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Xin H, Wei S, Zheng H, Qi Y, Xu S, Wang B, Jiang W, Deng N, Chen J. Comparison of a Supervised Home-Based Tele-Rehabilitation with Center-Based Pulmonary Rehabilitation: Protocol for a Randomized Non-Inferiority Multicenter Study in Ningxia. Int J Chron Obstruct Pulmon Dis 2024; 19:1707-1719. [PMID: 39081777 PMCID: PMC11287464 DOI: 10.2147/copd.s467945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/20/2024] [Indexed: 08/02/2024] Open
Abstract
Background Pulmonary rehabilitation (PR) is an effective intervention for people with chronic obstructive pulmonary disease (COPD). However, fewer than 5% of eligible individuals receive pulmonary rehabilitation, largely due to limited by the accessibility of rehabilitation and difficulties associated with travel and transport. Supervised home-based tele-rehabilitation (SHTR) is an alternative model to center-based pulmonary rehabilitation. We will determine whether supervised home-based tele-rehabilitation is non-inferior to center-based pulmonary rehabilitation. Methods The participants will undergo an 8-week rehabilitation program. Pulmonary rehabilitation comprises four main modules: exercise training, education, nutritional support, and psychological and behavioral interventions. We mainly focus on the module of exercise training and education. The education module includes information on exercise training, nutrition, and psychology, which are presented in an educational booklet provided to each participant. Blinded assessors will evaluate the outcomes at baseline, post-intervention, and 6 months after the intervention. The primary outcome is the change in the 6-minute walking distance. Secondary outcomes will assess changes in the patients' 1-minute sit-to-stand test, maximal inspiratory pressure (MIP), scales (CAT, mMRC, HAD), diaphragm ultrasound (TD, DE, DIF), changes in extrathoracic muscle volume and mass, completion rate of patient exercise prescriptions, occurrence of adverse events, as well as disease exacerbation and rehospitalization rates after rehabilitation and during the 6-month follow-up. Discussion In order to improve the accessibility of pulmonary rehabilitation and patient-related outcomes, it is necessary to propose an alternative model of pulmonary rehabilitation. This trial will establish whether a supervised home-based tele-rehabilitation is not inferior to traditional center-based pulmonary rehabilitation. Trial Registration Chinese Clinical Trial Registry ChiCTR2300076969. Registered on October 25, 2023.
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Affiliation(s)
- Hongxia Xin
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
| | - Shuoshuo Wei
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, Affiliated Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, People’s Republic of China
| | - Hao Zheng
- Department of Pulmonary and Critical Care Medicine, Yanchi County People’s Hospital, Wuzhong, Ningxia, People’s Republic of China
| | - Yanchao Qi
- Department of Pulmonary and Critical Care Medicine, Second People’s Hospital of Shizuishan, Shizuishan, Ningxia, People’s Republic of China
| | - Shuping Xu
- Department of Pulmonary and Critical Care Medicine II, Wuzhong People’s Hospital, WuZhong, Ningxia, People’s Republic of China
| | - Bei Wang
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
| | - Wangshu Jiang
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People’s Republic of China
| | - Ning Deng
- Ministry of Education Key Laboratory of Biomedical Engineering, College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, People’s Republic of China
| | - Juan Chen
- Department of Key Laboratory of Ningxia Stem Cell and Regenerative Medicine, Institute of Medical Sciences, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, People’s Republic of China
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Gullslett MK, Ronchi E, Lundberg L, Larbi D, Lind KF, Tayefi M, Ngo PD, Sy TR, Adib K, Hamilton C. Telehealth development in the WHO European region: Results from a quantitative survey and insights from Norway. Int J Med Inform 2024; 191:105558. [PMID: 39084085 DOI: 10.1016/j.ijmedinf.2024.105558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/21/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The COVID-19 pandemic sent shock waves through societies, economies, and health systems of Member States in the WHO European Region and beyond. During the pandemic, most countries transitioned from a slow to a rapid adoption of telehealth solutions, to accommodate the public health and social measures introduced to mitigate the spread of the disease. As countries shift to a post-pandemic world, the question remains whether telehealth's importance as a mode of care provision in Europe continues to be significant. OBJECTIVE This paper aims to present, synthesize, and interpret results from the Telehealth Programmes section of the 2022 WHO Survey on Digital Health (2022 WHO/Europe DH Survey). We specifically analyze the implementation and use of teleradiology, telemedicine, and telepsychiatry. Norwegian telehealth experiences will be used to illustrate survey findings, and we discuss some of the relevant barriers and facilitators that impact the use of telehealth services. METHODS The survey tool was revised from the 2015 WHO Global Survey on eHealth, updated to reflect recent progress and policy priorities.The 2022 WHO/Europe DH Survey was conducted by WHO and circulated to Member States in its European Region from April to October 2022. RESULTS The data analysis revealed that teleradiology, telemedicine, and telepsychiatry are the telehealth services most commonly used in the WHO European Region in 2022. Funding remains the most significant barrier to the implementation of telehealth in the Region, followed by infrastructure and capacity/human resources. The survey results highlighted in this study are presented in the following sections: (1) telehealth strategies and financing, (2) telehealth programmes and services offered by Member States of the WHO European Region, (3) barriers to implementing telehealth services, and (4) monitoring and evaluation of telehealth. CONCLUSION Based on WHO's 2022 survey, the use of telehealth in the WHO European Region is on the rise. However, merely having telehealth in place is not sufficient for its successful and sustained use for care provision. Responses also uncovered regional differences and barriers that need to be overcome. Successful implementation and scaling of telehealth requires rethinking the design of health and social care systems to create robust, trustworthy, and person-centred digital health and care services.
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Affiliation(s)
| | - Elettra Ronchi
- Division of Country Health Policies and Systems, WHO, Europe
| | - Lene Lundberg
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Dillys Larbi
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Maryam Tayefi
- Norwegian Centre for E-health Research, Tromsø, Norway
| | | | - Tyrone Reden Sy
- Division of Country Health Policies and Systems, WHO, Europe
| | - Keyrellous Adib
- Division of Country Health Policies and Systems, WHO, Europe
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Hug S, Cavalheri V, Lawson-Smith H, Gucciardi DF, Hill K. Interventions with a clear focus on achieving behaviour change are important for maintaining training-related gains in people with chronic obstructive pulmonary disease: a systematic review. J Physiother 2024; 70:193-207. [PMID: 38918084 DOI: 10.1016/j.jphys.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/27/2024] Open
Abstract
QUESTIONS In people with chronic obstructive pulmonary disease (COPD) who complete an exercise training program (ETP) offered at a sufficient dose to result in training-related gains, to what extent are these gains maintained 12 months after program completion? Do variables such as the application of behaviour change techniques moderate the maintenance of these training-related gains? DESIGN Systematic review, meta-analysis and meta-regression of randomised controlled trials. PARTICIPANTS People with stable COPD. INTERVENTION Trials were included if they applied ≥ 4 weeks of a whole-body ETP and reported outcome data immediately following program completion and 12 months after initial program completion. The control group received usual care that did not include a formal exercise training component. OUTCOME MEASURES Exercise tolerance, health-related quality of life and dyspnoea during activities of daily living. DATA SOURCES EMBASE, PEDro, PubMed and the Cochrane Library. RESULTS Nineteen randomised trials with 2,103 participants were found, of which 12 had a sufficiently similar design to be meta-analysed. At 12 months after ETP completion, compared with the control group, the experimental group demonstrated better exercise tolerance (SMD 0.48, 95% CI 0.19 to 0.77) and quality of life (SMD 0.22, 95% CI 0.03 to 0.41) with no clear effect on dyspnoea. Meta-regression using data from all 19 trials demonstrated that the magnitude of between-group differences at the 12-month follow-up was moderated by: behaviour change being a core aim of the strategies implemented following completion of the ETP; the experimental group receiving more behaviour change techniques during the program; and the magnitude of between-group change achieved from the program. CONCLUSION At 12 months after completion of an ETP of ≥ 4 weeks, small gains were maintained in exercise tolerance and health-related quality of life. Applying behaviour change techniques with a clear focus on participants integrating exercise into daily life beyond initial program completion is important to maintain training-related gains. REGISTRATION CRD42020193833.
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Affiliation(s)
- Sarah Hug
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Physiotherapy Department, Royal Perth Hospital, Perth, Australia.
| | - Vinicius Cavalheri
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Allied Health, South Metropolitan Health Service, Perth, Australia; Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Hollie Lawson-Smith
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Daniel F Gucciardi
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Kylie Hill
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Australia
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Dai Y, Huang H, Zhang Y, He N, Shen M, Li H. The effects of telerehabilitation on physiological function and disease symptom for patients with chronic respiratory disease: a systematic review and meta-analysis. BMC Pulm Med 2024; 24:305. [PMID: 38943129 PMCID: PMC11212271 DOI: 10.1186/s12890-024-03104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/17/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVE To compare the impact of telerehabilitation versus conventional rehabilitation on the recovery outcomes of patients with chronic respiratory disease (CRD). METHODS The Cochrane Library, MEDLINE, Web of Science and Embase were searched to collect randomized controlled trials (RCTs) on telerehabilitation for the rehabilitation of patients with chronic respiratory system diseases since the establishment of the database to November 14, 2023. Two researchers independently screened the literature and extracted valid data according to the inclusion criteria. The quality assessment of included studies was conducted individually by using the RoB 2(Risk of Bias 2) tool, followed by meta-analysis using RevMan5.3 software. RESULTS Based on inclusion and exclusion criteria, 21 RCTs were included, comprising 3030 participants, with 1509 in the telerehabilitation group and 1521 in the conventional rehabilitation group. Meta-analysis results indicated that compared to conventional rehabilitation, video conference-based telerehabilitation demonstrated significant improvements in short-term (≤ 6 months) outcomes, including 6-min walk distance (6MWD) (MD = 7.52, 95% CI: 2.09, 12.94), modified Medical Research Council Dyspnea Scale (mMRC) (MD = -0.29, 95% CI: -0.41, -0.18), COPD assessment test (CAT) (MD = -1.77, 95% CI: -3.52, -0.02), HADS (MD = -0.44, 95% CI: -0.86, -0.03), and St. George's Respiratory Questionnaire (SGRQ's) activity, impact, and symptom scores. In the long term (> 6 months), although improvements persisted in 6WMD [MD = 12.89, 95% CI (-0.37, 26.14)], mMRC [MD = -0.38, 95% CI (-0.56, -0.21)], CAT [MD = -1.39, 95% CI (-3.83, 1.05)], Hospital anxiety and depression scale (HADS) [MD = -0.34, 95% CI (-0.66, -0.03)], and SGRQ's Activity, Impact, and Symptom scores between intervention and control groups, statistically significant differences were observed only for mMRC and HADS. Without considering time factors, the intervention group exhibited some improvement in FEV1% predicted and the forced expiratory volume in the first one second (FEV1)/ forced vital capacity (FVC) (%) without statistical significance compared to the control group. CONCLUSION Telerehabilitation therapy demonstrates short-term benefits in enhancing patients' daily activity capacity, improving respiratory function, and enhancing mental health status, thereby improving patients' quality of life. However, further high-quality, large-sample RCTs are required to ascertain its long-term effectiveness conclusively. TRIAL REGISTRATION This study protocol was approved and registered in PROSPERO: CRD 42024509154.
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Affiliation(s)
- Yue Dai
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
| | - Hao Huang
- West China School of Nursing, Sichuan University, Sichuan, China
- Department of Nursing, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuchen Zhang
- Department of Day Surgery, West China Hospital, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Na He
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, Sichuan, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, Sichuan, China
| | - Min Shen
- Department of Nursing, West China Tianfu Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Li
- Department of Emergency Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
- Institute of Disaster Medicine, Sichuan University, Chengdu, Sichuan, China.
- Nursing Key Laboratory of Sichuan Province, Chengdu, Sichuan, China.
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Aburub A, Darabseh MZ, Badran R, Eilayyan O, Shurrab AM, Degens H. The Effects of Digital Health Interventions for Pulmonary Rehabilitation in People with COPD: A Systematic Review of Randomized Controlled Trials. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:963. [PMID: 38929580 PMCID: PMC11206104 DOI: 10.3390/medicina60060963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 05/30/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Chronic Obstructive Pulmonary Disease (COPD) is the third most common cause of death globally. Pulmonary rehabilitation (PR) programmes are important to reduce COPD symptoms and improve the quality of life of people with COPD. Digital health interventions have recently been adopted in PR programmes, which allow people with COPD to participate in such programmes with low barriers. The aim of this study is to review and discuss the reported effects of digital health interventions on PR outcomes in people with COPD. Materials and Methods: To achieve the study goals, a systematic literature search was conducted using PubMed (MEDLINE), CINAHL, AMED, SPORTDiscus and the Physiotherapy Evidence Database. Randomised clinical trials (RCTs) were included if they met specified criteria. Two reviewers independently checked titles, abstracts, and performed full-text screening and data extraction. The quality assessment and risk of bias were performed in accordance with the PEDRO scale and Cochrane Risk of Bias tool 2, respectively. Results: Thirteen RCTs were included in this systematic review with 1525 participants with COPD. This systematic review showed the potential positive effect of digital health PR on the exercise capacity-measured by 6- and 12-min walking tests, pulmonary function, dyspnoea and health-related quality of life. There was no evidence for advantages of digital health PR in the improvement of anxiety, depression, and self-efficacy. Conclusions: Digital health PR is more effective than traditional PR in improving the pulmonary and physical outcomes for people with COPD, but there was no difference between the two PR programmes in improving the psychosocial outcomes. The certainty of the findings of this review is affected by the small number of included studies.
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Affiliation(s)
- Aseel Aburub
- Department of Physiotherapy, Applied Science Private University, Amman 11931, Jordan;
| | - Mohammad Z. Darabseh
- Department of Physiotherapy, School of Rehabilitation Sciences, The University of Jordan, Amman 11942, Jordan
| | - Rahaf Badran
- Department of Physiotherapy, Faculty of Applied Medical Sciences, Middle East University, Amman 11831, Jordan
| | - Owis Eilayyan
- Department of Physical Therapy, Al-Ahliyya Amman University, Amman 19111, Jordan;
| | - Ala’a M. Shurrab
- Department of Basic Medical Science, Faculty of Medicine, Al-Balqa Applied University, Al Salt 19117, Jordan;
| | - Hans Degens
- Department of Life Sciences, Institute of Sport, Manchester Metropolitan University, Manchester M1 5GD, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
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Moy ML. Maintenance Pulmonary Rehabilitation: An Update and Future Directions. Respir Care 2024; 69:724-739. [PMID: 38744473 PMCID: PMC11147634 DOI: 10.4187/respcare.11609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend pulmonary rehabilitation (PR) for individuals with COPD to improve exercise capacity and health-related quality of life (HRQOL) and reduce symptoms of dyspnea. For cost-effectiveness in COPD care, PR is second only to smoking cessation. However, PR programs typically last 9-12 weeks. The benefits of PR in terms of exercise capacity and HRQOL often decrease toward pre-PR levels as early as 3-6 months after completing PR if patients do not continue to engage in exercise. This review will (1) briefly summarize the efficacy data that informed the 2023 American Thoracic Society (ATS) clinical practice guidelines for maintenance PR, (2) discuss exercise components of maintenance PR studied since 2020 when the last papers were included in the ATS guidelines, (3) explore future directions for delivery of maintenance PR using technology-mediated models, and (4) examine the need for behavior change techniques informed by theoretical models that underpin long-term behavior change. This review will focus on persons with COPD who have completed an out-patient core initial PR program as most of the data on maintenance PR have been published in this patient population. Core PR typically implies a facility-based initial intensive structured program. All patients who complete a core initial PR program should be counseled by PR staff at the discharge visit to engage in ongoing exercise. This usual care is equally as important as referral to a formal PR maintenance program. It is critical to emphasize that usual care after core initial PR means all patients should be supported to participate in regular ongoing exercise, regardless of whether supervised maintenance PR is available. Currently, the optimal frequency, exercise and/or physical activity content, and delivery mode for maintenance PR in persons with COPD and other chronic respiratory diseases remain unknown. Patient safety and degree of in-person supervision required due to the severity of the underlying lung disease need to be considered. Future research of maintenance PR should be underpinned by behavior change techniques. Finally, in the setting of finite resources, balancing the competing priorities of core initial programs with those of maintenance PR programs needs to be achieved.
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Affiliation(s)
- Marilyn L Moy
- Harvard Medical School, Boston, Massachusetts; and Pulmonary and Critical Care Medicine Department, VA Boston Healthcare System, Boston, Massachusetts.
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Sarpourian F, Sharifian R, Poursadeghfard M, Khayami SR, Erfannia L. Comparison of the Clinical Effectiveness of Telerehabilitation with Traditional Rehabilitation Methods in Multiple Sclerosis Patients: A Systematic Review. Telemed J E Health 2024. [PMID: 38739448 DOI: 10.1089/tmj.2023.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
Background: The rehabilitation process for multiple sclerosis (MS) patients is long and complex, which can lead to reduced rehabilitation outcomes and reduced quality improvement. Thus, there is a need to use new methods to boost traditional rehabilitation. Innovations such as telerehabilitation can be helpful to remove the obstacles to treatment, but evidence for their effectiveness is limited. The objective of this work was to compare the clinical effectiveness of telerehabilitation with traditional interventions in MS patients. Methods: Seven bibliographic databases (PubMed, Cochran Library, Scopus, Science Direct, Web of Science, Embase, and ProQuest) were used in this research. The initial search resulted in the extraction of 8,239 articles; after the review of the title, abstract, and full text, 11 articles were selected. In addition, backward reference list checking of the selected studies was conducted. Studies that were related to our objectives were included. Quality assessment was performed using the CONSORT checklist. Then, data extraction was done using the form set by the researcher in Word 2016 software. Results: Overall, telerehabilitation achieved more positive effects compared to traditional rehabilitation on physical (n = 6), cognitive (n = 3), cognitive, and physical outcomes (n = 2), respectively. Synchronous telerehabilitation was more effective than other modalities (n = 8). In four studies, virtual reality-based telerehabilitation was used. Also, telerehabilitation in home offered better clinical outcomes compared to rehabilitation center (n = 9). Conclusions: This review provides evidence for the potential effectiveness of telerehabilitation for the improvement of clinical outcomes in MS patients. However, more robust randomized controlled trials are needed to confirm the observed positive effects.
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Affiliation(s)
- Fatemeh Sarpourian
- Department of Health Information Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Roxana Sharifian
- Department of Health Information Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Poursadeghfard
- Department of Neurology, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Raouf Khayami
- Department of Computer Engineering and Information Technology, Shiraz University of Technology, Shiraz, Iran
| | - Leila Erfannia
- Department of Health Information Management, School of Health Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Kim C, Choi HE, Rhee CK, Song JH, Lee JH. Efficacy of Digital Therapeutics for Pulmonary Rehabilitation: A Multi-Center, Randomized Controlled Trial. Life (Basel) 2024; 14:469. [PMID: 38672740 PMCID: PMC11051347 DOI: 10.3390/life14040469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND This study aimed to investigate the efficacy and safety of digital therapeutics (DTx), EASYBREATH, for pulmonary rehabilitation (PR) in patients with chronic respiratory diseases (CRDs). MATERIALS AND METHODS This prospective randomized controlled trial was conducted at multiple centers. Participants were randomly allocated 1:1 to the DTx group (DTxG), provided with DTx using EASYBREATH. The DTxG underwent an 8-week PR program with evaluations conducted at baseline, four weeks, and eight weeks. The control group (CG) underwent one PR session and was advised to exercise and undergo the same evaluation. The primary outcome was the change in six-minute walking distance (6MWD) over eight weeks, and secondary outcomes included changes in scores of Modified Medical Research Council (mMRC), chronic obstructive pulmonary disease assessment test (CAT), and St. George's respiratory questionnaire (SGRQ). RESULTS The change in 6MWD after eight weeks demonstrated a significant difference between the DTxG and CG (57.68 m vs. 21.71 m, p = 0.0008). The change in mMRC scores (p = 0.0008), CAT scores (p < 0.0001), and total SGRQ scores (p = 0.0003) also showed a significant difference between the groups after eight weeks. CONCLUSIONS EASYBREATH significantly improved exercise capacity, alleviated dyspnea, and enhanced the overall quality of life at eight weeks. EASYBREATH is a highly accessible, time-efficient, and effective treatment option for CRD with high compliance.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea; (C.K.); (J.H.S.)
| | - Hee-Eun Choi
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea;
- Share and Service Inc., Busan 48002, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 02812, Republic of Korea;
| | - Jun Hyeong Song
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea; (C.K.); (J.H.S.)
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea
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Chai X, Wu L, He Z. Effects of virtual reality-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: A meta-analysis. Medicine (Baltimore) 2023; 102:e36702. [PMID: 38206693 PMCID: PMC10754576 DOI: 10.1097/md.0000000000036702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Virtual reality (VR)-based pulmonary rehabilitation has been used in the management of chronic obstructive pulmonary disease (COPD). The efficacy of VR-based pulmonary rehabilitation for improving lung function in patients with COPD is controversial. Therefore, the aim of this meta-analysis was to evaluate the efficacy of VR combined with pulmonary rehabilitation for lung function in patients with COPD. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search was performed in the Cochrane Library, EMBASE, Web of Science, PubMed, and China National Knowledge Infrastructure databases from inception to February 1, 2023. All included studies were randomized controlled trials that assessed VR combined with pulmonary rehabilitation for COPD patients. The effect size was calculated with standardized mean difference (SMD) and its 95% confidence interval (CI). The Cochrane Collaboration tool was used to assess the risk of bias. Publication bias was assessed by Egger test. RESULTS A total of 11 studies met the inclusion criteria and were included in this study. The combined effect size showed that VR combined with pulmonary rehabilitation was more effective than pulmonary rehabilitation alone at improving forced expiratory volume in 1 second% (SMD: 0.51; 95% CI 0.19,0.82; P = .002), forced expiratory volume in 1 second/forced vital capacity (SMD: 0.71; 95% CI 0.49,0.93; P < .001), dyspnea (SMD: -0.44; 95% CI -0.66, -0.22; P < .001), and 6-minute walking test (SMD: 059; 95% CI 0.39, 0.79; P < .001). In addition, the VR combined with pulmonary rehabilitation improved depression (SMD: -0.34; 95% CI -0.05, -0.03; P = .033) and anxiety mood (SMD: -0.57; 95% CI -1.11, -0.04; P = .036) compared with the pulmonary rehabilitation group. CONCLUSION This meta-analysis indicated that VR regimens could be used to enhance the therapeutic effect of pulmonary rehabilitation in patients with COPD. However, as a rapidly evolving field, more well-designed randomized controlled trials are needed to determine the impact of VR-based pulmonary rehabilitation on COPD patients.
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Affiliation(s)
- Xiuqin Chai
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, China
| | - Lingyun Wu
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Zhihong He
- Department of Pulmonary and Critical Care Medicine, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Quzhou, Zhejiang, China
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Alghamdi SM. Content, Mechanism, and Outcome of Effective Telehealth Solutions for Management of Chronic Obstructive Pulmonary Diseases: A Narrative Review. Healthcare (Basel) 2023; 11:3164. [PMID: 38132054 PMCID: PMC10742533 DOI: 10.3390/healthcare11243164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
Telehealth (TH) solutions for Chronic Obstructive Pulmonary Disease (COPD) are promising behavioral therapeutic interventions and can help individuals living with COPD to improve their health status. The linking content, mechanism, and outcome of TH interventions reported in the literature related to COPD care are unknown. This paper aims to summarize the existing literature about structured TH solutions in COPD care. We conducted an electronic search of the literature related to TH solutions for COPD management up to October 2023. Thirty papers presented TH solutions as an innovative treatment to manage COPD. TH and digital health solutions are used interchangeably in the literature, but both have the potential to improve care, accessibility, and quality of life. To date, current TH solutions in COPD care have a variety of content, mechanisms, and outcomes. TH solutions can enhance education as well as provide remote monitoring. The content of TH solutions can be summarized as symptom management, prompt physical activity, and psychological support. The mechanism of TH solutions is manipulated by factors such as content, mode of delivery, strategy, and intensity. The most common outcome measures with TH solutions were adherence to treatment, health status, and quality of life. Implementing effective TH with a COPD care bundle must consider important determinants such as patient's needs, familiarity with the technology, healthcare professional support, and data privacy. The development of effective TH solutions for COPD management also must consider patient engagement as a positive approach to optimizing implementation and effectiveness.
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Affiliation(s)
- Saeed Mardy Alghamdi
- Respiratory Care Program, Clinical Technology Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah 21961, Saudi Arabia
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Thomas M, Beasley R. The treatable traits approach to adults with obstructive airways disease in primary and secondary care. Respirology 2023; 28:1101-1116. [PMID: 37877554 DOI: 10.1111/resp.14610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023]
Abstract
The treatable traits approach is based on the recognition that the different clinical phenotypes of asthma and chronic obstructive airways disease (COPD) are a heterogeneous group of conditions with different underlying mechanisms and clinical manifestations, and that the identification and treatment of the specific clinical features or traits facilitates a personalised approach to management. Fundamentally, it recognises two important concepts. Firstly, that treatment for obstructive lung disease can achieve better outcomes if guided by specific clinical characteristics. Secondly, that in patients with a diagnosis of asthma, and/or COPD, poor respiratory health may also be due to numerous overlapping disorders that can present with symptoms that may be indistinguishable from asthma and/or COPD, comorbidities that might require treatment in their own right, and lifestyle or environmental factors that, if addressed, might lead to better control rather than simply increasing airways directed treatment. While these concepts are well accepted, how best to implement this personalised medicine approach in primary and secondary care within existing resource constraints remains uncertain. In this review, we consider the evidence base for this management approach and propose that the priority now is to assess different prototype templates for the identification and management of treatable traits in both asthma and COPD, in primary, secondary and tertiary care, to provide the evidence that will guide their use in clinical practice in different health care systems.
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Affiliation(s)
- Mike Thomas
- Primary Care Research, School of Primary Care, Population Sciences and Medical Education (PPM), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Richard Beasley
- Medicine, Medical Research Institute of New Zealand, Wellington, New Zealand
- Victoria University of Wellington, Wellington, New Zealand
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LaMarca A, Tse I, Keysor J. Rehabilitation Technologies for Chronic Conditions: Will We Sink or Swim? Healthcare (Basel) 2023; 11:2751. [PMID: 37893825 PMCID: PMC10606667 DOI: 10.3390/healthcare11202751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Chronic conditions such as stroke, Parkinson's disease, spinal cord injury, multiple sclerosis, vestibular disorders, chronic pain, arthritis, diabetes, chronic obstructive pulmonary disease (COPD), and heart disease are leading causes of disability among middle-aged and older adults. While evidence-based treatment can optimize clinical outcomes, few people with chronic conditions engage in the recommended levels of exercise for clinical improvement and successful management of their condition. Rehabilitation technologies that can augment therapeutic care-i.e., exoskeletons, virtual/augmented reality, and remote monitoring-offer the opportunity to bring evidence-based rehabilitation into homes. Successful integration of rehabilitation techniques at home could help recovery and access and foster long term self-management. However, widespread uptake of technology in rehabilitation is still limited, leaving many technologies developed but not adopted. METHODS In this narrative review, clinical need, efficacy, and obstacles and suggestions for implementation are discussed. The use of three technologies is reviewed in the management of the most prevalent chronic diseases that utilize rehabilitation services, including common neurological, musculoskeletal, metabolic, pulmonary, and cardiac conditions. The technologies are (i) exoskeletons, (ii) virtual and augmented reality, and (iii) remote monitoring. RESULTS Effectiveness evidence backing the use of technology in rehabilitation is growing but remains limited by high heterogeneity, lack of long-term outcomes, and lack of adoption outcomes. CONCLUSION While rehabilitation technologies bring opportunities to bridge the gap between clinics and homes, there are many challenges with adoption. Hybrid effectiveness and implementation trials are a possible path to successful technology development and adoption.
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Affiliation(s)
- Amber LaMarca
- Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA 02129, USA;
| | - Ivy Tse
- Doctor of Physical Therapy Program, MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Julie Keysor
- School of Health Care Leadership, MGH Institute of Health Professions, Boston, MA 02129, USA
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Heerema J, Hug S, Bear N, Hill K. Characterising hospitalisation risk for chronic obstructive pulmonary disease exacerbations: Bedside and outpatient clinic assessments of easily measured variables. Chron Respir Dis 2023; 20:14799731231211852. [PMID: 37934787 PMCID: PMC10631319 DOI: 10.1177/14799731231211852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/15/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVE To identify the characteristics of people with chronic obstructive pulmonary disease (COPD) who require hospitalisation for exacerbations. METHODS People with COPD were recruited either during hospitalisation or from out-patient respiratory medicine clinics. Hospital admissions were tracked throughout the 5-months recruitment period. For participants who were admitted, hospital readmissions were tracked for at least 30 days following discharge. Participants were grouped as either needing; (i) no hospital admission during the study period (no admission; ø-A), (ii) one or more hospital admissions during the study period but no readmission within 30 days of discharge (no rapid readmission; ø-RR) or (iii) one or more hospital admissions with a readmission within 30 days of discharge (rapid readmission; RR). RESULTS Compared with the ø-A group (n=211), factors that independently increased the risk of ø-RR (n=146) and/or RR (n=57) group membership were being aged >60 years, identifying as an Indigenous person (relative risk ratio, 95% confidence interval 7.8 [1.8 to 34.0]) and the use of a support person or community service for activities of daily living (1.5 [1.0 to 2.4]. A body mass index ≥25 kg/m2 was protective. CONCLUSIONS Variables recorded at the bedside or in clinic provided information on hospitalisation risk.
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Affiliation(s)
- Joshua Heerema
- Physiotherapy Department, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Sarah Hug
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Physiotherapy Department, Royal Perth Hospital, Perth, Australia
| | - Natasha Bear
- Institute of Health Sciences, Notre Dame University, Perth, Australia
| | - Kylie Hill
- Curtin School of Allied Health, Curtin University, Perth, Australia
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