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Méndez A, Labra P, Guerrero JP, Nieto C, Martínez B, Hidalgo G, Rodríguez-Núñez I. Conceptual validation of an innovative remote pulmonary rehabilitation solution for Chronic Obstructive Pulmonary Disease. CANADIAN JOURNAL OF RESPIRATORY THERAPY : CJRT = REVUE CANADIENNE DE LA THERAPIE RESPIRATOIRE : RCTR 2021; 57:121-125. [PMID: 34447882 PMCID: PMC8372870 DOI: 10.29390/cjrt-2021-025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the world. Pulmonary rehabilitation (PR) reduces COPD hospitalisations, although its use is low. Telerehabilitation is effective; however, in Chile the development of remote PR technology is incipient. Therefore, the aim of the study was to validate conceptual aspects of an innovative remote PR solution for COPD. METHODS This mixed study used a nonprobabilistic sample of PR professionals and people with COPD (PwCOPD) from Santiago. The perception of a conceptual solution for PR through a semi-structured interview was determined. Professionals were also asked about willingness to use technology using a questionnaire designed and validated in 75 professionals in this study. The study was approved by the Ethics Committee and data were collected after informed consent. RESULTS Twenty-two participants were recruited, of which 14 were professionals and eight were PwCOPD. Among professionals and patients, the willingness to use the solution is positive because it would reduce visits and improve self-management, although it should include a remote/in-person combination, training, and user-friendly interface. Most of the professionals were willing to use technology for pulmonary rehabilitation. CONCLUSIONS The development of telehealth technologies should consider the expectations of patients and professionals and may incorporate elements of persuasive technologies in the design. The results could contribute to the development of digital solutions for remote PR in PwCOPD.
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Affiliation(s)
- Andrea Méndez
- Escuela de Kinesiología, Facultad de Salud y Ciencias Sociales, Campus Providencia, Sede Santiago, Universidad de las Américas, Santiago, Chile
- Centro de Investigación e Innovación Biopsicosocial en Enfermedades Crónicas, Facultad de Salud y Ciencias Sociales, Universidad de las Américas, Santiago, Chile
| | - Patricio Labra
- Centro de Salud Familiar Alberto Bachelet Martínez, Corporación Municipal de Salud de Conchalí, Santiago, Chile
| | - Juan Pablo Guerrero
- Escuela de Tecnología Médica, Facultad de Ciencias de la Salud, Universidad Central de Chile
| | - Carlos Nieto
- Escuela de Kinesiología, Facultad de Salud y Ciencias Sociales, Campus Providencia, Sede Santiago, Universidad de las Américas, Santiago, Chile
- Centro de Investigación e Innovación Biopsicosocial en Enfermedades Crónicas, Facultad de Salud y Ciencias Sociales, Universidad de las Américas, Santiago, Chile
| | - Bárbara Martínez
- Escuela de Kinesiología, Facultad de Salud y Ciencias Sociales, Campus Providencia, Sede Santiago, Universidad de las Américas, Santiago, Chile
- Centro de Investigación e Innovación Biopsicosocial en Enfermedades Crónicas, Facultad de Salud y Ciencias Sociales, Universidad de las Américas, Santiago, Chile
| | - Gonzalo Hidalgo
- Escuela de Kinesiología, Facultad de Salud y Ciencias Sociales, Campus Providencia, Sede Santiago, Universidad de las Américas, Santiago, Chile
- Centro de Investigación e Innovación Biopsicosocial en Enfermedades Crónicas, Facultad de Salud y Ciencias Sociales, Universidad de las Américas, Santiago, Chile
- Hospital de niños Dr. Luis Calvo Mackenna
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Abstract
Pulmonary rehabilitation is a highly effective treatment for people with chronic lung disease but remains underused across the world. Recent years have seen the emergence of new program models that aim to improve access and uptake, including telerehabilitation and low-cost, home-based models. This workshop was convened to achieve consensus on the essential components of pulmonary rehabilitation and to identify requirements for successful implementation of emerging program models. A Delphi process involving experts from across the world identified 13 essential components of pulmonary rehabilitation that must be delivered in any program model, encompassing patient assessment, program content, method of delivery, and quality assurance, as well as 27 desirable components. Only those models of pulmonary rehabilitation that have been tested in clinical trials are currently considered as ready for implementation. The characteristics of patients most likely to succeed in each program model are not yet known, and research is needed in this area. Health professionals should use clinical judgment to determine those patients who are best served by a center-based, multidisciplinary rehabilitation program. A comprehensive patient assessment is critical for personalization of pulmonary rehabilitation and for effectively addressing individual patient goals. Robust quality-assurance processes are important to ensure that any pulmonary rehabilitation service delivers optimal outcomes for patients and health services. Workforce capacity-building and training should consider the skills necessary for emerging models, many of which are delivered remotely. The success of all pulmonary rehabilitation models will be judged on whether the essential components are delivered and on whether the expected patient outcomes, including improved exercise capacity, reduced dyspnea, enhanced health-related quality of life, and reduced hospital admissions, are achieved.
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103
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A Systematic Review and Meta-Analysis of Telemonitoring Interventions on Severe COPD Exacerbations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136757. [PMID: 34201762 PMCID: PMC8268154 DOI: 10.3390/ijerph18136757] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/12/2022]
Abstract
This systematic review and meta-analysis aimed to provide current evidence regarding the effectiveness of telemonitoring for preventing COPD exacerbations, focusing on severe exacerbations requiring hospitalisation or emergency room (ER) visits. We systematically searched for randomised controlled trials using nine databases from August to September 2020 following the Cochrane Collaboration Guidelines. Of 2159 records identified, 22 studies involving 2906 participants met the inclusion criteria. The participants in 55% and 59% of studies had severe airflow limitations and severe exacerbation histories in the preceding year, respectively. The most commonly telemonitored data were oxygen saturation (91%) and symptoms (73%). A meta-analysis showed that telemonitoring did not reduce the number of admissions (12 studies) but decreased the number of ER visits due to severe exacerbations [7 studies combined, standardised mean difference (SMD) = −0.14; 95% confidence interval (CI): −0.28, −0.01]. Most studies reported no benefit in mortality, quality of life, or cost-effectiveness. All eight studies that surveyed participant satisfaction reported high satisfaction levels. Our review suggested that adding telemonitoring to usual care reduced unnecessary ER visits but was unlikely to prevent hospitalisations due to COPD exacerbations and that telemonitoring was well-accepted by patients with COPD and could be easily integrated into their existing care.
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104
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Tanguay P, Marquis N, Gaboury I, Kairy D, Touchette M, Tousignant M, Décary S. Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic. Int J Telerehabil 2021; 13:e6383. [PMID: 34345354 PMCID: PMC8287730 DOI: 10.5195/ijt.2021.6383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. Methods We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants' attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. Results We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. Conclusion We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease.
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Affiliation(s)
- Pamela Tanguay
- École De Réadaptation, Université De Sherbrooke, QC, Canada
| | - Nicole Marquis
- École De Réadaptation, Université De Sherbrooke, QC, Canada
| | | | - Dahlia Kairy
- École De Réadaptation, Université De Montréal, QC, Canada
| | - Matthieu Touchette
- Faculté De Médecine Et Des Sciences De La Santé, Université De Sherbrooke, QC, Canada
| | - Michel Tousignant
- École De Réadaptation, Université De Sherbrooke, QC, Canada.,Centre De Recherche Sur Le Vieillissement, Ciusss-Iugs, QC, Canada
| | - Simon Décary
- École De Réadaptation, Université De Sherbrooke, QC, Canada.,Tier 1 Canada Research Chair In Shared Decision Making and Knowledge Translation, Vitam - Centre De Recherche En Santé Durable, QC, Canada
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105
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Khoza-Shangase K, Moroe N, Neille J. Speech-Language Pathology and Audiology in South Africa: Clinical Training and Service in the Era of COVID-19. Int J Telerehabil 2021; 13:e6376. [PMID: 34345349 PMCID: PMC8287713 DOI: 10.5195/ijt.2021.6376] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION AND PURPOSE The novel coronavirus (COVID-19) presented new and unanticipated challenges to the provision of clinical services, from student training to the care of patients with speech-language and hearing (SLH) disorders. Prompt changes in information and communication technologies (ICT), were required to ensure that clinical training continued to meet the Health Professions Council of South Africa's regulations and patients received effective clinical care. The purpose of this study was to investigate online clinical training and supervision to inform current and future training and clinical care provision in SLH professions. METHODOLOGY A scoping review was conducted using the Arksey and O'Malley (2005) framework. The electronic bibliographic databases Science Direct, PubMed, Scopus, MEDLINE, and ProQuest were searched to identify publications about online clinical training and supervision and their impact on clinical service during COVID-19. Selection and analysis were performed by three independent reviewers using pretested forms. RESULTS AND CONCLUSIONS The findings revealed important benefits of teletraining and telepractice with potential application to South African clinical training and service provision. Five themes emerged: (1) practice produces favorable outcomes, (2) appreciation for hybrid models of training and service delivery, (3) cost effectiveness is a "big win" (4) internationalization of remote clinical training and service provision, and (5) comparable modality outcomes. These findings may have significant implications for teletraining and telepractice in low-and-middle income countries (LMICs) in the COVID-19 era and beyond, wherein demand versus capacity challenges (e.g., in human resources) persist. Current findings highlight the need for SLH training programmes to foster a hybrid clinical training model. Few studies were conducted in LMICs, indicating a gap in such research.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomfundo Moroe
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Neille
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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106
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Sobierajska-Rek A, Mański Ł, Jabłońska-Brudło J, Śledzińska K, Wasilewska E, Szalewska D. Respiratory Telerehabilitation of Boys and Young Men with Duchenne Muscular Dystrophy in the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126179. [PMID: 34200985 PMCID: PMC8229414 DOI: 10.3390/ijerph18126179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
Background: The COVID-19 pandemic forced reorganization of the multidisciplinary healthcare system for Duchenne muscular dystrophy. Digital solutions seem to be optimal for providing rehabilitation at this time. The aim of this study was to investigate whether it is possible to conduct respiratory physical therapy with the use of telerehabilitation in Duchenne muscular dystrophy. Methods: The study was conducted during an online conference for families with DMD. During the physical therapy panel we showed the video with the instructions of respiratory exercises. All participants (n = 152) were asked to fill in the online survey evaluating the quality, acceptance, and understanding of the instructions. Results: The survey was filled in by 45 (29.6%) participants. The mean rating of satisfaction was 4.70/5, and for intelligibility was 4.78/5. Thirty-seven (82.2%) patients declared that they had performed the exercises, all caregivers declared that it was possible to perform the proposed exercises a few times a week or daily, and only two respondents replied to invitations to individual online sessions. Conclusions: Findings from the study show that respiratory telerehabilitation may be implemented for DMD patients; however, the interest in digital rehabilitation among caregivers of DMD boys in Poland is low. The reasons for this situation require further research.
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Affiliation(s)
- Agnieszka Sobierajska-Rek
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-219 Gdansk, Poland; (J.J.-B.); (D.S.)
- Correspondence:
| | - Łukasz Mański
- Department of Physical Therapy, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Joanna Jabłońska-Brudło
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-219 Gdansk, Poland; (J.J.-B.); (D.S.)
| | - Karolina Śledzińska
- Department of Internal and Pediatric Nursing, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Eliza Wasilewska
- Department of Pulmonology and Allergology, Faculty of Medicine, Medical University of Gdansk, 80-211 Gdansk, Poland;
| | - Dominika Szalewska
- Department of Rehabilitation Medicine, Faculty of Health Sciences with Institute of Maritime and Tropical Medicine, Medical University of Gdansk, 80-219 Gdansk, Poland; (J.J.-B.); (D.S.)
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107
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Grosbois JM, Gephine S, Le Rouzic O, Chenivesse C. Feasibility, safety and effectiveness of remote pulmonary rehabilitation during COVID-19 pandemic. Respir Med Res 2021; 80:100846. [PMID: 34153703 PMCID: PMC8183002 DOI: 10.1016/j.resmer.2021.100846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/11/2021] [Accepted: 05/30/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | - Sarah Gephine
- FormAction Santé, 59840 Pérenchies, France; EA 7369, URePSSS, unité de recherche pluridisciplinaire sport santé société, University Artois, University Littoral Côte d'Opale, University Lille, 59000 Lille, France; Institut universitaire de cardiologie et de pneumologie de Québec, université Laval, Québec, Canada
| | - Olivier Le Rouzic
- Service de pneumologie et immuno-allergologie, centre de référence constitutif des maladies pulmonaires rares, CHU de Lille, 59000 Lille, France
| | - Cécile Chenivesse
- Service de pneumologie et immuno-allergologie, centre de référence constitutif des maladies pulmonaires rares, CHU de Lille, 59000 Lille, France
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108
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Hansen H, Beyer N, Frølich A, Godtfredsen N, Bieler T. Inter-Day Test-Retest Reproducibility of the CAT, CCQ, HADS and EQ-5D-3L in Patients with Severe and Very Severe COPD. PATIENT-RELATED OUTCOME MEASURES 2021; 12:117-128. [PMID: 34104024 PMCID: PMC8179805 DOI: 10.2147/prom.s306352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
Introduction In patients with COPD, the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and EuroQol 5D (EQ-5D-3L) are widely used patient reported outcome measures (PROMs) of respiratory symptoms, anxiety, depression and quality of life. Despite established validity, responsiveness and minimal important change (MIC), the reproducibility and especially important agreement parameters remain unreported in these frequently used PROMs. The aim of this study was to investigate the inter-day test–retest reliability and agreement of the CAT, CCQ, HADS and EQ-5D-3L in patients with severe and very severe COPD (FEV1 <50%) eligible for hospital-based pulmonary rehabilitation. Patients and Methods Fifty patients (22 females, mean [SD] age 67 [9] yrs.; FEV1 32[9] %; 6-minute walk distance 347 [102] meters; CAT 21 [6] points; BMI: 26 [6] kg/m2) completed the questionnaires (CAT, CCQ, HADS, EQ-5D-3L) in combination with functional performance test instructed by one assessor on test-day one (T1) and by another assessor 7–10 days later on test-day two (T2). Results The inter-day test–retest reliability ICC was 0.88 (LL95CI: 0.80) for CAT; 0.69 (LL95CI: 0.46) for CCQ; 0.86 (LL95CI: 0.75) and 0.90 (LL95CI: 0.82) for HADS-anxiety (A) and depression (D) and 0.87 (LL95CI: 0.76) for EQ-5D-VAS. The corresponding agreements within a single measurement (standard error of measurement, SEM) and for repeated measurement errors (smallest real difference, SRD) were respectively 2.1 and 2.9 points for CAT; 0.5 and 0.7 points for CCQ total; 1.3 and 1.9 points for HADS-A; 0.9 and 1.3 points for HADS-D and 6.8 and 9.7 VAS-score for EQ-5D-3L, respectively. Ceiling/flooring effect was present in <5% for all questionnaires. Conclusion In patients with severe and very severe COPD, the CAT, CCQ, HADS and EQ-5D-3L questionnaires presented moderate to excellent inter-day test–retest reliability, and no floor or ceiling effect was documented for any of the questionnaires. Only CAT and HADS had an acceptable SRD below the established MIC for assessing change over time on group level, and none of the PROMS were fit to assess individual changes over time.
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Affiliation(s)
- Henrik Hansen
- Department of Respiratory Medicine, Respiratory Research Unit, Hvidovre University Hospital, Hvidovre, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Respiratory Research Unit, Hvidovre University Hospital, Hvidovre, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Bieler
- Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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109
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Leitl D, Jarosch I, Glöckl R, Schneeberger T, Rembert Koczulla A. [Rehabilitation in pneumology]. PNEUMOLOGE 2021; 18:241-250. [PMID: 33976600 PMCID: PMC8103139 DOI: 10.1007/s10405-021-00395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/02/2022]
Abstract
Die pneumologische Rehabilitation (PR) ist eine evidenzbasierte interdisziplinäre Behandlung für Patienten mit chronischen Erkrankungen der Atmungsorgane. Die Indikation für ihre Beantragung ist bei entsprechender Rehabilitationsfähigkeit, -bedürftigkeit und günstigen -prognose gegeben. Ziele einer PR sind die Reduktion der Symptome sowie die Steigerung der Lebensqualität und körperlichen Belastbarkeit. Die Effektivität ist für COPD-Patienten (COPD: chronisch obstruktive Lungenerkrankung) mit dem höchsten und für Nicht-COPD-Patienten mit zunehmend gutem Evidenzgrad durch randomisiert kontrollierte Studien und Metaanalysen gesichert. Die Therapieinhalte einer PR werden durch ein multidisziplinäres Behandlungsteam individuell an die Bedürfnisse der Patienten angepasst. Um den Rehabilitationserfolg nachhaltig zu gestalten, besteht die Möglichkeit, an ambulanten Nachsorgeprogrammen (z. B. Lungensport) teilzunehmen sowie digitale Technologien als unterstützende Maßnahme einzusetzen.
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Affiliation(s)
- Daniela Leitl
- Forschungsinstitut für pneumologische Rehabilitation, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471 Schönau am Königssee, Deutschland.,Pneumologische Rehabilitation, Deutsches Zentrum für Lungenforschung, Philipps-Universität Marburg, Marburg, Deutschland
| | - Inga Jarosch
- Forschungsinstitut für pneumologische Rehabilitation, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471 Schönau am Königssee, Deutschland
| | - Rainer Glöckl
- Forschungsinstitut für pneumologische Rehabilitation, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471 Schönau am Königssee, Deutschland
| | - Tessa Schneeberger
- Forschungsinstitut für pneumologische Rehabilitation, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471 Schönau am Königssee, Deutschland.,Pneumologische Rehabilitation, Deutsches Zentrum für Lungenforschung, Philipps-Universität Marburg, Marburg, Deutschland
| | - Andreas Rembert Koczulla
- Forschungsinstitut für pneumologische Rehabilitation, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471 Schönau am Königssee, Deutschland.,Pneumologische Rehabilitation, Deutsches Zentrum für Lungenforschung, Philipps-Universität Marburg, Marburg, Deutschland.,Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
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110
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Langer D. Elastic Resistance Exercises: Making Pulmonary Rehabilitation More Accessible? Chest 2021; 159:1696-1698. [PMID: 33965121 DOI: 10.1016/j.chest.2021.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/18/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Daniel Langer
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, Faculty of Kinesiology and Rehabilitation Sciences, and the Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE department CHROMETA, Leuven, Belgium.
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111
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Happe L, Lau S, Koschate J, Diekmann R, Hein A, Zieschang T. [Feasibility and acceptance of video-based physiotherapy : New medical care provision for older people during the COVID-19 pandemic]. Z Gerontol Geriatr 2021; 54:346-352. [PMID: 33938980 PMCID: PMC8090529 DOI: 10.1007/s00391-021-01899-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
Hintergrund und Ziel Einschränkungen des öffentlichen Lebens durch die COVID-19-Pandemie dienen insbesondere dazu, Risikogruppen vor einer Ansteckung zu schützen. Darunter fallen auch ältere, multimorbide Patienten, für die körperliche Inaktivität und Auslassen von Maßnahmen wie Physiotherapie jedoch negative Folgen haben können. Die vorliegende Studie untersucht die Machbarkeit und die subjektive Bewertung videobasierter Physiotherapie (VT). Methoden Von April bis Juni 2020 nahmen 4 Einrichtungen mit 9 Patienten (6 Frauen, 64 bis 82 Jahre) an der Studie teil, die mit Tablets ausgestattet wurden. Durch semistrukturierte Telefoninterviews wurden körperliche Aktivität, funktionelle Kompetenz und Partizipation vor und während den Einschränkungen bei 8 Patienten erfasst. Patienten und Therapeuten wurden zu ihren subjektiven Erfahrungen mit der VT befragt. Ergebnisse Es fanden insgesamt 92 VT-Einheiten statt. Die Umsetzung der Übungen wurde als gut bis sehr gut bewertet. Insgesamt zeigte sich eine hohe Akzeptanz der VT. Vier von 8 Patienten beschrieben eine subjektive Reduzierung ihrer körperlichen Aktivitäten aufgrund der Einschränkungen. Diese Veränderungen wurden über die verwendeten Fragebogen zur Partizipation und zur körperlichen Aktivität nicht abgebildet. Diskussion Bei älteren Patienten ist VT mit geringer technischer Unterstützung machbar. Sowohl in Pandemiesituationen als auch in anderen Kontexten stellt sich VT als eine realisierbare Ergänzung oder Alternative zur normalen Physiotherapie dar. Weitere Studien zur Identifikation von geeigneten Patientengruppen, Effektivität der VT und Weiterentwicklung inhaltlicher Aspekte sind dringend notwendig. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-021-01899-3) enthalten.
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Affiliation(s)
- Lisa Happe
- Abteilung für Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Sandra Lau
- Abteilung für Geriatrie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Jessica Koschate
- Abteilung für Geriatrie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - Rebecca Diekmann
- Abteilung für Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - Andreas Hein
- Abteilung für Assistenzsysteme und Medizintechnik, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
| | - Tania Zieschang
- Abteilung für Geriatrie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
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112
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Shah NM, Kaltsakas G. Telemedicine in the management of patients with chronic respiratory failure. Breathe (Sheff) 2021; 17:210008. [PMID: 34295411 PMCID: PMC8291909 DOI: 10.1183/20734735.0008-2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022] Open
Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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113
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Lewis A, Knight E, Bland M, Middleton J, Mitchell E, McCrum K, Conway J, Bevan-Smith E. Feasibility of an online platform delivery of pulmonary rehabilitation for individuals with chronic respiratory disease. BMJ Open Respir Res 2021; 8:8/1/e000880. [PMID: 33762360 PMCID: PMC7993314 DOI: 10.1136/bmjresp-2021-000880] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction SARS-CoV-2 has restricted access to face-to-face delivery of pulmonary rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR. However, it is unknown whether patients who have been referred to face-to-face programmes can feasibly complete an online-PR programme. Methods This service evaluation used a mixed-methods approach to investigate a rapid PR service remodelling using the University of Gloucestershire eLearn Moodle platform. Quantitative baseline demographic and PR outcome data were collected from online-PR participants, and semistructured interviews were completed with PR staff and participants. Results Twenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and 14 completed PR. Significant pre-post online PR improvements were achieved in 1 min sit-to-stand (CI 2.1 to 9 (p=0.004)), Generalised Anxiety Disorder (CI −0.3 to −2.6 (p=0.023)), Primary Health Questionnaire-9 (CI −0.3 to −5.1 (p=0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 to 1.3 (p=0.001)), fatigue (CI 0.7 to 2 (p=0.0004)), emotion (CI 0.7 to 1.7 (p=0.0002)), mastery (CI 0.4 to 1.3 (p=0.001)). Interviews indicated that patient PR inclusion was made possible with digital support and a PR introduction session improved participant engagement and safety. Incremental progression of exercise was perceived as more successful online compared with face-to-face PR. However, perceptions were that education sessions were less successful. Online-PR required significant staff time resource. Discussion Online-PR improves patient outcomes and is feasible and acceptable for individuals referred for face-to-face PR in the context of a requirement for social distancing. Face-to-face programmes can be adapted in a rapid fashion with both staff and participants perceiving benefit. Future pragmatic trials are now warranted comparing online-PR including remote assessments to centre-based PR with suitably matched outcomes, and patient and staff perceptions sought regarding barriers and facilitators of online delivery.
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Affiliation(s)
- Adam Lewis
- Health Sciences, Brunel University London, London, UK
| | - Ellena Knight
- Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK
| | - Matthew Bland
- Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK
| | | | - Esther Mitchell
- Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK
| | - Kate McCrum
- University of Gloucestershire, Cheltenham, UK
| | - Joy Conway
- Centre for Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
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114
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Taito S, Yamauchi K, Kataoka Y. Telerehabilitation in Subjects With Respiratory Disease: A Scoping Review. Respir Care 2021; 66:686-698. [PMID: 33531356 PMCID: PMC9993993 DOI: 10.4187/respcare.08365] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Considering the current coronavirus disease (COVID-19) pandemic, telerehabilitation may be a viable first-line option for patients with respiratory tract disease. To date, there has been no systematic review on telerehabilitation for respiratory tract diseases, including COVID-19. Therefore, this scoping review aimed to determine what telerehabilitation for patients with respiratory tract diseases consists of, how safe telerehabilitation is for patients with respiratory tract diseases, and how feasible telerehabilitation is for hospitalized patients with COVID-19. In May 2020, we conducted a search of the following publication databases on the use of telerehabilitation in the treatment of respiratory tract diseases: Medical Literature Analysis and Retrieval System Online, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Literature, and Physiotherapy Evidence Database. Of the 208 articles identified, 23 studies were subsequently included in this scoping review. In 22 of the included studies, subjects had stable COPD and underwent telerehabilitation at home. The final included study was a case series of subjects with severe acute respiratory syndrome coronavirus 2 infection who underwent telerehabilitation in-hospital. Most telerehabilitation programs consisted of aerobic exercises using a cycle ergometer or a treadmill, walking, and muscle-strengthening exercises. The reported number of adverse events was low, and most studies reported that the average session adherence rate was > 70%. The majority of the telerehabilitation programs included a face-to-face rehabilitation assessment. Our findings indicate that, in its current state, telerehabilitation may be safe and feasible and may lead to reduced face-to-face rehabilitation therapy; in addition, remote rehabilitation assessment should be considered during the COVID-19 pandemic. Further research that targets a more diverse range of respiratory tract diseases and considers telerehabilitation in a hospital setting is required.
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Affiliation(s)
- Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan.
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Kota Yamauchi
- Department of Rehabilitation, Steel Memorial Yawata Hospital, Kitakyushu, Fukuoka, Japan
| | - Yuki Kataoka
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
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Grosbois JM, Fry S, Tercé G, Wallaert B, Chenivesse C. [Physical activity and pulmonary rehabilitation in adults with asthma]. Rev Mal Respir 2021; 38:382-394. [PMID: 33744072 DOI: 10.1016/j.rmr.2021.02.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
Physical activity is reduced in people with asthma compared to the general population, especially in situations where patients have uncontrolled asthma symptoms, persistent airflow obstruction and other long-term medical problems, in particular obesity and anxiety. Exertional dyspnea, which is of multifactorial origin, is the main cause of reduced physical activity reduction and draws patients into a vicious circle further impairing quality of life and asthma control. Both the resumption of a regular physical activity, integrated into daily life, adapted to patients' needs and wishes as well as physical and environmental possibilities for mild to moderate asthmatics, and pulmonary rehabilitation (PR) for severe and/or uncontrolled asthmatics, improve control of asthma, dyspnea, exercise tolerance, quality of life, anxiety, depression and reduce exacerbations. A motivational interview to promote a regular programme of physical activity in mild to moderate asthma (steps 1 to 3) should be offered by all health professionals in the patient care pathway, within the more general framework of therapeutic education. The medical prescription of physical activities, listed in the Public Health Code for patients with long-term diseases, and pulmonary rehabilitation should be performed more often by specialists or the attending physician. Pulmonary rehabilitation addresses the needs of severe asthma patients (steps 4 and 5), and of any asthmatic patient with poorly controlled disease and/or requiring hospitalized for acute exacerbations, regardless of the level of airflow obstruction, and/or with associated comorbidities, and before prescribing biological therapies.
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Affiliation(s)
- J-M Grosbois
- FormAction Santé, zone d'activité du bois, rue de Pietralunga, 59840 Pérenchies, France; CH Béthune, service de réadaptation respiratoire et de pneumologie, 62400 Béthune, France; Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France.
| | - S Fry
- CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France; CRISALIS, F-CRIN INSERM network, Lille, France
| | - G Tercé
- CH Béthune, service de réadaptation respiratoire et de pneumologie, 62400 Béthune, France
| | - B Wallaert
- Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France; CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France
| | - C Chenivesse
- CHU Lille, service de pneumologie et immuno-allergologie, université Lille, institut Pasteur de Lille, U1019, UMR 9017, Center for Infection and Immunity of Lille (CIIL), 59000 Lille, France; CRISALIS, F-CRIN INSERM network, Lille, France
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- Alvéole, groupe de travail de la SPLF, exercice et réadaptation respiratoire, 75006 Paris, France
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116
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Tsutsui M, Gerayeli F, Sin DD. Pulmonary Rehabilitation in a Post-COVID-19 World: Telerehabilitation as a New Standard in Patients with COPD. Int J Chron Obstruct Pulmon Dis 2021; 16:379-391. [PMID: 33642858 PMCID: PMC7903963 DOI: 10.2147/copd.s263031] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/07/2021] [Indexed: 12/15/2022] Open
Abstract
Pulmonary rehabilitation (PR) is effective in reducing symptoms and improving health status, and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD). The coronavirus disease 19 (COVID-19) pandemic has greatly impacted PR programs and their delivery to patients. Owing to fears of viral transmission and resultant outbreaks of COVID-19, institution-based PR programs have been forced to significantly reduce enrolment or in some cases completely shut down during the pandemic. As a majority of COPD patients are elderly and have multiple co-morbidities including cardiovascular disease and diabetes, they are notably susceptible to severe complications of COVID-19. As such, patients have been advised to stay at home and avoid social contact to the maximum extent possible. This has increased patients’ vulnerability to physical deconditioning, depression, and social isolation. To address this major gap in care, some traditional hospital or clinic-centered PR programs have converted some or all of their learning contents to home-based telerehabilitation during the pandemic. There are, however, some significant barriers to this approach that have impeded its implementation in the community. These include variable access and use of technology (by patients), a lack of standardization of methods and tools for evaluation of the program, and inadequate training and resources for health professionals in optimally delivering telerehabilitation to patients. There is a pressing need for high-quality studies on these modalities of PR to enable the successful implementation of PR at home and via teleconferencing technologies. Here, we highlight the importance of telerehabilitation of patients with COPD in the post-COVID world and discuss various strategies for clinical implementation.
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Affiliation(s)
- Mai Tsutsui
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Firoozeh Gerayeli
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Don D Sin
- Centre for Heart Lung Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Division of Respiratory Medicine, University of British Columbia, Vancouver, BC, Canada
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A group-based real-time videoconferencing telerehabilitation programme in recently discharged geriatric patients: a feasibility study. Eur Geriatr Med 2021; 12:801-808. [PMID: 33544388 PMCID: PMC7863611 DOI: 10.1007/s41999-020-00444-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/17/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Exercise at home and improvement in the ability to undertake daily tasks are highly valued by older people after hospitalisation. New telerehabilitation (TR) technologies make it possible to supervise and communicate with exercising participants through videoconferencing equipment. This technology has been shown to be both feasible and effective in Danish chronic obstructive pulmonary disease patients in terms of basic mobility, safety, social interactions and patient perception. This study sought to examine whether it was feasible to carry out TR through home exercises in groups. METHODS Both medical and hip-fracture home-dwelling patients aged 65 years and older admitted to the Emergency Department (ED) and Department of Geriatrics for acute reasons were asked to participate in the study just before their discharge. The inclusion criteria were normal cognitive function, being dependent on a walking aid and computer users before hospitalisation. RESULTS At discharge, 333 patients were consecutively screened for participation. Of those, 300 patients were excluded. Thirty-three patients met the inclusion criteria. They had a mean age of 82.3 years (± 7.8) and 76% were women. Nine patients agreed to participate, but seven withdrew. The most frequent explanation was exhaustion in the continuation of hospitalisation. CONCLUSION It was not possible to conduct a videoconference TR study in a geriatric population, as many were excluded and those who were eligible withdrew after inclusion. During the COVID-19 pandemic, TR may be an important tool for isolated older persons to hinder functional decline. Aspects such as recruitment procedures and IT solutions designed for older people must be considered.
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118
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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: 103] [Impact Index Per Article: 34.3] [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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Abstract
The rehabilitation needs of individuals undergoing thoracic surgery are changing, especially as surgical management is increasingly being offered to patients who are at risk of developing functional limitations during and after hospital discharge. In the past rehabilitative management of these patients was frequently limited to specific respiratory physiotherapy interventions in the immediate postoperative setting with the aim to prevent postoperative pulmonary complications. In the past two decades, this focus has shifted toward pulmonary rehabilitation interventions that aim to improve functional status of individuals, both in the pre- and (longer-term) postoperative period. While there is increased interest in (p)rehabilitation interventions the majority of thoracic surgery patients are however currently on their own with respect to progression of their exercise and physical activity regimens after they have been discharged from hospital. There are also no formal guidelines supporting the referral of these patients to outpatient rehabilitation programs. The current evidence regarding rehabilitation interventions initiated before, during, and after the hospitalization period will be briefly reviewed with special focus on patients undergoing surgery for lung cancer treatment and patients undergoing lung transplantation. More research will be necessary in the coming years to modify or change clinical rehabilitation practice beyond the acute admission phase in patients undergoing thoracic surgery. Tele rehabilitation or web-based activity counseling programs might also be interesting emerging alternatives in the (long-term) postoperative rehabilitative treatment of these patients.
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Affiliation(s)
- Daniel Langer
- Research Group for Rehabilitation in Internal Disorders, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Clinical Department of Respiratory Diseases, UZ Leuven, BREATHE Department CHROMETA, KU Leuven, Leuven, Belgium
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Priya N, Isaac BTJ, Thangakunam B, Christopher DJ. Effect of home-based pulmonary rehabilitation on health-related quality of life, lung function, exercise tolerance, and dyspnea in chronic obstructive pulmonary disorder patients in a tertiary care center in South India. Lung India 2021; 38:211-215. [PMID: 33942743 PMCID: PMC8194434 DOI: 10.4103/lungindia.lungindia_895_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: Home-based pulmonary rehabilitation (PR) can increase compliance in chronic obstructive pulmonary disorder (COPD). There is paucity of data on this in India. Aims: To study the effectiveness of home-based PR on lung function, health-related quality of life, exercise tolerance and dyspnea among patients with COPD. Setting: The Department of Pulmonary Medicine, Christian Medical College, Vellore. Subjects and Methods: This was a quasi-experimental study which included COPD patients who found hospital-based PR impractical. Those willing for home-based PR constituted the intervention group and those unwilling, constituted the control group. Both groups received standard of care otherwise. At 6 weeks, forced expiratory volume in 1 sec (FEV1), St. George Respiratory Questionnaire (SGRQ), six-minute walk test distance (6MWD), COPD assessment test (CAT) score and modified Borg dyspnea scale were compared with their baseline values. Statistical Analysis: Student paired t-test. Results: A total of 42 patients completed the study, 21 in each arm. The baseline characteristics were comparable. The improvement in FEV1 was 90 ml in the intervention group and 4 ml in the control group (P = 0.01). There was no significant difference in 6MWD change. SGRQ score, Borg scale and CAT score improved significantly by 10.4, 2.4, and 3.4, respectively, in the intervention group when compared to the control group (P = 0.01). Conclusions: Home-based PR effectively provides tangible benefits in FEV1, QOL, exercise tolerance and dyspnea. It should be offered to those who are unable to avail institution-based PR, especially in this era of COVID pandemic.
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Affiliation(s)
- N Priya
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Barney T J Isaac
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
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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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Philip KE, Lewis A, Jeffery E, Buttery S, Cave P, Cristiano D, Lound A, Taylor K, Man WDC, Fancourt D, Polkey MI, Hopkinson NS. Moving singing for lung health online in response to COVID-19: experience from a randomised controlled trial. BMJ Open Respir Res 2020; 7:e000737. [PMID: 33239406 PMCID: PMC7689537 DOI: 10.1136/bmjresp-2020-000737] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Singing for lung health (SLH) is a popular arts-in-health activity for people with long-term respiratory conditions. Participants report biopsychosocial benefits, however, research on impact is limited. The 'SLH: Improving Experiences of Lung Disease trial', a randomised controlled, single (assessor) blind, trial of 12 weeks SLH versus usual care for people with chronic obstructive pulmonary disease (COPD) (n=120) was setup to help to address this. The first group (n=18, nine singing and nine controls) started face-to-face (five sessions) before changing to online delivery (seven sessions) due to COVID-19-related physical distancing measures. As such, the experience of this group is here reported as a pilot study to inform further research in this area. METHODS We conducted semistructured interviews and thematic analysis regarding barriers, facilitators and key considerations for transitioning from face-to-face to online delivery. Pilot quantitative outcomes include attendance, premeasures and postmeasures of quality of life and disease impact (Short Form 36 Health Survey, COPD Assessment Test score), breathlessness (Medical Research Council breathlessness scale, Dyspnoea-12), depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalised Anxiety Disorder-7), balance confidence (Activity specific Balance Confidence, ABC scale) and physical activity (clinical visit PROactive physical activity in COPD tool, combining subjective rating and actigraphy). RESULTS Attendance was 69% overall, (90% of the face-to-face sessions, 53% online sessions). Analysis of semistructured interviews identified three themes regarding participation in SLH delivered face to face and online, these where (1) perceived benefits; (2) digital barriers (online) and (3) digital facilitators (online). Findings were summarised into key considerations for optimising transitioning singing groups from face-to-face to online delivery. Pilot quantitative data suggested possible improvements in depression (treatment effect -4.78 PHQ-9 points, p<0.05, MCID 5) and balance confidence (treatment effect +17.21 ABC scale points, p=0.04, MCID 14.2). DISCUSSION This study identifies key considerations regarding the adaptation of SLH from face-to-face to online delivery. Pilot data suggest online group singing for people with COPD may deliver benefits related to reducing depression and improved balance confidence.
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Affiliation(s)
- Keir Ej Philip
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Edmund Jeffery
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sara Buttery
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Phoene Cave
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniele Cristiano
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Adam Lound
- Respiratory Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Karen Taylor
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - William D-C Man
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Michael I Polkey
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Nicholas S Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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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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124
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Holland AE, Malaguti C, Hoffman M, Lahham A, Burge AT, Dowman L, May AK, Bondarenko J, Graco M, Tikellis G, Lee JY, Cox NS. Home-based or remote exercise testing in chronic respiratory disease, during the COVID-19 pandemic and beyond: A rapid review. Chron Respir Dis 2020; 17:1479973120952418. [PMID: 32840385 PMCID: PMC7450293 DOI: 10.1177/1479973120952418] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: To identify exercise tests that are suitable for home-based or remote
administration in people with chronic lung disease. Methods: Rapid review of studies that reported home-based or remote administration of
an exercise test in people with chronic lung disease, and studies reporting
their clinimetric (measurement) properties. Results: 84 studies were included. Tests used at home were the 6-minute walk test
(6MWT, two studies), sit-to-stand tests (STS, five studies), Timed Up and Go
(TUG, 4 studies) and step tests (two studies). Exercise tests administered
remotely were the 6MWT (two studies) and step test (one study). Compared to
centre-based testing the 6MWT distance was similar when performed outdoors
but shorter when performed at home (two studies). The STS, TUG and step
tests were feasible, reliable (intra-class correlation coefficients
>0.80), valid (concurrent and known groups validity) and moderately
responsive to pulmonary rehabilitation (medium effect sizes). These tests
elicited less desaturation than the 6MWT, and validated methods to prescribe
exercise were not reported. Discussion: The STS, step and TUG tests can be performed at home, but do not accurately
document desaturation with walking or allow exercise prescription. Patients
at risk of desaturation should be prioritised for centre-based exercise
testing when this is available.
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Affiliation(s)
- Anne E Holland
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Carla Malaguti
- Department of Cardiorespiratory and Skeletal muscle, 28113Federal University of Juiz de Fora, São Pedro, Juiz de Fora, Brazil
| | - Mariana Hoffman
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Aroub Lahham
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Angela T Burge
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Leona Dowman
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Australia
| | - Anthony K May
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Melbourne, Victoria, Australia
| | - Janet Bondarenko
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Marnie Graco
- Institute for Breathing and Sleep, Australia.,Allied Health, 5392Alfred Health, Melbourne, Victoria, Australia
| | - Gabriella Tikellis
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Joanna Yt Lee
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia
| | - Narelle S Cox
- Department of Allergy, Immunology and Respiratory Medicine, 2541Monash University, Clayton, Victoria, Australia.,Institute for Breathing and Sleep, Australia
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125
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12-months follow-up of pulmonary tele-rehabilitation versus standard pulmonary rehabilitation: A multicentre randomised clinical trial in patients with severe COPD. Respir Med 2020; 172:106129. [PMID: 32905893 DOI: 10.1016/j.rmed.2020.106129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 11/24/2022]
Abstract
Between March 2016 and October 2017, we randomised 134 patients with severe COPD from 8 hospitals in the Capital Region of Denmark to participate in either standardised, outpatient pulmonary rehabilitation (control group) or on-line, supervised and home-based tele-rehabilitation (intervention group). We found no difference between the groups in the primary outcome: six minutes walking distance (6MWD) after completion of the programme. The current study presents results from the 12-month follow-up with assessment of the 6MWD and analyses of hospitalisation and mortality. There were no significant differences between or within the groups in the 6MWD one year after completion of the programme.
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Houchen-Wolloff L, Steiner MC. Pulmonary rehabilitation at a time of social distancing: prime time for tele-rehabilitation? Thorax 2020; 75:446-447. [PMID: 32398319 DOI: 10.1136/thoraxjnl-2020-214788] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Linzy Houchen-Wolloff
- Centre for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK .,Department of Respiratory Science, University of Leicester, Leicester, UK
| | - Michael C Steiner
- Centre for Exercise and Rehabilitation Science (CERS), NIHR Leicester Biomedical Research Centre - Respiratory, Glenfield Hospital, Leicester, UK.,Department of Respiratory Science, University of Leicester, Leicester, UK
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