Teleconsultation in respiratory medicine - A position paper of the Portuguese Pulmonology Society

Is the Rehabilitation Complexity Scale useful in individuals undergoing in-hospital pulmonary rehabilitation?

OBJECTIVE

To assess validity and responsiveness of the Extended Rehabilitation Complexity Scale (RCS-Ev13) to in-hospital pulmonary rehabilitation (PR) in individuals with chronic respiratory diseases (CRD).

DESIGN

cross-sectional multicentric study. Assessments in individuals attending units on two non-consecutive days.

SETTING

14 Italian in-hospital PR units.

PARTICIPANTS

Five hundred forty-seventh individuals (59.2% male, age 72 [65-78] years): 317 with Chronic Respiratory Failure due to various causes (CRF group); 96 with chronic obstructive pulmonary disease without CRF (COPD), 39 Tracheostomized and Ventilated (Tx/V), and 95 with other diseases (Miscellaneous).

INTERVENTION

Assessment of RCS-Ev13 before and after the PR program.

MAIN OUTCOME MEASURES

RCS-Ev13 and outcome measures: Barthel Index (BI), Barthel Index Dyspnoea (BiD), Medical Research Council Scale for dyspnoea (MRC), COPD Assessment Test (CAT), Short Physical Performance Battery (SPPB), Six-Minute Walking Test (6MWT).

RESULTS

The highest RCS-Ev13 admission values (median; IQR) were found in TX/V (17; 15-18) as compared to other groups (8; 7-10, 10; 9-12, 8; 8-10 in COPD, CRF and Miscellaneous respectively, p<0.001). At admission and discharge, RCS-Ev13 correlated strongly with BI, 6MWT, and SPPB and moderately with MRC and BiD (r: 0.43 to 0.60). After the program RCS-Ev13 as well as all outcome measures improved significantly in all groups (p< 0.001 for all). The size of improvement was different among groups according to the different variables. In the overall group the effect size was high for changes in RCS-E v13 (Cohen's d = -2.0984), CAT = (-1.1937), MRC (- 1.0505), BiD (- 0.9364) and SPPB (0.9231) while moderate for 6MWT (0.7670) and BI (0.6574).

CONCLUSIONS

RCS-E v13 varies according to different CRDs, is responsive to PR, has good construct and concurrent validity, and correlates with most of the accepted outcome measures of PR. Its scoring may provide useful information on the care burden of individuals undergoing PR.

Role of the internet of medical things in care for patients with interstitial lung disease

PURPOSE OF REVIEW

Online technologies play an increasing role in facilitating care for patients with interstitial lung disease (ILD). In this review, we will give an overview of different applications of the internet of medical things (IoMT) for patients with ILD.

RECENT FINDINGS

Various applications of the IoMT, including teleconsultations, virtual MDTs, digital information, and online peer support, are now used in daily care of patients with ILD. Several studies showed that other IoMT applications, such as online home monitoring and telerehabilitation, seem feasible and reliable, but widespread implementation in clinical practice is lacking. The use of artificial intelligence algorithms and online data clouds in ILD is still in its infancy, but has the potential to improve remote, outpatient clinic, and in-hospital care processes. Further studies in large real-world cohorts to confirm and clinically validate results from previous studies are needed.

SUMMARY

We believe that in the near future innovative technologies, facilitated by the IoMT, will further enhance individually targeted treatment for patients with ILD by interlinking and combining data from various sources.