The feasibility of an online platform delivery of pulmonary rehabilitation for individuals with chronic respiratory disease

Abstract

Copyright © Author(s) (or their employer(s)) 2021. Introduction SARS-CoV-2 has restricted access to face-to-face delivery of Pulmonary Rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR. However, it is unknown whether patients who have been referred to face-to-face programmes can feasibly complete an online-PR programme. Methods This service evaluation used a mixed-methods approach to investigate a rapid PR service remodelling using the University of Gloucestershire eLearn Moodle platform. Quantitative baseline demographic and PR outcome data were collected from online-PR participants, and semi-structured interviews were completed with PR staff and participants. Results Twenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and fourteen completed PR. Significant Pre-post online PR improvements were achieved in 1-minute sit-to-stand (Confidence interval (CI) 2.1 - 9 (p = 0.004)), Generalised Anxiety Disorder (CI -0.3 - -2.6(p = 0.023)), Primary Health Questionnaire-9 (CI -5.1 - -0.3 (p = 0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 - 1.3 (p = 0.001)), Fatigue (CI 0.7 - 2 (p = 0.0004)), Emotion (CI 0.7 - 1.7 (p = 0.0002)), Mastery (CI 0.4 - 1.3(p = 0.001)). Interviews indicated that patient PR inclusion was made possible with digital support and a PR introduction session improved participant engagement and safety. Incremental progression of exercise was perceived as more successful online compared to face-to-face PR. However, perceptions were that education sessions were less successful. Online-PR required significant staff time resource. Discussion Online-PR improves patient outcomes, is feasible and acceptable for individuals referred for face-to-face PR in the context of a requirement for social distancing. Face-to-face programmes can be adapted in a rapid fashion with both staff and participants perceiving benefit. Future pragmatic trials are now warranted comparing online-PR including remote assessments to centre-based PR with suitably matched outcomes, and patient and staff perceptions sought regarding barriers and facilitators of online delivery.