Abstract
BackgroundComprehensive multidisciplinary pulmonary rehabilitation is vital in the management of chronic obstructive pulmonary disease (COPD) and is considered for any stage of the disease. Rehabilitation programmes are often centre-based and organised in groups. However, the distance from the patient’s home to the centre and lack of transportation may hinder participation. Rehabilitation at home can improve access to care for patients regardless of disease severity. We had previously studied the technology usability and acceptability of a comprehensive home rehabilitation programme designed for patients with very severe COPD receiving long-term oxygen therapy. The acceptability of such comprehensive home programmes for those with less severe COPD, who may be less homebound, is not known. The aims of this feasibility study were to assess patient acceptability of the delivery mode and components of a comprehensive pulmonary rehabilitation programme for any stage of COPD, as well as the technology usability, patient outcomes and economic aspects.MethodsTen participants with COPD in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade I–IV were enrolled in a 9-week home programme and divided into two rehabilitation groups, with five patients in each group. The programme included exercise training and self-management education in online groups of patients, and individual online consultations. The patients also kept a digital health diary. To assess the acceptability of the programme, the patients were interviewed after the intervention using a semi-structured interview guide. In addition the number of sessions attended was observed. The usability of the technology was assessed using interviews and the System Usability Scale questionnaire. The St George’s Respiratory Questionnaire (SGRQ) was used to measure health-related quality of life.ResultsThe mode of delivery and the components of the programme were well accepted by the patients. The programme provided an environment for learning from both healthcare professionals and peers, for asking questions and discussing disease-related issues and for group exercising. The patients considered that it facilitated health-enhancing behaviours and social interactions with a social group formed among the participants. Even participants who were potentially less homebound appreciated the home group and social aspects of the programme. The participants found the technology easy to learn and use. The acceptability and usability results were consistent with those in our previous study of patients with very severe COPD. Only the mean change in the SGRQ total score of −6.53 (CI 95 % −0.38 to −12.68, p = 0.04) indicates a probable clinically significant effect. Economic calculations indicated that the cost of the programme was feasible.ConclusionsThe results of this study indicate that comprehensive pulmonary rehabilitation delivered in home-based online groups may be feasible in COPD. The mode of delivery and components of the programme appeared to be acceptable across patients with different disease severity. The results in terms of patient outcomes are inconclusive, and further assessment is needed.
Highlights
Demonstration of the technology A group exercise session Assessment of each patient’s baseline Assessment of each patient Frequency Activity DailyAnswer the daily questions in the digital health diaryMeasure and enter pulse oximetry (SpO2) values and accumulated step counts in the digital health diaryAt least once or twice Exercising with the follow-along exercise video Any dayWatch the educational video(s), if any, on the upcoming topic (10–40 min) TuesdayOn-line group exercising session (30 min)
The results of this study indicate that comprehensive pulmonary rehabilitation delivered in homebased online groups may be feasible in chronic obstructive pulmonary disease (COPD)
According to the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) [32], one participant was in grade I, one in grade II, four in grade III and four in grade IV
Summary
We had previously studied the technology usability and acceptability of a comprehensive home rehabilitation programme designed for patients with very severe COPD receiving long-term oxygen therapy. The acceptability of such comprehensive home programmes for those with less severe COPD, who may be less homebound, is not known. The 2013 American Thoracic Society and European Respiratory Society statement [4] defines pulmonary rehabilitation as a comprehensive intervention “based on a thorough patient assessment followed by patient-tailored therapies, which include, but are not limited to, exercise training, education, and behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence of health-enhancing behaviours”. Programmes are often organised in group settings [3] because groups can be helpful with respect to learning and sharing experiences [4]
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