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Rutkowski S, Bogacz K, Rutkowska A, Szczegielniak J, Casaburi R. Inpatient post-COVID-19 rehabilitation program featuring virtual reality-Preliminary results of randomized controlled trial. Front Public Health 2023; 11:1121554. [PMID: 36815161 PMCID: PMC9939639 DOI: 10.3389/fpubh.2023.1121554] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 01/23/2023] [Indexed: 02/09/2023] Open
Abstract
Background Numerous recommendations from pulmonary scientific societies indicate the need to implement rehabilitation programs for patients after COVID-19. The aim of this study was to propose an innovative comprehensive intervention based on a hospital-based pulmonary rehabilitation program for individuals with post-acute sequelae of COVID-19. Methods It was decided to evaluate two forms of hospital rehabilitation: traditional and one provided through virtual reality. Preliminary results are based on a group of 32 patients (20 female and 12 male), of average age 57.8 (4.92) years in the period of 3-6 months after the initial infection. Primary outcomes included analysis of lung function, exercise performance and stress level. A 3-week, high-intensity, five-times per week pulmonary rehabilitation program was designed to compare the effectiveness of a traditional form with a VR-led, novel form of therapy. Results The analysis of the results showed a statistically significant improvement in both groups with regard to exercise performance expressed as 6MWT distance. Moreover, a statistically significant decrease in dyspnoea levels following the 6MWT was also noted in intergroup comparison, but the between-group comparison revealed non-statistically significant changes with low effect size. Regarding lung function, the analysis showed essentially normal lung function at baseline and a non-statistically significant improvement after the completion of the rehabilitation program. The analysis of the stress level showed a statistically significant improvement in both groups within the inter-group comparison, yet the between-group comparison of deltas values showed a non-significant difference with low effect size. Conclusion A 3-weeks inpatients pulmonary rehabilitation program led to improvement of the exercise performance of people with post-acute sequelae of COVID-19, but not lung function. Furthermore, the program was shown to reduce patients' stress levels. A comparison of the traditional form of rehabilitation to the novel form using VR, shows similar effectiveness in terms of exercise performance and stress levels.
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Affiliation(s)
- Sebastian Rutkowski
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,*Correspondence: Sebastian Rutkowski ✉
| | - Katarzyna Bogacz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy, Głuchołazy, Poland
| | - Anna Rutkowska
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Jan Szczegielniak
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland,Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy, Głuchołazy, Poland
| | - Richard Casaburi
- Rehabilitation Clinical Trials Center, Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States
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Rutkowski S, Bogacz K, Czech O, Rutkowska A, Szczegielniak J. Effectiveness of an Inpatient Virtual Reality-Based Pulmonary Rehabilitation Program among COVID-19 Patients on Symptoms of Anxiety, Depression and Quality of Life: Preliminary Results from a Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416980. [PMID: 36554860 PMCID: PMC9779397 DOI: 10.3390/ijerph192416980] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 06/01/2023]
Abstract
Forms of rehabilitation for patients after COVID-19 are gaining interest. The purpose of this study was to investigate and compare an innovative in-hospital pulmonary rehabilitation programs augmented with training elements performed in virtual reality. This randomized controlled study included 32 patients enrolled in post-COVID-19 rehabilitation at a Public Hospital in Poland. The rehabilitation models included exercise capacity training on a cycle ergometer, breathing and general fitness workout, resistance training, and relaxation. The forms of training and relaxation differed between the groups: the experimental group employed virtual reality, and the control group used a traditional form of therapy. Exercise tolerance was assessed using a 6 min walk test (6 MWT), while psychological parameters were evaluated using the Hospital Anxiety and Depression Scale (HADS) and the brief World Health Organization Quality of Life Scale (WHOQOL-BRIEF). The analysis of the post-rehabilitation results showed a statistically significant improvement in both groups regarding depression (VR: 6.9 (3.9) vs. 4.7 (3.5), p = 0.008; CG: 7.64 (4.5) vs. 6.6 (4.8), p = 0.017) and anxiety (VR: 8.6 (4.6) vs. 5.6 (3.3), p < 0.001; CG: 9.57 (6.0) vs. 8 (4.8), p = 0.003). No statistically significant improvements in quality of life were noted in both groups. Moreover, the analysis showed a statistically significant improvement in the exercise capacity in both groups after completion of the rehabilitation program, expressed as a distance in the 6 MWT, as well as a statistically significant improvement in dyspnea in the VR group. To conclude, the analysis of the preliminary data revealed that a 3-week hospital-based pulmonary rehabilitation program for COVID-19 patients led to an improvement in exercise tolerance as well as a reduction in the symptoms of anxiety and depression. The virtual reality-based form of training delivery, despite its attractiveness, did not significantly affect patients' performance.
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Affiliation(s)
- Sebastian Rutkowski
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
| | - Katarzyna Bogacz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
- Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy, 48-340 Głuchołazy, Poland
| | - Oliver Czech
- Department of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | - Anna Rutkowska
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
| | - Jan Szczegielniak
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
- Specialist Hospital of the Ministry of the Interior and Administration in Głuchołazy, 48-340 Głuchołazy, Poland
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Szczegielniak J, Szczegielniak A, Łuniewski J, Bogacz K. Proprietary Model of Qualification for In-Hospital Rehabilitation after COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10450. [PMID: 36012085 PMCID: PMC9408005 DOI: 10.3390/ijerph191610450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Since the beginning of the SARS-CoV-2 epidemic in Poland, 6,128,006 people have been diagnosed, of which 116,798 died. Patients who recovered from COVID-19 and require rehabilitation due to varied impairments should be provided an opportunity to participate in an individualized, complex rehabilitation program starting from acute care and being continued in the post-acute and long-term rehabilitation phase. It is recommended to offer out-patient and in-hospital rehabilitation procedures depending on the type and persistence of symptoms and dysfunctions. The aim of this paper is to present the qualification process of post-COVID19 patients for an in-hospital complex rehabilitation program developed on the basis of pulmonary physical therapy. METHODS The presented qualification program was developed on the basis of clinical experience of over 2000 patients participating in the pilot program of in-hospital rehabilitation launched in September 2020 and based on the Regulation of the Polish Minister of Health of 13 July 2020. RESULTS The proposed model of patients' qualification rests on well-known and validated tools for functional assessment: exercise tolerance assessment, dyspnea intensity assessment, functional fitness assessment, assessment of arterial blood saturation, lung ventilation function assessment, assessment of long-lasting COVID-19 symptoms, and patient's basic mental health condition. CONCLUSIONS The proposed qualification model for the post-COVID rehabilitation program allows us to introduce adequate qualifications followed by much needed assessment of the health effects.
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Affiliation(s)
- Jan Szczegielniak
- Physiotherapy Department, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
- Ministry of Internal Affairs and Administration’s Specialist Hospital of St. John Paul II, 48-340 Głuchołazy, Poland
| | - Anna Szczegielniak
- Department of Psychoprophylaxis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jacek Łuniewski
- Physiotherapy Department, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
- Stobrawskie Medical Center in Kup, 46-082 Kup, Poland
| | - Katarzyna Bogacz
- Physiotherapy Department, Faculty of Physical Education and Physiotherapy, Opole University of Technology, 45-758 Opole, Poland
- Ministry of Internal Affairs and Administration’s Specialist Hospital of St. John Paul II, 48-340 Głuchołazy, Poland
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Monitoring Physical Activity with a Wearable Sensor in Patients with COPD during In-Hospital Pulmonary Rehabilitation Program: A Pilot Study. SENSORS 2021; 21:s21082742. [PMID: 33924536 PMCID: PMC8068926 DOI: 10.3390/s21082742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/08/2021] [Accepted: 04/11/2021] [Indexed: 01/10/2023]
Abstract
Accelerometers have become a standard method of monitoring physical activity in everyday life by measuring acceleration in one, two, or three axes. These devices provide reliable and objective measurements of the duration and intensity of physical activity. We aimed to investigate whether patients undertake physical activity during non-supervised days during stationary rehabilitation and whether patients adhere to the rigor of 24 h monitoring. The second objective was to analyze the strengths and weaknesses of such kinds of sensors. The research enrolled 13 randomly selected patients, qualified for in-patient, 3 week, high-intensity, 5 times a week pulmonary rehabilitation. The SenseWear armband was used for the assessment of physical activity. Participants wore the device 24 h a day for the next 4 days (Friday-Monday). The analysis of the number of steps per day, the time spent lying as well as undertaking moderate or vigorous physical activity (>3 metabolic equivalents of task (METs)), and the energy expenditure expressed in kcal showed no statistically significant difference between the training days and the days off. It seems beneficial to use available physical activity sensors in patients with chronic obstructive pulmonary disease (COPD); measurable parameters provide feedback that may increase the patient's motivation to be active to achieve health benefits.
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Assessment of Stress, Depressive and Anxiety Symptoms in Patients with COPD during In-Hospital Pulmonary Rehabilitation: An Observational Cohort Study. ACTA ACUST UNITED AC 2021; 57:medicina57030197. [PMID: 33669130 PMCID: PMC7996584 DOI: 10.3390/medicina57030197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 12/21/2022]
Abstract
Background and Objectives: The relationship between physical health and mental health has been considered for years. A number of studies have shown a correlation between depressive states and the progress of somatic diseases. It seems that the proper cooperation of specialists may result in the improvement of the patient’s well-being and a positive effect on the course of the rehabilitation process. The aim of this study was to assess the symptoms of depression, anxiety, and stress in patients with chronic obstructive pulmonary disease (COPD) as well as the assessment of the relationship of psychological symptoms with sociodemographic factors and physical condition. Materials and Methods: The study enrolled 51 COPD patients who underwent a three-week pulmonary rehabilitation program. After admission to the rehabilitation department, the subjects were asked to complete the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perception of Stress Questionnaire (PSQ), and a sociodemographic questionnaire. Results: Anxiety states were diagnosed in 70% of respondents and depressive states were diagnosed in 54% of patients. Some of the respondents (14%) also showed a tendency to experience various grounded stresses. Additionally, there were correlations between the mental state and the results of fitness and respiratory tests. Conclusions: Patients with COPD are at risk for mental disorders, which may adversely affect their general health and significantly limit their physical and respiratory efficiencies. The development of widely available therapeutic solutions to reduce symptoms associated with depression, anxiety, and stress seems to be an important challenge for the management of patients with COPD.
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Portable Oxygen Therapy: Is the 6-Minute Walking Test Overestimating the Actual Oxygen Needs? J Clin Med 2020; 9:jcm9124007. [PMID: 33322352 PMCID: PMC7764027 DOI: 10.3390/jcm9124007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 01/07/2023] Open
Abstract
The appropriate titration for the personalized oxygen needs of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia is a determining factor in the success of long-term oxygen therapy. There are no standardized procedures to assist in determining the patient’s needs during the physical activities of daily life. Despite that effort tests are a wide broad approach, further research concerning the development of protocols to titrate O2 therapy is needed. The main objective of this study was to assess whether the level of oxygen titrated through the 6-minute walking test (6MWT) for patients with COPD and exertional hypoxemia is adequate to meet the patients’ demand during their activities of daily living. Physiological and subjective variables were estimated for a study population during two walking tests: a 6MWT and a 20-minute walking circuit (20MWC), designed ad-hoc to reproduce daily physical activities more truthfully. The results indicate that in a significant proportion of patients, the 6MWT might not accurately predict their oxygen needs at a domiciliary environment. Therefore, the titration of the portable O2 therapy could not be optimal in these cases, with the detrimental impact on the patient’s health (hyperoxia episodes), the autonomy of the oxygen device, and the decrease of time out of the home.
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Kang K, Meng X, Li B, Yuan J, Tian E, Zhang J, Zhang W. Effect of thoracic paravertebral nerve block on the early postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery. World J Surg Oncol 2020; 18:298. [PMID: 33183325 PMCID: PMC7664097 DOI: 10.1186/s12957-020-02071-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 10/27/2020] [Indexed: 12/31/2022] Open
Abstract
Objective To evaluate the effect of thoracic paravertebral nerve block on early postoperative rehabilitation in patients undergoing radical thoracoscopic surgery for lung cancer. Methods Ninety patients scheduled for elective video-assisted thoracoscopic lobectomy of lung cancer were divided into 2 groups: the general anesthesia group (GA group, n = 45) and the TPVB group (TP group, n = 45). The primary outcome was the decline rate of the 6-min walking test (6MWT); the second outcomes were as follows: absolute value and the completion rate of 6MWT, postoperative analgesia deficiency and pain scores, oxycodone consumption, sleep quality, the incidence of postoperative pulmonary complications, and the hospital stay. Results Compared with the GA group, the TP group had a lower decline rate of the 6MWT on POD1 and POD2. The walking distance on POD1 and POD2 in the TP group was significantly longer than that in the GA group; the completion rate at POD1 in the TP group was higher than that in the GA group. The pain scores and oxycodone consumption at POD1 in the TP group were lower than the GA group. The sleep quality in the TP group was higher than the GA group. Conclusions TPVB can significantly improve postoperative rehabilitation in patients undergoing thoracoscopic radical lung cancer surgery, which is helpful for promoting the early recovery of patients. Trial registration Chinese Clinical Trial Registry, ChiCTR1900026213. Registered 26 Sept. 2019, http://www.chictr.org.cn/showproj.aspx?proj=43733.
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Affiliation(s)
- Kang Kang
- Department of Perioperative Medicine and Anesthesiology, Henan University People's Hospital; Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China
| | - Xing Meng
- Department of Perioperative Medicine and Anesthesiology, Henan University People's Hospital; Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China
| | - Bing Li
- Department of Perioperative Medicine and Anesthesiology, Henan University People's Hospital; Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China
| | - Jingli Yuan
- Department of Perioperative Medicine and Anesthesiology, Henan University People's Hospital; Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China
| | - Erhu Tian
- Department of Cardiology, Henan University People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China
| | - Jiaqiang Zhang
- Department of Perioperative Medicine and Anesthesiology, Henan University People's Hospital; Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China
| | - Wei Zhang
- Department of Perioperative Medicine and Anesthesiology, Henan University People's Hospital; Henan Provincial People's Hospital, No. 7, Weiwu Road, Zhengzhou City, Henan Province, China.
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Rutkowski S, Rutkowska A, Kiper P, Jastrzebski D, Racheniuk H, Turolla A, Szczegielniak J, Casaburi R. Virtual Reality Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial. Int J Chron Obstruct Pulmon Dis 2020; 15:117-124. [PMID: 32021150 PMCID: PMC6968810 DOI: 10.2147/copd.s223592] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/21/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose This study compared the effects of inpatient-based rehabilitation program of patients with chronic obstructive pulmonary disease (COPD) using non-immersive virtual reality (VR) training with a traditional pulmonary rehabilitation program. The aims of this study were to determine 1) whether rehabilitation featuring both VR as well as exercise training provides benefits over exercise training (ET) alone and 2) whether rehabilitation featuring VR training instead of exercise training provides equivalent benefits. Patients and Methods The study recruited 106 patients with COPD to a 2-week high-intensity, five times a week intervention. Randomized into three groups, 34 patients participated in a traditional pulmonary rehabilitation program including endurance exercise training (ET), 38 patients participated in traditional pulmonary rehabilitation, including both endurance exercise training and virtual reality training (ET+VR) and 34 patients participated in pulmonary rehabilitation program including virtual reality training but no endurance exercise training (VR). The traditional pulmonary rehabilitation program consisted of fitness exercises, resistance respiratory muscle and relaxation training. Xbox 360® and Kinect® Adventures software were used for the VR training of lower and upper body strength, endurance, trunk control and dynamic balance. Comparison of the changes in the Senior Fitness Test was the primary outcome. Analysis was performed using linear mixed-effects models. Results The comparison between ET and ET+VR groups showed that ET+VR group was superior to ET group in Arm Curl (p<0.003), Chair stand (p<0.008), Back scratch (p<0.002), Chair sit and reach (p<0.001), Up and go (p<0.000), 6-min walk test (p<0.011). Whereas, the comparison between ET and VR groups showed that VR group was superior to ET group in Arm Curl (p<0.000), Chair stand (p<0.001), 6-min walk test (p<0.031). Conclusion Results suggest that pulmonary rehabilitation program supplemented with VR training is beneficial intervention to improve physical fitness in patients with COPD.
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Affiliation(s)
- Sebastian Rutkowski
- Institute of Physiotherapy, Department of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Anna Rutkowska
- Institute of Physiotherapy, Department of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Paweł Kiper
- Laboratory of Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - Dariusz Jastrzebski
- School of Medicine with the Division of Dentistry, Department of Lung Diseases and Tuberculosis, Medical University of Silesia, Zabrze, Poland
| | - Henryk Racheniuk
- Institute of Physiotherapy, Department of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, Fondazione Ospedale San Camillo IRCCS, Venice, Italy
| | - Jan Szczegielniak
- Institute of Physiotherapy, Department of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Richard Casaburi
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
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Giansanti D, Maccioni G. Toward the Integration of Devices for Pulmonary Respiratory Rehabilitation in Telemedicine and e-Health. Telemed J E Health 2018; 25:257-259. [PMID: 30040535 DOI: 10.1089/tmj.2018.0057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Respiratory rehabilitation is a therapeutic path based on performing regular physical exercise. It aims to modify the impact that the respiratory disease has on the patients' quality of life, reducing the severity of the symptoms, and improving their ability to adhere to the activities of daily life. After an initial assessment, they are prescribed (1) different forms and modes of physical exercise and (2) exercise of pulmonary musculature to improve individual performance and the consequences of the symptoms of the emotional sphere related to the pathological condition. At the moment, the devices for pulmonary exercitation/incentivization, even if gamified, give out qualitative information and are not provided with electronics and/or are not connected to the network. The objective of this opinion article is to introduce new models of rehabilitation in this field of Telemedicine and e-Health at a first stage of research. In particular, a new environment for home rehabilitation is proposed, which is based to gamified devices for pulmonary incentivization integrated to the e-Healthcare system integratable also with automatic systems for the 6-min walk tests proposed by the same authors. A first device has been designed and tested. The next steps will be dedicated to the widening of the environment with the design of other devices and to complete the integration with the healthcare system.
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