Using Telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients

Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Canadian respiratory journal: journal of the Canadian Thoracic Society (Impact Factor: 1.66). 07/2011; 18(4):216-20.
Source: PubMed


Pulmonary rehabilitation (PR) is an effective therapeutic strategy to improve health outcomes in patients with chronic obstructive pulmonary disease (COPD); however, there is insufficient PR capacity to service all COPD patients, thus necessitating creative solutions to increase the availability of PR.
To examine the efficacy of PR delivered via Telehealth (Telehealth-PR) compared with PR delivered in person through a standard outpatient hospital-based program (Standard-PR).
One hundred forty-seven COPD patients participated in an eight-week rural PR program delivered via Telehealth-PR. Data were compared with a parallel group of 262 COPD patients who attended Standard-PR. Education sessions were administered two days per week via Telehealth, and patients exercised at their satellite centre under direct supervision. Standard-PR patients viewed the same education sessions in person and exercised at the main PR site. The primary outcome measure was change in quality of life as evaluated by the St George's Respiratory Questionnaire (SGRQ). A noninferiority analysis was performed using both intention-to-treat and per-protocol approaches.
Both Telehealth-PR and Standard-PR resulted in clinically and statistically significant improvements in SGRQ scores (4.5 ± 0.8% versus 4.1 ± 0.6%; P<0.05 versus baseline for both groups), and the improvement in SGRQ was not different between the two programs. Similarly, exercise capacity, as assessed by 12 min walk test, improved equally in both Telehealth-PR and Standard-PR programs (81±10 m versus 82 ± 10 m; P<0.05 versus baseline for both groups).
Telehealth-PR was an effective tool for increasing COPD PR services, and demonstrated improvements in quality of life and exercise capacity comparable with Standard-PR.

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Available from: Wendy Rodgers, Feb 04, 2014
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    • "In-home telerehabilitation, defined as the provision of remote rehabilitation services to individuals with disabilities using information technologies and telecommunications in their home [1] , is growing as a complementary intervention to traditional face-to-face therapy for stroke patients [2] [3] [4] . Satisfaction is an important indicator of the degree of efficacy of an intervention. "
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    ABSTRACT: The purpose of this study was to investigate the satisfaction of patients and physiotherapists toward technology used during in-home teletreatment following discharge from an acute care hospital after a stroke. The teletreatment that was delivered to the patients consisted of 45-minute sessions of exercises inspired from Tai Chi movements, twice a week, over a period of 8 weeks. The health care services satisfaction questionnaire was completed by the patients at the end of the intervention. The subjective appreciation of the technical quality of the physiotherapist using the technology during the telerehabilitation treatment was noted at the end of each treatment session. The analyses for this pilot study have thus been completed on a total of 6 patients and over 96 sessions by a physiotherapist. Satisfaction towards health care services provided was high for both patients (86%) and physiotherapists (90%). While patient satisfaction is very important in maintaining treatment compliance, the satisfaction of health care professionals must be high in order for new treatments to become mainstream in clinics. Our results show that in-home telerehabilitation seems to be a promising alternative to traditional face-to-face treatments.
    Assistive Technology: From Research to Practice : AAATE, Vilamoura, Portugal; 09/2013
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    • "For COPD, videoconferencing has been used to provide group education to users at remote centres [26], but not for group education at home. "
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    ABSTRACT: The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers.This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user's own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home.
    BMC Medical Informatics and Decision Making 03/2013; 13(1):33. DOI:10.1186/1472-6947-13-33 · 1.83 Impact Factor
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    • "Ethical approval was obtained from the Health Research Ethics Board at the University of Alberta (Pro00013674). The PR program is outlined briefly below and has been described in detail elsewhere [11] "
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    ABSTRACT: Objective This study examined if ongoing support delivered by telephone following pulmonary rehabilitation (PR) assisted chronic obstructive pulmonary disease (COPD) patients to maintain health outcomes. Methods Phase one (n = 79) compared post-rehabilitation telephone-based support delivered by peers compared to usual care (UC). The second phase (n = 168) compared post-rehabilitation support from peer educators, respiratory therapists (RT), or UC. Primary outcome variables were St. George's Respiratory Questionnaire (SGRQ) total score and the six minute walk test (6MWT). Measures were obtained at baseline, immediately following PR, and six-months post PR. Results Six-month follow-up data for phase one was collected for 66 COPD patients (n = 35 peer support, n = 31 UC) and 142 for phase two (n = 42 peer support, n = 52 RT support, n = 48 UC). Per-protocol and intention to treat (ITT) analysis in both phases found no significant group by time differences for SGRQ or 6MWT. Conclusions Providing peer or RT support via telephone following PR was not more effective than UC for maintaining health outcomes. Practice implications There are concerns with using peers to provide ongoing support to COPD patients. Additionally, COPD patients require a higher level of care than telephone support can provide.
    Patient Education and Counseling 01/2013; 95(1). DOI:10.1016/j.pec.2013.12.008 · 2.20 Impact Factor
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