRATION PROSPERO CRD42020165773.
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Jácome C, Marques A, Oliveira A, Rodrigues LV, Sanches I. Pulmonary telerehabilitation: An international call for action. Pulmonology 2020; 26:335-337. [PMID: 32591279 PMCID: PMC7311341 DOI: 10.1016/j.pulmoe.2020.05.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- C Jácome
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto (FMUP), Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto Faculty of Medicine, Porto, Portugal.
| | - A Marques
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - A Oliveira
- Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal; School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada; West Park Healthcare Centre, Toronto, ON, Canada
| | - L V Rodrigues
- Pulmonology Department, Unidade Local de Saúde da Guarda E.P.E. - Hospital Sousa Martins, Portugal; Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - I Sanches
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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Simonÿ C, Andersen IC, Bodtger U, Nyberg M, Birkelund R. Raised illness mastering – a phenomenological hermeneutic study of chronic obstructive pulmonary disease patients’ experiences while participating in a long-term telerehabilitation programme. Disabil Rehabil Assist Technol 2020; 17:594-601. [DOI: 10.1080/17483107.2020.1804630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Charlotte Simonÿ
- Institute of the Regional Health, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Denmark
| | - Ingrid Charlotte Andersen
- Institute of the Regional Health, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Naestved and Slagelse Hospitals, Slagelse, Denmark
| | - Uffe Bodtger
- Institute of the Regional Health, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
- Department of Respiratory Medicine, Roskilde Hospital, Roskilde, Denmark
| | - Mette Nyberg
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Denmark
| | - Regner Birkelund
- Institute of the Regional Health, University of Southern Denmark, Odense, Denmark
- Department of Health Research, Vejle Sygehus, Vejle, Denmark
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Galdiz JB, Gómez A, Rodriguez D, Guell R, Cebollero P, Hueto J, Cejudo P, Ortega F, Sayago I, Chic S, Iscar M, Amado C, Rodríguez Trigo G, Cosio BG, Bustamante V, Pijoan JI. Telerehabilitation Programme as a Maintenance Strategy for COPD Patients: A 12-Month Randomized Clinical Trial. Arch Bronconeumol 2020; 57:195-204. [PMID: 32439253 DOI: 10.1016/j.arbres.2020.03.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is uncertainty regarding efficacy of telehealth-based approaches in COPD patients for sustaining benefits achieved with intensive pulmonary rehabilitation (PR). RESEARCH QUESTION To determine whether a maintenance pulmonary telerehabilitation (TelePR) programme, after intensive initial PR, is superior to usual care in sustaining over time benefits achieved by intensive PR. STUDY DESIGN AND METHODS A multicentre open-label pragmatic parallel-group randomized clinical trial was conducted. Two groups were created at completion of an 8-week intensive outpatient hospital PR programme. Intervention group (IG) patients were given appropriate training equipment and instructed to perform three weekly training sessions and send performance data through an app to a web-based platform. Patients in the control group (CG) were advised to exercise regularly (usual care). RESULTS Ninety-four patients (46 IG, 48 CG) were randomized. The analysis of covariance showed non-significant improvements in 6-min walk distance [19.9m (95% CI -4.1/+43.8)] and Chronic Respiratory Disease Questionnaire - Emotion score [0.4 points (0-0.8)] in the IG. Secondary linear mixed models showed improvements in the IG in Short Form-36 mental component summary [9.7, (4.0-15.4)] and Chronic Respiratory Disease Questionnaire - Emotion [0.5, (0.2-0.9)] scores, but there was no association between compliance and outcomes. Acute exacerbations were associated with a marginally significant decrease in 6-minute walk distance of 15.8m (-32.3/0.8) in linear models. CONCLUSIONS The TelePR maintenance strategy was both feasible and safe but failed to show superiority over usual care, despite improvements in some HRQoL domains. Acute exacerbations may have an important negative influence on long-term physical function. CLINICALTRIALS. GOV IDENTIFIER NCT03247933.
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Affiliation(s)
- Juan B Galdiz
- Respiratory Department, Hospital Universitario Cruces, Osakidetza, Biocruces Bizkaia Health Research Institute, CibeRes, Barakaldo, Spain.
| | - Alba Gómez
- Unitat Rehabilitació Cardio-Respiratoria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Diego Rodriguez
- Respiratory Department, Hospital del Mar, CibeRes, Barcelona, Spain
| | - Rosa Guell
- Respiratory Department, Hospital de la Santa Creu i San Pau, CibeRes, Barcelona, Spain
| | - Pilar Cebollero
- Respiratory Department, Complejo Hospitalario Navarra, Pamplona, Spain
| | - Javier Hueto
- Respiratory Department, Complejo Hospitalario Navarra, Pamplona, Spain
| | - Pilar Cejudo
- Instituto de Biomedicina de Sevilla, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Virgen Rocío, Sevilla, Spain
| | - Francisco Ortega
- Instituto de Biomedicina de Sevilla, Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Virgen Rocio, CibeRes, Sevilla, Spain
| | - Itxaso Sayago
- Respiratory Department, Clínica Asunción, Tolosa, Gipuzkoa, Spain
| | - Susana Chic
- Internal Medicine Department (Respiratory Unit), Hospital de Mendaro, Osakidetza, Mendaro, Gipuzkoa, Spain
| | - Marta Iscar
- Respiratory Department, Hospital General de Asturias, Oviedo, Spain
| | - Carlos Amado
- Respiratory Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Borja G Cosio
- Respiratory Department, Hospital Universitary Son Espases, Palma de Mallorca, CibeRes, Spain
| | - Victor Bustamante
- Respiratory Department, Hospital Universitario Basurto, Bilbao, Spain
| | - José Ignacio Pijoan
- Clinical Epidemiology Unit, Hospital Universitario de Cruces, Biocruces Bizkaia, Health Research Institute, Bilbao, Spain
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Rao SS, Loeb AE, Amin RM, Golladay GJ, Levin AS, Thakkar SC. Establishing Telemedicine in an Academic Total Joint Arthroplasty Practice: Needs and Opportunities Highlighted by the COVID-19 Pandemic. Arthroplast Today 2020; 6:617-622. [PMID: 32328510 PMCID: PMC7177124 DOI: 10.1016/j.artd.2020.04.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 11/23/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has prompted rapid restructuring of the health-care system in an effort to stop the spread of the virus and to treat patients who are acutely ill with COVID-19, while continuing to provide outpatient care for the remainder of patients. To help control spread of this pandemic, many centers, including total joint arthroplasty clinics, have boosted telemedicine capability to care for patients who would typically be seen in person in outpatient settings. We review key components relevant to the establishment and effective use of telemedicine, focused on patient education, practice logistics, technological considerations, and sensitive patient health information–associated compliance factors, which are necessary to provide care remotely for total joint arthroplasty patients.
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Affiliation(s)
- Sandesh S Rao
- The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Alexander E Loeb
- The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Raj M Amin
- The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Gregory J Golladay
- The Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Adam S Levin
- The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Savyasachi C Thakkar
- The Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
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Home-based telerehabilitation software systems for remote supervising: a systematic review. Int J Technol Assess Health Care 2020; 36:113-125. [PMID: 32151291 DOI: 10.1017/s0266462320000021] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES In the past decade, with the ever-increasing growth of information and communication technologies, telerehabilitation, especially home-based rehabilitation (HBR), has been widely considered by researchers. Many software systems are developed to address HBR programs, which includes various functionalities. The aim of this study is to review the functional features of these systems designed for remote supervising of HBR programs. METHODS Scopus, PubMed, EMBASE, ISI Web of Science, Cochrane Library, IEEE Xplore Digital Library, and ProQuest databases were searched for English-language articles published between January 2008 and February 2018 to retrieve studies reported an home-based telerehabilitation software system aiming to remotely supervise HBR program. RESULTS A total of fifty studies that reported twenty-two unique systems met the inclusion criteria. Various functional features were identified including but not limited to exercise plan management, report/statistics generating, patient education, and task scheduling. Disorders or diseases addressed by these systems could mainly be grouped into five categories: musculoskeletal, neurological, respiratory, cardiovascular, and other health-related problems. Usability and acceptability, and clinical/patient outcomes were the most reported outcomes and data analysis was used by the majority of included studies to measure the outcomes. CONCLUSIONS Systems developed for supervising of HBR program are diverse. However, preliminary results of this review revealed that these systems share more or less common functionalities. However, further research is needed to determine the requirements, structure, and effectiveness of these systems in real-life settings.
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Simonÿ C, Andersen IC, Bodtger U, Birkelund R. Breathing through a troubled life - a phenomenological-hermeneutic study of chronic obstructive pulmonary disease patients' lived experiences during the course of pulmonary rehabilitation. Int J Qual Stud Health Well-being 2019; 14:1647401. [PMID: 31432771 PMCID: PMC6713173 DOI: 10.1080/17482631.2019.1647401] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 01/10/2023] Open
Abstract
Purpose: Exploring real-life experiences of Chronic Obstructive Pulmonary Disease (COPD) patients during rehabilitation can contribute with new knowledge of what has significance for their participation and chance for improved health and well-being. Therefore, this study aims to gain in-depth knowledge of COPD patients' lived experiences while following standard pulmonary out-patient rehabilitation. Methods: Combined participant observations and interviews were conducted among 21 participants in pulmonary rehabilitation. A three-leveled phenomenological-hermeneutic interpretation was applied. Results: Living with COPD was challenging due to dyspnea and other physical troubles. This caused a lack of trust in the body and complicated rehabilitation participation. When improving management of breath during rehabilitation, the patients gained a new sense of trust in the body. This was accompanied by a nascent hope and increased well-being. However, not succeeding in this left patients with a persistent lack of hope. Conclusions: Comprehensive troubles in living with COPD paradoxically prevents patients' prospect of overcoming a perceived lack of trust in their body during standard pulmonary rehabilitation. Enhancing breath management has a significant impact on COPD patients' trust in own capabilities to improve well-being and health. Future rehabilitation must accommodate COPD patients' troubles by longer-lasting, well-coordinated, individually supportive and more easily accessible programmes.
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Affiliation(s)
- Charlotte Simonÿ
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Slagelse, Denmark
- Institute of Regional Health, University of Southern Denmark, Odense, Denmark
- Section of Nursing Science, Institute of Health, Aarhus University, Aarhus, Denmark
| | - Ingrid Charlotte Andersen
- Institute of Regional Health, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine M1, Slagelse Hospital, Slagelse, Denmark
| | - Uffe Bodtger
- Department of Respiratory Medicine (M1), Naestved Hospital, Naestved, Denmark
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
- Institute of Regional Health Science, University of Southern Denmark, Odense, Denmark
| | - Regner Birkelund
- Department of Health Research , Lillebaelt Hospital, Vejle, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Albergoni A, Hettinga FJ, La Torre A, Bonato M, Sartor F. The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review. SPORTS MEDICINE - OPEN 2019; 5:41. [PMID: 31512075 PMCID: PMC6739434 DOI: 10.1186/s40798-019-0214-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue. METHODS This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: "Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?". RESULTS The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1-12) and three low levels (56% week-12, 41% year-2, 14 year-3). CONCLUSION The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
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Affiliation(s)
- Andrea Albergoni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
| | - Florentina J. Hettinga
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Francesco Sartor
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- College of Health & Behavioural Science, Bangor University, Bangor, UK
- Philips Electronics Nederland B.V, HTC 34 1.011, P.O. Box WB61, 5656 AE Eindhoven, The Netherlands
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Simonÿ C, Riber C, Bodtger U, Birkelund R. Striving for Confidence and Satisfaction in Everyday Life with Chronic Obstructive Pulmonary Disease: Rationale and Content of the Tele-Rehabilitation Programme >C☺PD-Life>>. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183320. [PMID: 31505861 PMCID: PMC6766220 DOI: 10.3390/ijerph16183320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022]
Abstract
Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to these patients. To expand useful knowledge in the field, more sophisticated telerehabilitation interventions must be developed and appraised, but first and foremost, thoroughly described. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the >C☺PD-Life>> programme, within the bounds of the checklist of Template for Intervention Description and Replication (TIDieR). Approach:>C☺PD-Life>> is a telerehabilitation programme for COPD patients delivered as a study intervention by an interprofessional team of clinicians collaborating from both the hospital and the municipal healthcare system. Making use of two-way audio and visual communication software, 15 patients participated in the intervention via a tablet computer from their private setting. The programme was a six-month-long empowerment-based rehabilitation that aimed to support COPD patients in leading a satisfactory and confident life with appropriate physical activity and high disease management. Conclusions: A long-term interprofessional cross-sectoral telerehabilitation programme has been justified and described. The intervention was tested in 2017–2018 and the qualitative appraisal, along with an analysis of case-based measurements of development in physical capacity, COPD Assesment Test, and health management, is currently under production.
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Affiliation(s)
- Charlotte Simonÿ
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Faelledvej 7, 4200 Slagelse, Denmark.
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
| | - Claus Riber
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Faelledvej 7, 4200 Slagelse, Denmark.
| | - Uffe Bodtger
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
- Department of Respiratory Medicine, Naestved Hospital, Ringstedgade 61, 4700 Naestved, Denmark.
- Department of Respiratory Medicine, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
| | - Regner Birkelund
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
- Department of Health Research, Lillebaelt Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. Exploring the potential benefits of digital health technology for the management of COPD: a qualitative study of patient perceptions. ERJ Open Res 2019; 5:00239-2018. [PMID: 31111039 PMCID: PMC6513035 DOI: 10.1183/23120541.00239-2018] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/08/2019] [Indexed: 11/05/2022] Open
Abstract
Engaging chronic obstructive pulmonary disease (COPD) patients to actively participate in self-management has proven difficult. Digital health technology (DHT) promises to facilitate a patient-centred care model for the management of COPD by empowering patients to self-manage effectively. However, digital health studies in COPD have yet to demonstrate significant patient outcomes, suggesting that this research has still to adequately address the needs of patients in the intervention development process. The current study explored COPD patients' perceptions of the potential benefits of DHT in the self-management and treatment of their disease. A sample of convenience was chosen and participants (n=30) were recruited from two Dublin university hospitals and each underwent a qualitative semi-structured interview. Thematic analysis of the data was completed using NVivo 12 software. Six themes were identified: symptom management, anxiety management, interaction with physician, care management, personalising care and preventative intervention. In our findings, patients reported a willingness to take a more active role in self-management using DHT. They perceived DHT potentially enhancing their self-management by improving self-efficacy and engagement and by supporting healthcare professionals to practise preventative care provision. The findings can be used to inform patient-centred COPD digital interventions for researchers and clinicians who wish to develop study aims that align with the needs and preferences of patients.
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Affiliation(s)
- Patrick Slevin
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Threase Kessie
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - John Cullen
- Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Marcus W. Butler
- University College Dublin, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
| | - Seamas C. Donnelly
- Tallaght University Hospital, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - Brian Caulfield
- The Insight Centre for Data Analytics, University College Dublin, Dublin, Ireland
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Verification of a Portable Motion Tracking System for Remote Management of Physical Rehabilitation of the Knee. SENSORS 2019; 19:s19051021. [PMID: 30823373 PMCID: PMC6427361 DOI: 10.3390/s19051021] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 01/06/2023]
Abstract
Rehabilitation following knee injury or surgery is critical for recovery of function and independence. However, patient non-adherence remains a significant barrier to success. Remote rehabilitation using mobile health (mHealth) technologies have potential for improving adherence to and execution of home exercise. We developed a remote rehabilitation management system combining two wireless inertial measurement units (IMUs) with an interactive mobile application and a web-based clinician portal (interACTION). However, in order to translate interACTION into the clinical setting, it was first necessary to verify the efficacy of measuring knee motion during rehabilitation exercises for physical therapy and determine if visual feedback significantly improves the participant’s ability to perform the exercises correctly. Therefore, the aim of this study was to verify the accuracy of the IMU-based knee angle measurement system during three common physical therapy exercises, quantify the effect of visual feedback on exercise performance, and understand the qualitative experience of the user interface through survey data. A convenience sample of ten healthy control participants were recruited for an IRB-approved protocol. Using the interACTION application in a controlled laboratory environment, participants performed ten repetitions of three knee rehabilitation exercises: heel slides, short arc quadriceps contractions, and sit-to-stand. The heel slide exercise was completed without feedback from the mobile application, then all exercises were performed with visual feedback. Exercises were recorded simultaneously by the IMU motion tracking sensors and a video-based motion tracking system. Validation showed moderate to good agreement between the two systems for all exercises and accuracy was within three degrees. Based on custom usability survey results, interACTION was well received. Overall, this study demonstrated the potential of interACTION to measure range of motion during rehabilitation exercises for physical therapy and visual feedback significantly improved the participant’s ability to perform the exercises correctly.
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Bonnevie T, Gravier FE, Elkins M, Dupuis J, Prieur G, Combret Y, Viacroze C, Debeaumont D, Robleda-Quesada A, Quieffin J, Lamia B, Patout M, Cuvelier A, Muir JF, Medrinal C, Tardif C. People undertaking pulmonary rehabilitation are willing and able to provide accurate data via a remote pulse oximetry system: a multicentre observational study. J Physiother 2019; 65:28-36. [PMID: 30573441 DOI: 10.1016/j.jphys.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/13/2018] [Accepted: 11/21/2018] [Indexed: 01/16/2023] Open
Abstract
QUESTIONS Can people referred to pulmonary rehabilitation easily learn to use a system for remote transmission of oximetry data? Do they consider remote transmission of oximetry data to be satisfactory? Are the transmitted data valid compared with locally stored data? DESIGN Multicentre, prospective, observational study. PARTICIPANTS One hundred and five adults with chronic respiratory disease who were referred to pulmonary rehabilitation. INTERVENTION At an initial session, participants were taught to record and transmit their oximetry data to a remote server. At subsequent testing session(s), participants were requested to independently activate and use the oximetry monitoring system for a period of exercise on a cycle ergometer, until autonomy with the system was demonstrated. A subgroup of five participants undertook five 45-minute training sessions to generate a dataset to assess whether the transmitted data were valid compared with the locally stored data. OUTCOME MEASURES Outcome measures included the number of sessions needed to become autonomous, participant satisfaction with the system, and measures of the validity of the transmitted data. RESULTS Participants became autonomous quickly: 86% at the first testing session and 100% within three testing sessions. At least 98% of participants agreed that the system was easy to use and they would be willing to use it throughout pulmonary rehabilitation. The system transmitted usable data from 98% (95% CI 96 to 100) of sessions and introduced minimal artefact. Mean absolute differences were 0.365 beats/minute for heart rate and 0.133% for oxyhaemoglobin saturation. For heart rate, exact agreement was 72% (SD 9) and similar agreement (within 3 beats/minute) was 99% (SD 1). For oxyhaemoglobin saturation, exact agreement was 87% (SD 3) and similar agreement (within 3%) was 100% (SD 0). CONCLUSION The telemonitoring system used in this study was sufficiently valid and acceptable for use in at-home pulmonary rehabilitation by people with chronic respiratory disease. STUDY REGISTRATION ClinicalTrials.gov NCT03295474 and NCT03004716 (subgroup study).
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Affiliation(s)
- Tristan Bonnevie
- ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France.
| | - Francis-Edouard Gravier
- ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France
| | - Mark Elkins
- Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Education and Workforce Development, Sydney Local Health District, Sydney, Australia
| | - Johan Dupuis
- ADIR Association, Rouen University Hospital, Rouen, France
| | - Guillaume Prieur
- UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre - Hôpital Jacques Monod, Montivilliers, France
| | - Yann Combret
- Service de kinésithérapie, Groupe Hospitalier du Havre - Hôpital Jacques Monod, Montivilliers, France; Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL & Dermatologie, Université Catholique de Louvain, Brussels, Belgium
| | - Catherine Viacroze
- Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | | | - Aurora Robleda-Quesada
- Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre - Hôpital Jacques Monod, Montivilliers, France
| | - Jean Quieffin
- Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre - Hôpital Jacques Monod, Montivilliers, France
| | - Bouchra Lamia
- UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre - Hôpital Jacques Monod, Montivilliers, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Maxime Patout
- UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Antoine Cuvelier
- UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Jean-François Muir
- ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Pulmonary, Thoracic Oncology and Respiratory Intensive Care Department, Rouen University Hospital, Rouen, France
| | - Clement Medrinal
- UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Service de réanimation médico-chirurgicale, Groupe Hospitalier du Havre - Hôpital Jacques Monod, Montivilliers, France
| | - Catherine Tardif
- ADIR Association, Rouen University Hospital, Rouen, France; UPRES EA 3830 Haute Normandie Research and Biomedical Innovation, Normandie University, Rouen, France; Physiology Department, Rouen University Hospital, Rouen, France
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Burkow TM, Vognild LK, Johnsen E, Bratvold A, Risberg MJ. Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD. BMC Med Inform Decis Mak 2018; 18:136. [PMID: 30563507 PMCID: PMC6299608 DOI: 10.1186/s12911-018-0721-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Physical inactivity is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). It is therefore crucial for patients to have a physically active lifestyle. The aims of this feasibility study were to assess a tablet-based physical activity behavioural intervention in virtual groups for COPD regarding 1) patients’ acceptance 2) technology usability 3) patients’ exercise programme adherence and 4) changes in patients’ physical activity level. Methods We used an application with functionality for a virtual peer group, a digital exercise diary, a follow-along exercise video, and visual rewards on the home screen wallpaper. The exercise programme combined scheduled virtual group exercising (outdoor ground walking, indoor resistance and strength training) with self-chosen individual exercises. Ten participants with COPD were enrolled into two exercise training groups. Patients’ acceptance was assessed by semi-structured interviews, technology usability was assessed by the System Usability Scale, and exercise programme adherence and level of physical activity by self-reporting. The interviews were also used for the latter three aspects. Results The virtual peer group was experienced as motivating, helping participants to get started and be physically active. They updated their own activity status and kept track of the others’ status. Having a time schedule for the virtual group exercises helped them to avoid postponing the exercise training. All participants recorded individual exercises in the diary, the exercise video was well received and used, and most participants paid attention to the visual rewards. All participants found the technology easy both to learn and to use. The exercise programme adherence was good, with, on average, 77% attendance for the virtual group exercises, and all participants performed additional individual exercises. The average number of physical activity sessions per week was doubled from 2.9 (range 0–10, median 2) at baseline to 5.9 (range 3.3–10.33, median 4.8) during the intervention period. Conclusion The results indicate that the tablet-based intervention may be feasible in COPD, and that it was acceptable, encouraged a sense of peer support and fellowship in the group and motivated participants to physical activity and exercise training in daily life. Further assessment is needed on patient outcomes.
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Affiliation(s)
- Tatjana M Burkow
- University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway.
| | - Lars K Vognild
- , Norut, P.O. Box 6434 Forskningsparken, N-9294, Tromsø, Norway
| | - Elin Johnsen
- University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway
| | - Astrid Bratvold
- University Hospital of North Norway, P.O. Box 35, N-9038, Tromsø, Norway
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Péran L, Le Ber C, Pichon R, Cabillic M, Beaumont M. [Follow-up and evaluation of plans developed during pulmonary rehabilitation]. Rev Mal Respir 2018; 35:929-938. [PMID: 30201399 DOI: 10.1016/j.rmr.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 05/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pulmonary rehabilitation inevitably contains two essential components: therapeutic education and exercise training. The principal aim of this study was to evaluate the evolution over a year of the realization of plans determined during a pulmonary rehabilitation program (PRP). METHODS At the end of a PRP the patient made plans in accordance with his health condition. A telephone enquiry was undertaken at 3, 7 and 12 months to evaluate the progress of the plans, the motivation to perform them, dyspnoea and quality of life. RESULTS The data of 65 patients were analyzed (87 inclusions). Fifty-seven percent of the plans continued for one year. Walking had an adherence rating of 71%. Loss of motivation appeared to be the main cause for stopping (20%). Quality of life remained stable (p=0.39) and an increase in dyspnoea, though statistically significant (p<0.01), was of no clinical relevance. CONCLUSION The majority of plans were maintained but without clinical effect on the quality of life or the level of dyspnoea. Decreased motivation was the major limitation to realization or continuation of the plans. New studies will have to be implemented to analyze the factors which lead to this decrease.
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Affiliation(s)
- L Péran
- Service de réhabilitation respiratoire, centre hospitalier des Pays de Morlaix, 29672 Morlaix, France.
| | - C Le Ber
- Service de réhabilitation respiratoire, centre hospitalier des Pays de Morlaix, 29672 Morlaix, France
| | - R Pichon
- Service de réhabilitation respiratoire, centre hospitalier des Pays de Morlaix, 29672 Morlaix, France
| | | | - M Beaumont
- Service de réhabilitation respiratoire, centre hospitalier des Pays de Morlaix, 29672 Morlaix, France; EA3878 (GETBO), CHU Brest, 29200 Brest, France
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Donner CF, Raskin J, ZuWallack R, Nici L, Ambrosino N, Balbi B, Blackstock F, Casaburi R, Dreher M, Effing T, Goldstein R, Krishnan J, Lareau SC, Make BJ, Maltais F, Meek P, Morgan M, Pépin JL, Rabbito C, Rochester CL, Silverman AR, Singh S, Spruit MA, Vitacca M, Williams L. Incorporating telemedicine into the integrated care of the COPD patient a summary of an interdisciplinary workshop held in Stresa, Italy, 7-8 September 2017. Respir Med 2018; 143:91-102. [PMID: 30261999 DOI: 10.1016/j.rmed.2018.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
Abstract
This report is a summary of a workshop focusing on using telemedicine to facilitate the integrated care of chronic obstructive pulmonary disease (COPD). Twenty-five invited participants from 8 countries met for one and one-half days in Stresa, Italy on 7-8 September 2017, to discuss this topic. Participants included physiotherapists, nurses, a nurse practitioner, and physicians. While evidence-based data are always at the center of sound inference and recommendations, at this point in time the science behind telemedicine in COPD remains under-developed; therefore, this document reflects expert opinion and consensus. While telemedicine has great potential to expand and improve the care of our COPD patients, its application is still in its infancy. While studies have demonstrated its effectiveness in some patient-centered outcomes, the results are by no means consistently positive. Whereas this tool may potentially reduce health care costs by moving some medical interventions from centralized locations in to patient's home, its cost-effectiveness has had mixed results and telemonitoring has yet to prove its worth in the COPD population. These discordant results should not be unexpected in view of patient complexity and the heterogeneity of telemedicine. This is reflected in the very limited support offered by the National Health Services to a wider application of telemedicine in the integrated care of COPD patients. However, this situation should challenge us to develop the necessary science to clarify the role of telemedicine in the medical management of our patients, providing a better and definitive scientific basis to this approach.
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Affiliation(s)
- Claudio F Donner
- Fondazione Mondo Respiro ONLUS, Via Monsignor Cavigioli, 10, 28021, Borgomanero, NO, Italy.
| | - Jonathan Raskin
- Pulmonary and Internal Medicine, 1000 Park Ave, New York, NY, 10028, USA.
| | - Richard ZuWallack
- University of CT, Pulmonary and Critical Care, St Francis Hospital and Medical Center, Hartford, CT, 06015, USA.
| | | | | | - Bruno Balbi
- ICS Maugeri, I.R.C.C.S. Institute of Veruno (Novara), Italy.
| | - Felicity Blackstock
- School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia.
| | - Richard Casaburi
- UCLA School of Medicine, Rehabilitation Clinical Trial Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center Torrance, California, 90502, USA.
| | - Michael Dreher
- Division of Pneumology, University Hospital RWTH Aachen, Germany.
| | - Tanja Effing
- College of Medicine & Public Health, Flinders University, Adelaide, Australia, Department of Respiratory Medicine, Southern Adelaide Local Health Network, Adelaide, Australia.
| | - Roger Goldstein
- University of Toronto, NSA Chair in Respiratory Rehabilitation Research, USA.
| | | | - Suzanne C Lareau
- College of Nursing, Univ. of Colorado Denver, Anschutz Medical Campus, C288-04, ED 2 North, Rm 4327, 13120 East 19th Ave, Aurora, CO, 80045, USA.
| | - Barry J Make
- Department of Medicine, University of Colorado, USA.
| | - Francois Maltais
- Institut Universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Canada.
| | - Paula Meek
- College of Nursing, Anschutz Medical Campus, University of Colorado, USA.
| | - Michael Morgan
- University of Leicester, Chair NHS England Respiratory Clinical Reference Group, National Clinical Director Respiratory NHS, UK.
| | - Jean-Louis Pépin
- Sleep and Exercise Department, Scientific Director of Clinical Research Administration, Research Division at Grenoble University Hospital, Grenoble, FR, France.
| | - Chiara Rabbito
- Rabbito Law Firm, Via Piave 44, San Lazzaro, 40068, BO, Italy.
| | - Carolyn L Rochester
- Yale University School of Medicine, Pulmonary Rehabilitation Program, VA Connecticut Healthcare System, USA.
| | - Adam R Silverman
- Quinnipiac University School of Medicine, 95 Woodland St, 4th Floor, Hartford, CT, 06105, USA.
| | - Sally Singh
- University Hospitals of Leicester Leicester, UK.
| | - Martijn A Spruit
- Department of Research and Education, Ciro, Horn, the Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, the Netherlands; REVAL - Rehabilitation Research Center, BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium.
| | - Michele Vitacca
- Respiratory Department ICS S. Maugeri IRCCS Lumezzane (Bs) Italy, Respiratory Department, Via Mazzini 129, Lumezzane, 25066, Bs, Italy.
| | - Loreen Williams
- Management Program, Pulmonary and Critical Care, St Francis Hospital & Med Ctr, Hartford, CT, 06105, USA.
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72
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Damhus CS, Emme C, Hansen H. Barriers and enablers of COPD telerehabilitation - a frontline staff perspective. Int J Chron Obstruct Pulmon Dis 2018; 13:2473-2482. [PMID: 30154650 PMCID: PMC6103610 DOI: 10.2147/copd.s167501] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Telerehabilitation (TR) aimed at patients with COPD has shown promising effects on symptoms, physical function, and quality of life, but little research has been conducted to understand the impact of implementation on frontline health professionals. Therefore, the aim of this study was to examine the barriers and enablers of health professionals to online exercise-based TR in patients with COPD, to support a successful implementation process. Methods Semistructured individual and focus group interviews were conducted with 25 health professionals working with conventional COPD rehabilitation or TR. Interviews were audio-taped and transcribed verbatim. Investigator triangulation was applied during data generation. The Theoretical Domains Framework directed the interview guide and was used as a coding framework in the analysis. Results We identified six predominant domains essential in understanding the enablers and barriers of TR from a staff perspective: 1) skills, 2) professional role and identity, 3) beliefs about capabilities, 4) beliefs about consequences, 5) environmental context and resources, and 6) social influences. We found that health professionals held both enablers and barriers important for the implementation process of TR. TR introduces new work tasks and new ways for the health professionals to communicate and exercise with the patients, which influence their professional role and self-perceived capability. Conclusion Specific attention toward involvement of the health professionals in the decision process combined with sufficient education and skill training is highly essential to support a successful implementation of TR in clinical practice.
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Affiliation(s)
- Christina Sadolin Damhus
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark, henrik.hansen.09.regionh.dk
| | - Christina Emme
- Department of Quality and Education, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Henrik Hansen
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark, henrik.hansen.09.regionh.dk
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73
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Robinson H, Williams V, Curtis F, Bridle C, Jones AW. Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies. NPJ Prim Care Respir Med 2018; 28:19. [PMID: 29867117 PMCID: PMC5986863 DOI: 10.1038/s41533-018-0085-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 04/16/2018] [Accepted: 04/17/2018] [Indexed: 11/30/2022] Open
Abstract
Pulmonary rehabilitation has short-term benefits on dyspnea, exercise capacity and quality of life in COPD, but evidence suggests these do not always translate to increased daily physical activity on a patient level. This is attributed to a limited understanding of the determinants of physical activity maintenance following pulmonary rehabilitation. This systematic review of qualitative research was conducted to understand COPD patients' perceived facilitators and barriers to physical activity following pulmonary rehabilitation. Electronic databases of published data, non-published data, and trial registers were searched to identify qualitative studies (interviews, focus groups) reporting the facilitators and barriers to physical activity following pulmonary rehabilitation for people with COPD. Thematic synthesis of qualitative data was adopted involving line-by-line coding of the findings of the included studies, development of descriptive themes, and generation of analytical themes. Fourteen studies including 167 COPD patients met the inclusion criteria. Seven sub-themes were identified as influential to physical activity following pulmonary rehabilitation. These included: intentions, self-efficacy, feedback of capabilities and improvements, relationship with health care professionals, peer interaction, opportunities following pulmonary rehabilitation and routine. These encapsulated the facilitators and barriers to physical activity following pulmonary rehabilitation and were identified as sub-themes within the three analytical themes, which were beliefs, social support, and the environment. The findings highlight the challenge of promoting physical activity following pulmonary rehabilitation in COPD and provide complementary evidence to aid evaluations of interventions already attempted in this area, but also adds insight into future development of interventions targeting physical activity maintenance in COPD.
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Affiliation(s)
- Hayley Robinson
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK.
| | - Veronika Williams
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ffion Curtis
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
| | | | - Arwel W Jones
- Lincoln Institute for Health, University of Lincoln, Lincoln, UK
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74
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Mirón Rubio M, Ceballos Fernández R, Parras Pastor I, Palomo Iloro A, Fernández Félix BM, Medina Miralles J, Zamudio López E, González Pastor J, Amador Lorente C, Mena Hortelano N, Domínguez Sánchez A, Alonso-Viteri S. Telemonitoring and home hospitalization in patients with chronic obstructive pulmonary disease: study TELEPOC. Expert Rev Respir Med 2018; 12:335-343. [PMID: 29460648 DOI: 10.1080/17476348.2018.1442214] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major consumer of healthcare resources, with most costs related to disease exacerbations. Telemonitoring of patients with COPD may help to reduce the number of exacerbations and/or the related costs. On the other hand, home hospitalization is a cost-saving alternative to inpatient hospitalization associated with increased comfort for patients. The results are reported regarding using telemonitoring and home hospitalization for the management of patients with COPD. METHODS Twenty-eight patients monitored their health parameters at home for six months. A nurse remotely revised the collected parameters and followed the patients as programmed. A home care unit was dispatched to the patients' home if an alarm signal was detected. The outcomes were compared to historical data from the same patients. RESULTS The number of COPD exacerbations during the study period did not reduce but the number of hospital admissions decreased by 60% and the number of emergency room visits by 38%. On average, costs related to utilization of healthcare resources were reduced by €1,860.80 per patient per year. CONCLUSIONS Telemonitoring of patients with COPD combined with home hospitalization may allow for a reduction in healthcare costs, although its usefulness in preventing exacerbations is still unclear.
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Affiliation(s)
- Manuel Mirón Rubio
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | | | | | - Amaya Palomo Iloro
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Borja Manuel Fernández Félix
- d Biostatistic Unit , University Ramón y Cajal Hospital (IRYCIS), CIBER epidemiología y salud pública (CIBERESP) , Madrid , Spain
| | - Jenifer Medina Miralles
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Esther Zamudio López
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Javier González Pastor
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Caridad Amador Lorente
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Nazaret Mena Hortelano
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
| | - Alejandro Domínguez Sánchez
- a Home Hospitalization Unit , Torrejón University Hospital, Universidad Francisco de Vitoria , Madrid , Spain
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75
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Kruse CS, Beane A. Health Information Technology Continues to Show Positive Effect on Medical Outcomes: Systematic Review. J Med Internet Res 2018; 20:e41. [PMID: 29402759 PMCID: PMC5818676 DOI: 10.2196/jmir.8793] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 09/17/2017] [Accepted: 10/04/2017] [Indexed: 01/08/2023] Open
Abstract
Background Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT’s contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature. Objective The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is a positive association between the adoption of HIT and medical outcomes. Methods We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed databases for peer-reviewed publications in the last 5 years that defined an HIT intervention and an effect on medical outcomes in terms of efficiency or effectiveness. We structured the review from the Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and we conducted the review in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR). Results We narrowed our search from 3636 papers to 37 for final analysis. At least one improved medical outcome as a result of HIT adoption was identified in 81% (25/37) of research studies that met inclusion criteria, thus strongly supporting our hypothesis. No statistical difference in outcomes was identified as a result of HIT in 19% of included studies. Twelve categories of HIT and three categories of outcomes occurred 38 and 65 times, respectively. Conclusions A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports efforts that prepare for stage 3 of meaningful use. This aligns with previous reviews in other time frames.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Amanda Beane
- School of Health Administration, Texas State University, San Marcos, TX, United States
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76
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Bairapareddy KC, Chandrasekaran B, Agarwal U. Telerehabilitation for Chronic Obstructive Pulmonary Disease Patients: An Underrecognized Management in Tertiary Care. Indian J Palliat Care 2018; 24:529-533. [PMID: 30410270 PMCID: PMC6199829 DOI: 10.4103/ijpc.ijpc_89_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary rehabilitation (PR) is proved to be best supportive management in chronic obstructive pulmonary disease (COPD) individuals. The literature claims the reduction of dyspnea, fatigue, exacerbations, and improved functional capacity and quality of life. Home-based PR is being prescribed widely than hospital-based rehab due to be less cost and ease of caregiver burden, but efficacy is usually questioned. The poor efficacy may be probably due to recurrent exacerbation and poor quality of life even after years of home rehabilitation. Telerehabilitation is an excellent rehab measure where the COPD patients exercise at his home, while expertise from the tertiary care centers monitors the rehab sessions remotely. In India, the tele-PR is at its budding state. This review shall enable the readers with the basics of telerehabilitation in comparison with the other available rehab measures and evidence in the management of COPD.
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Affiliation(s)
| | - Baskaran Chandrasekaran
- Center for Exercise, Sports Science, Medicine and Research, Manipal University, Manipal, Karnataka, India
| | - Umang Agarwal
- Department of Physiotherapy, School of Allied Health Sciences, Manipal University, Manipal, Karnataka, India
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77
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Li Y, Feng J, Li Y, Jia W, Qian H. A new pulmonary rehabilitation maintenance strategy through home-visiting and phone contact in COPD. Patient Prefer Adherence 2018; 12:97-104. [PMID: 29391781 PMCID: PMC5768185 DOI: 10.2147/ppa.s150679] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The benefit of pulmonary rehabilitation (PR) for patients with COPD diminishes over time. We investigated a new strategy involving home-visit and phone contact and compared this to usual care in maintenance of PR benefits. METHODS A total of 172 stable COPD patients receiving 8-week PR program were recruited for this prospective study. Patients were allocated into usual care group (UC) and PR maintenance group (PRMG) randomly. Patients in PRMG participated in maintenance strategy at home under supervision through home-visit and phone contact. The 6-minute walking test (6MWT), COPD assessment test (CAT), and modified Medical Research Council scale (mMRC) scores were evaluated every 3 months. RESULTS Of the total, 151 patients completed 8-week PR program with satisfactory PR results (p<0.001), and 104 patients finished the follow-up. The clinical improvements in 6MWT, CAT, and mMRC scores were maintained (p<0.001) in PRMG. In comparison, the benefit of PR diminished gradually in UC. The differences in 6MWT, CAT, and mMRC scores between groups were observed 6, 9, and 6 months after PR, respectively (p<0.05). Total frequency of exacerbations in PRMG was lower than UC (p=0.021). CONCLUSION Maintenance strategy involving home-visit and phone contact is superior to usual care to preserve PR benefits, and reduces the acute COPD exacerbation rate.
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Affiliation(s)
- Yi Li
- Graduate School, Tianjin Medical University
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital
| | - Jing Feng
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
- Neuropharmacology Section, Laboratory of Toxicology and Pharmacology, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC, USA
- Correspondence: Jing Feng, Respiratory Department, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin 300052, People’s Republic of China, Email
| | - Yuechuan Li
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital
- Yuechuan Li, Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, 261 Taierzhuang South Road, Tianjin 300300, People’s Republic of China, Email
| | - Wei Jia
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital
| | - Hongyu Qian
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital
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78
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Vorrink S, Huisman C, Kort H, Troosters T, Lammers JW. Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention. JMIR Hum Factors 2017; 4:e20. [PMID: 28928110 PMCID: PMC5627045 DOI: 10.2196/humanfactors.7196] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/28/2017] [Accepted: 06/05/2017] [Indexed: 11/29/2022] Open
Abstract
Background If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use. Objective The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users. Methods In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months’ use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH). Results A total of 60 patients with COPD filled out the questionnaire, and 24 PHTs were interviewed. The mobile phone app was used 89.0% (160.2/180 days) (standard deviation [SD] 18.5) of the time by patients; 53% (13/24) of PHTs reported low or no use. Patients scored the ease of use of the app 5.09 (SD 1.14) (on a 7-point scale). They found the presentation of the PA information in the app to be clear, insightful, and stimulating. All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients. Patients mostly sent informative, neutral messages concerning the PA goal, and PHTs sent mostly motivating, positive messages concerning the PA goal. Messages were not perceived as supportive in reaching the PA goal according to the patients. Perceived usefulness of the intervention for the PHTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. For patients, it was that the intervention supported them in increasing their PA and that it made them feel fitter. Barriers to use of the intervention according to the PHTs were time constraints and financial reasons. Seventy-nine percent (19/24) of the PHTs and 58% (35/60) of the patients mentioned they would be interested in using the intervention in the future. Conclusions PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention. This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future.
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Affiliation(s)
- Sigrid Vorrink
- Faculty Chair Demand Driven Care, Research Centre for Innovations in Health Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Chantal Huisman
- Faculty Chair Demand Driven Care, Research Centre for Innovations in Health Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Helianthe Kort
- Faculty Chair Demand Driven Care, Research Centre for Innovations in Health Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
| | | | - Jan-Willem Lammers
- Division Heart and Lungs, Department of Respiratory Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
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79
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Yan M, Or C. A 12-week pilot study of acceptance of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension. Health Informatics J 2017; 25:828-843. [PMID: 28820007 DOI: 10.1177/1460458217724580] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study tested a structural model examining the effects of perceived usefulness, perceived ease of use, attitude, subjective norm, perceived behavioral control, health consciousness, and application-specific self-efficacy on the acceptance (i.e. behavioral intention and actual usage) of a computer-based chronic disease self-monitoring system among patients with type 2 diabetes mellitus and/or hypertension. The model was tested using partial least squares structural equation modeling, with 119 observations that were obtained by pooling data across three time points over a 12-week period. The results indicate that all of the seven constructs examined had a significant total effect on behavioral intention and explained 74 percent of the variance. Also, application-specific self-efficacy and behavioral intention had a significant total effect on actual usage and explained 17 percent of the variance. This study demonstrates that technology acceptance is determined by patient characteristics, technology attributes, and social influences. Applying the findings may increase the likelihood of acceptance.
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Affiliation(s)
- Mian Yan
- The University of Hong Kong, Hong Kong
| | - Calvin Or
- The University of Hong Kong, Hong Kong
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80
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Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, Brooks M. Telehealth and patient satisfaction: a systematic review and narrative analysis. BMJ Open 2017; 7:e016242. [PMID: 28775188 PMCID: PMC5629741 DOI: 10.1136/bmjopen-2017-016242] [Citation(s) in RCA: 624] [Impact Index Per Article: 89.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/23/2017] [Accepted: 06/23/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The use of telehealth steadily increases as it has become a viable modality to patient care. Early adopters attempt to use telehealth to deliver high-quality care. Patient satisfaction is a key indicator of how well the telemedicine modality met patient expectations. OBJECTIVE The objective of this systematic review and narrative analysis is to explore the association of telehealth and patient satisfaction in regards to effectiveness and efficiency. METHODS Boolean expressions between keywords created a complex search string. Variations of this string were used in Cumulative Index of Nursing and Allied Health Literature and MEDLINE. RESULTS 2193 articles were filtered and assessed for suitability (n=44). Factors relating to effectiveness and efficiency were identified using consensus. The factors listed most often were improved outcomes (20%), preferred modality (10%), ease of use (9%), low cost 8%), improved communication (8%) and decreased travel time (7%), which in total accounted for 61% of occurrences. CONCLUSION This review identified a variety of factors of association between telehealth and patient satisfaction. Knowledge of these factors could help implementers to match interventions as solutions to specific problems.
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Affiliation(s)
| | | | | | - Lan Tran
- Texas State University, San Marcos, Texas, USA
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81
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Yan M, Or C. Factors in the 4-week Acceptance of a Computer-Based, Chronic Disease Self-Monitoring System in Patients with Type 2 Diabetes Mellitus and/or Hypertension. Telemed J E Health 2017; 24:121-129. [PMID: 28737995 DOI: 10.1089/tmj.2017.0064] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Health information technology (HIT) interventions developed to support patients' self-care for chronic diseases have become popular, but people may not always accept and sustain their use. INTRODUCTION This study examined factors that affected patients' acceptance of a computer-based, chronic disease self-monitoring system over a 4-week period. MATERIALS AND METHODS A research model was developed to test the relationships between the perceived usefulness, perceived ease of use, attitude, and subjective norm and the patients' behavioral intention to use the system (i.e., acceptance). Data were collected with surveys of 42 patients with type 2 diabetes mellitus and/or hypertension at baseline, 2 weeks after implementation, and 4 weeks after implementation. Path analysis was used for model testing. RESULTS Perceived usefulness affected behavioral intention indirectly at 2 weeks and directly at 4 weeks; perceived ease of use affected behavioral intention indirectly at 2 and 4 weeks; attitude directly affected behavioral intention at 2 weeks; and subjective norm affected behavioral intention indirectly at 2 weeks and directly at baseline and at 4 weeks. CONCLUSIONS Patients' acceptance of HIT is affected by the factors proposed in our research model. It is suggested that healthcare stakeholders consider and address the effects of these factors and their variations over time before implementing HIT.
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Affiliation(s)
- Mian Yan
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong , Pokfulam, Hong Kong, China
| | - Calvin Or
- Department of Industrial and Manufacturing Systems Engineering, The University of Hong Kong , Pokfulam, Hong Kong, China
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82
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Cottrell E, Foster NE, Porcheret M, Rathod T, Roddy E. GPs' attitudes, beliefs and behaviours regarding exercise for chronic knee pain: a questionnaire survey. BMJ Open 2017; 7:e014999. [PMID: 28624759 PMCID: PMC5541518 DOI: 10.1136/bmjopen-2016-014999] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/22/2017] [Accepted: 04/25/2017] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate general practitioners' (GPs) attitudes, beliefs and behaviours regarding the use of exercise for patients with chronic knee pain (CKP) attributable to osteoarthritis. SETTING Primary care GPs in the UK. PARTICIPANTS 5000 GPs, randomly selected from Binley's database, were mailed a cross-sectional questionnaire survey. OUTCOME MEASURES GPs' attitudes and beliefs were investigated using attitude statements, and reported behaviours were identified using vignette-based questions. GPs were invited to report barriers experienced when initiating exercise with patients with CKP RESULTS: 835 (17%) GPs responded. Overall, GPs were positive about general exercise for CKP. 729 (87%) reported using exercise, of which, 538 (74%) reported that they would use both general and local (lower limb) exercises. However, only 92 (11% of all responding) GPs reported initiating exercise in ways aligning with best-evidence recommendations. 815 (98%) GPs reported barriers in using exercise for patients with CKP, most commonly, insufficient time in consultations (n=419; 51%) and insufficient expertise (n=337; 41%). CONCLUSIONS While GPs' attitudes and beliefs regarding exercise for CKP were generally positive, initiation of exercise was often poorly aligned with current recommendations, and barriers and uncertainties were reported. GPs' use of exercise may be improved by addressing the key barriers of time and expertise, by developing a pragmatic approach that supports GPs to initiate individualised exercise, and/or by other professionals taking on this role.
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Affiliation(s)
- Elizabeth Cottrell
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Nadine E Foster
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Mark Porcheret
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
| | - Trishna Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
- Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Edward Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, UK
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83
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Inskip JA, Lauscher HN, Li LC, Dumont GA, Garde A, Ho K, Hoens AM, Road JD, Ryerson CJ, Camp PG. Patient and health care professional perspectives on using telehealth to deliver pulmonary rehabilitation. Chron Respir Dis 2017; 15:71-80. [PMID: 28569116 PMCID: PMC5802656 DOI: 10.1177/1479972317709643] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to identify the necessary features of pulmonary telerehabilitation (P-TR) from the perspectives of individuals living with chronic lung disease and health care professionals (HCPs) who deliver pulmonary rehabilitation (PR). Focus groups were carried out with patients (n = 26) and HCPs (n = 26) to elicit and explore their opinions about the critical elements of in-person PR and ideas for how these elements could be supported using technology. A questionnaire was used to assess technology use, PR experience, and general health status. Four key elements of PR were identified as critical to P-TR: the social aspect of PR; communicating with HCPs for education and support; using biosensors for monitoring and promoting self-knowledge; and the evolution of support with progress over time. A range of technology-enabled devices and programs were suggested as means to recreate aspects of these integral elements. Consultations with patients and HCPs suggest that users are interested in technology and want to ensure it recreates the important aspects of PR. Patients and HCPs identified similar key elements for P-TR. The opinions and suggestions of patients and HCPs should be the driving force of innovation if P-TR is to succeed in improving health outcomes.
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Affiliation(s)
- J A Inskip
- 1 Centre for Heart Lung Innovation, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada
| | - H Novak Lauscher
- 3 Digital Emergency Medicine, UBC, Vancouver, British Columbia, Canada
| | - L C Li
- 2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada.,4 Arthritis Research Canada, Richmond, Canada
| | - G A Dumont
- 5 Electrical and Computer Engineering, UBC, Vancouver, Canada
| | - A Garde
- 5 Electrical and Computer Engineering, UBC, Vancouver, Canada
| | - K Ho
- 3 Digital Emergency Medicine, UBC, Vancouver, British Columbia, Canada
| | - A M Hoens
- 2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada
| | - J D Road
- 6 Division of Respiratory Medicine, Department of Medicine, UBC, Vancouver, British Columbia, Canada
| | - C J Ryerson
- 1 Centre for Heart Lung Innovation, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,7 Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - P G Camp
- 1 Centre for Heart Lung Innovation, University of British Columbia (UBC), Vancouver, British Columbia, Canada.,2 Department of Physical Therapy, UBC, Vancouver, British Columbia, Canada.,7 Providence Health Care, St. Paul's Hospital, Vancouver, British Columbia, Canada
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84
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Vasilopoulou M, Papaioannou AI, Kaltsakas G, Louvaris Z, Chynkiamis N, Spetsioti S, Kortianou E, Genimata SA, Palamidas A, Kostikas K, Koulouris NG, Vogiatzis I. Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. Eur Respir J 2017; 49:49/5/1602129. [DOI: 10.1183/13993003.02129-2016] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 02/16/2017] [Indexed: 01/24/2023]
Abstract
Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits.Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR.In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389–0.687, and IRR 0.635, 95% CI 0.473–0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100–0.358, and IRR 0.375, 95% CI 0.207–0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072–0.185).Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR.
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85
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Hwang R, Mandrusiak A, Morris NR, Peters R, Korczyk D, Bruning J, Russell T. Exploring patient experiences and perspectives of a heart failure telerehabilitation program: A mixed methods approach. Heart Lung 2017; 46:320-327. [PMID: 28427763 DOI: 10.1016/j.hrtlng.2017.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 03/04/2017] [Accepted: 03/10/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe patient experiences and perspectives of a group-based heart failure (HF) telerehabilitation program delivered to the homes via online video-conferencing. BACKGROUND Limited information currently exists on patient experiences of telerehabilitation for HF. Patient feedback and end-user perspectives provide important information regarding the acceptability of this new delivery model which may have a substantial impact on future uptake. METHODS We used mixed-methods design with purposive sampling of patients with HF. We used self-report surveys and semi-structured interviews to measure patient experiences and perspectives following a 12-week telerehabilitation program. The telerehabilitation program encompassed group-based exercise and education, and were delivered in real-time via videoconferencing. Interviews were transcribed and coded, with thematic analysis undertaken. RESULTS Seventeen participants with HF (mean age [SD] of 69 [12] years and 88% males) were recruited. Participants reported high visual clarity and ease of use for the monitoring equipment. Major themes included motivating and inhibiting influences related to telerehabilitation and improvement suggestions. Participants liked the health benefits, access to care and social support. Participants highlighted a need for improved audio clarity and connectivity as well computer training for those with limited computer experience. The majority of participants preferred a combined face-to-face and online delivery model. CONCLUSION Participants in this study reported high visual clarity and ease-of-use, but provided suggestions for further improvements in group-based video telerehabilitation for HF.
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Affiliation(s)
- Rita Hwang
- Department of Physiotherapy, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia; Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
| | - Allison Mandrusiak
- Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Norman R Morris
- The Menzies Health Institute Queensland and The School of Allied Health Sciences, Griffith University, Gold Coast, Australia; Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Australia
| | - Robyn Peters
- Department of Cardiology, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Dariusz Korczyk
- Department of Cardiology, Princess Alexandra Hospital, Metro South Health, Brisbane, Australia; School of Medicine, The University of Queensland, Brisbane, Australia
| | - Jared Bruning
- Department of Physiotherapy, Heart Failure Support Service, The Prince Charles Hospital, Brisbane, Australia
| | - Trevor Russell
- Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; Centre for Research Excellence in Telehealth, The University of Queensland, Brisbane, Australia
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86
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Ambulant monitoring and web-accessible home-based exercise program during outpatient follow-up for resected lung cancer survivors: actual use and feasibility in clinical practice. J Cancer Surviv 2017; 11:720-731. [PMID: 28396993 PMCID: PMC5671546 DOI: 10.1007/s11764-017-0611-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 02/24/2017] [Indexed: 01/05/2023]
Abstract
Purpose The aim of this study is to evaluate the feasibility of a telehealthcare application for operable lung cancer (OLC) patients, consisting of ambulant symptom and physical activity monitoring (S&PAM) and a web-accessible home-based exercise program (WEP), and identify possible barriers for successful adoption and implementation. Methods A two-stage mixed methods design was used, in which 22 OLC patients and their treating healthcare professionals (HCPs) participated from pre-surgery to three (stage 1; n = 10) or six (stage 2; n = 12) months post-surgery. Actual use and acceptability (usability, usefulness, and satisfaction) were evaluated. Results Seventeen OLC patients (age (SD): 59 (8) years; 8 female) actively used the modules. S&PAM use varied from 1 to 11 monitoring days prior to outpatient consultations. Patients used WEP most frequently during the first 5 weeks, with an average of four logins a week. Fifty-eight percent used WEP beyond 7 weeks. No adverse situations occurred, and patients felt confident using the applications. Perceived added value included active lifestyle promotion, decreased anxiety, and accessibility to specialized HCPs. Physiotherapists used WEP as intended. Contrarily, physicians scarcely used information from S&PAM. To promote future adoption, strategies should focus on high-level patient tailoring of the technology, and formalization of including the applications in the clinical workflow. Conclusions Ambulant monitoring and web-accessible home exercise is clinically feasible for OLC patients. However, low level of adoption by referring physicians may hamper successful implementation. Implications for cancer survivors Patients perceived both ambulant monitoring and web-accessible exercise as an added value to regular care and feasible to use in the period before and after lung resection. Electronic supplementary material The online version of this article (doi:10.1007/s11764-017-0611-6) contains supplementary material, which is available to authorized users.
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87
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Morton K, Dennison L, May C, Murray E, Little P, McManus RJ, Yardley L. Using digital interventions for self-management of chronic physical health conditions: A meta-ethnography review of published studies. PATIENT EDUCATION AND COUNSELING 2017; 100:616-635. [PMID: 28029572 PMCID: PMC5380218 DOI: 10.1016/j.pec.2016.10.019] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/16/2016] [Accepted: 10/19/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVES To understand the experiences of patients and healthcare professionals (HCPs) using self-management digital interventions (DIs) for chronic physical health conditions. METHODS A systematic search was conducted in 6 electronic databases. Qualitative studies describing users' experiences of self-management DIs were included, and authors' interpretations were synthesised using meta-ethnography. RESULTS 30 papers met the inclusion criteria, covering a range of DIs and chronic conditions, including hypertension, asthma and heart disease. The review found that patients monitoring their health felt reassured by the insight this provided, and perceived they had more meaningful consultations with the HCP. These benefits were elicited by simple tele-monitoring systems as well as multifaceted DIs. Patients appeared to feel more reliant on HCPs if they received regular feedback from the HCP. HCPs focused mainly on their improved clinical control, and some also appreciated patients' increased understanding of their condition. CONCLUSIONS Patients using self-management DIs tend to feel well cared for and perceive that they adopt a more active role in consultations, whilst HCPs focus on the clinical benefits provided by DIs. PRACTICE IMPLICATIONS DIs can simultaneously support patient condition management, and HCPs' control of patient health. Tele-monitoring physiological data can promote complex behaviour change amongst patients.
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Affiliation(s)
- Katherine Morton
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Laura Dennison
- Academic unit of Psychology, University of Southampton, Southampton, UK.
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK.
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, University College London, London, UK.
| | - Paul Little
- Primary Care Research, University of Southampton, Southampton, UK.
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Lucy Yardley
- Academic unit of Psychology, University of Southampton, Southampton, UK.
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88
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Tsai LLY, McNamara RJ, Dennis SM, Moddel C, Alison JA, McKenzie DK, McKeough ZJ. Satisfaction and Experience With a Supervised Home-Based Real-Time Videoconferencing Telerehabilitation Exercise Program in People with Chronic Obstructive Pulmonary Disease (COPD). Int J Telerehabil 2016; 8:27-38. [PMID: 28775799 PMCID: PMC5536727 DOI: 10.5195/ijt.2016.6213] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8) and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD) age 73 (8) years, forced expiratory volume in 1 second (FEV1) 60 (23) % predicted) showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing.
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Affiliation(s)
- Ling Ling Y Tsai
- DISCIPLINE OF PHYSIOTHERAPY, UNIVERSITY OF SYDNEY, LIDCOMBE, NEW SOUTH WALES, AUSTRALIA.,DEPARTMENT OF PHYSIOTHERAPY, PRINCE OF WALES HOSPITAL, RANDWICK, NEW SOUTH WALES, AUSTRALIA
| | - Renae J McNamara
- DEPARTMENT OF PHYSIOTHERAPY, PRINCE OF WALES HOSPITAL, RANDWICK, NEW SOUTH WALES, AUSTRALIA.,DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE, PRINCE OF WALES HOSPITAL, RANDWICK, NEW SOUTH WALES, AUSTRALIA
| | - Sarah M Dennis
- DISCIPLINE OF PHYSIOTHERAPY, UNIVERSITY OF SYDNEY, LIDCOMBE, NEW SOUTH WALES, AUSTRALIA
| | - Chloe Moddel
- NEW SOUTH WALES AGENCY FOR CLINICAL INNOVATION, CHATSWOOD, NEW SOUTH WALES, AUSTRALIA
| | - Jennifer A Alison
- DISCIPLINE OF PHYSIOTHERAPY, UNIVERSITY OF SYDNEY, LIDCOMBE, NEW SOUTH WALES, AUSTRALIA.,ALLIED HEALTH, SYDNEY LOCAL HEALTH DISTRICT, NEW SOUTH WALES, AUSTRALIA
| | - David K McKenzie
- DEPARTMENT OF RESPIRATORY AND SLEEP MEDICINE, PRINCE OF WALES HOSPITAL, RANDWICK, NEW SOUTH WALES, AUSTRALIA
| | - Zoe J McKeough
- DISCIPLINE OF PHYSIOTHERAPY, UNIVERSITY OF SYDNEY, LIDCOMBE, NEW SOUTH WALES, AUSTRALIA
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89
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Hoaas H, Morseth B, Holland AE, Zanaboni P. Are Physical activity and Benefits Maintained After Long-Term Telerehabilitation in COPD? Int J Telerehabil 2016; 8:39-48. [PMID: 28775800 PMCID: PMC5536728 DOI: 10.5195/ijt.2016.6200] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This study investigated whether physical activity levels and other outcomes were maintained at 1-year from completion of a 2-year telerehabilitation intervention in COPD. During the post-intervention year, nine patients with COPD (FEV1 % of pred. 42.4±19.8%; age 58.1±6 years) were encouraged to exercise on a treadmill at home and monitor daily symptoms and training sessions on a webpage as during the intervention. Participants were not provided supervision or motivational support. Physical activity levels decreased from 3,806 steps/day to 2,817 steps/day (p= 0.039). There was a decline in time spent on light physical activity (p=0.009), but not on moderate-to-vigorous activity (p=0.053). Adherence to registration of symptoms and training sessions decreased significantly. Other outcomes including health status, quality of life, anxiety and depression, self-efficacy, and healthcare utilization did not change significantly. In conclusion, provision of equipment for self-management and unsupervised home exercise might not be enough to maintain physical activity levels.
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Affiliation(s)
- Hanne Hoaas
- NORWEGIAN CENTRE FOR E-HEALTH RESEARCH, UNIVERSITY HOSPITAL OF NORTH NORWAY, TROMSØ, NORWAY
- FACULTY OF HEALTH SCIENCES, UIT THE ARCTIC UNIVERSITY OF NORWAY, TROMSØ, NORWAY
| | - Bente Morseth
- DEPARTMENT OF COMMUNITY MEDICINE, UIT THE ARCTIC UNIVERSITY OF NORWAY, TROMSØ, NORWAY
- SCHOOL OF SPORTS SCIENCE, UIT THE ARCTIC UNIVERSITY OF NORWAY, TROMSØ, NORWAY
| | - Anne E Holland
- LA TROBE UNIVERSITY, MELBOURNE, AUSTRALIA
- ALFRED HEALTH, MELBOURNE, AUSTRALIA
- INSTITUTE FOR BREATHING AND SLEEP, MELBOURNE, AUSTRALIA
| | - Paolo Zanaboni
- NORWEGIAN CENTRE FOR E-HEALTH RESEARCH, UNIVERSITY HOSPITAL OF NORTH NORWAY, TROMSØ, NORWAY
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90
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Zanaboni P, Dinesen B, Hjalmarsen A, Hoaas H, Holland AE, Oliveira CC, Wootton R. Long-term integrated telerehabilitation of COPD Patients: a multicentre randomised controlled trial (iTrain). BMC Pulm Med 2016; 16:126. [PMID: 27549782 PMCID: PMC4994273 DOI: 10.1186/s12890-016-0288-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 08/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic obstructive pulmonary disease (COPD). However, available resources are often limited, and many patients bear with poor availability of programmes. Sustaining PR benefits and regular exercise over the long term is difficult without any exercise maintenance strategy. In contrast to traditional centre-based PR programmes, telerehabilitation may promote more effective integration of exercise routines into daily life over the longer term and broaden its applicability and availability. A few studies showed promising results for telerehabilitation, but mostly with short-term interventions. The aim of this study is to compare long-term telerehabilitation with unsupervised exercise training at home and with standard care. METHODS/DESIGN An international multicentre randomised controlled trial conducted across sites in three countries will recruit 120 patients with COPD. Participants will be randomly assigned to telerehabilitation, treadmill and control, and followed up for 2 years. The telerehabilitation intervention consists of individualised exercise training at home on a treadmill, telemonitoring by a physiotherapist via videoconferencing using a tablet computer, and self-management via a customised website. Patients in the treadmill arm are provided with a treadmill only to perform unsupervised exercise training at home. Patients in the control arm are offered standard care. The primary outcome is the combined number of hospitalisations and emergency department presentations. Secondary outcomes include changes in health status, quality of life, anxiety and depression, self-efficacy, subjective impression of change, physical performance, level of physical activity, and personal experiences in telerehabilitation. DISCUSSION This trial will provide evidence on whether long-term telerehabilitation represents a cost-effective strategy for the follow-up of patients with COPD. The delivery of telerehabilitation services will also broaden the availability of PR and maintenance strategies, especially to those living in remote areas and with no access to centre-based exercise programmes. TRIAL REGISTRATION ClinicalTrials.gov: NCT02258646 .
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Birthe Dinesen
- Department of Health Science and Technology, Laboratory of Assistive Technologies - Telehealth & Telerehabilitation, SMI, Aalborg University, Aalborg, Denmark
| | - Audhild Hjalmarsen
- Heart and Lung Clinic, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Hanne Hoaas
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Anne E. Holland
- La Trobe University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
- Institute for Breathing and Sleep, Melbourne, Australia
| | | | - Richard Wootton
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
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