Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits

Pulmonary rehabilitation (PR) remains grossly underutilised by suitable patients worldwide. We investigated whether home-based maintenance tele-rehabilitation will be as effective as hospital-based maintenance rehabilitation and superior to usual care in reducing the risk for acute chronic obstructive pulmonary disease (COPD) exacerbations, hospitalisations and emergency department (ED) visits. Following completion of an initial 2-month PR programme this prospective, randomised controlled trial (between December 2013 and July 2015) compared 12 months of home-based maintenance tele-rehabilitation (n=47) with 12 months of hospital-based, outpatient, maintenance rehabilitation (n=50) and also to 12 months of usual care treatment (n=50) without initial PR. In a multivariate analysis during the 12-month follow-up, both home-based tele-rehabilitation and hospital-based PR remained independent predictors of a lower risk for 1) acute COPD exacerbation (incidence rate ratio (IRR) 0.517, 95% CI 0.389–0.687, and IRR 0.635, 95% CI 0.473–0.853), respectively, and 2) hospitalisations for acute COPD exacerbation (IRR 0.189, 95% CI 0.100–0.358, and IRR 0.375, 95% CI 0.207–0.681), respectively. However, only home-based maintenance tele-rehabilitation and not hospital-based, outpatient, maintenance PR was an independent predictor of ED visits (IRR 0.116, 95% CI 0.072–0.185). Home-based maintenance tele-rehabilitation is equally effective as hospital-based, outpatient, maintenance PR in reducing the risk for acute COPD exacerbation and hospitalisations. In addition, it encounters a lower risk for ED visits, thereby constituting a potentially effective alternative strategy to hospital-based, outpatient, maintenance PR

Tele-rehabilitation following Covid-19: a sub analysis dependant on level of respiratory intervention during hospitalisation

Introduction: Tele-rehabilitation has been shown to be effective in improving exercise capacity, quality of life, fatigue and mood in patients discharged from hospital following Covid-19 infection. It remains unknown however whether the level intervention received during hospitalisation is associated with the response to tele-rehabilitation. The aims of this research were therefore to identify the effect tele-rehabilitation in individuals that received high, low and no respiratory intervention during hospitalisation. Methods: Forty patients (Female; n=17, Male; n=23) discharged from two University Teaching Hospitals in the North of England following Covid-19 infection participated in a single centre, mixed methods, fast-track, randomised control trial of tele-rehabilitation. Participants completed a 6-week tele-rehabilitation programme, with exercise sessions occurring twice a week and weekly education events and peer support. Data analysis and outcome measures: Participants were split by the level of intervention they received during hospitalisation, which were high respiratory intervention (Ventilation, Continuous Positive Airway Pathway), low respiratory intervention (High Flow Nasal Oxygen, Oxygen) and no respiratory intervention. The primary outcome measures were exercise capacity (1 minute sit-to-stand), Quality of life, [EuroQol -Visual Analogue Scale (EQ-VAS)], Fatigue [Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F)] and mood [Hospital Anxiety and Depression Scale (HADS)]. Results: Improvements in exercise capacity, respiratory symptoms, and quality-of-life were seen. Sit-to-stand scores improved from 19 (14-24) at baseline to 26 (23-28) following telerehabilitation (p0.05), however improved in the low respiratory intervention group from 11 (4.75-13.75) at baseline to 7 (6-11) post-rehabilitation (p<0.05).Conclusion: Our results show that tele-rehabilitation is a successful method of providing rehabilitation in patients regardless of the level of intervention during hospitalisation. However, data indicates the need for more psychological support in individuals that received intensive hospital treatment, which should be considered during the development of long-covid treatment strategies

Tele-rehabilitation of a middle-aged female with bronchiectasis as post COVID-19 sequelae: a case report

COVID-19 pneumonia causes dilatation of lung parenchyma which leads to destruction of segmental bronchi that can further progress into bronchiectasis. COVID-19 causes many sequels in the respiratory system and frequently presents with dyspnoea, fatigue, loss of strength, reduced functional capacity and sometimes severe multi-organ affection. Physiotherapy interventions through tele-rehabilitation have acquired a fundamental role in the recovery of the functions and quality of life. Pulmonary tele-rehabilitation which is done in this case report study includes patient education, respiratory care, exercise training, ambulatory program with supplementary oxygen, strengthening, endurance training and energy conservation. All these interventions play an important role in patent’s treatment protocol from hospital discharge to resuming work by assisting in weaning of supplementary oxygen, improving functional capacity of lungs and thus facilitating recovery. Rehabilitation of COVID-19 causing bronchiectasis in healthy individual has not been reported in literature yet. So, here we present a case report of tele-rehabilitation of a middle- aged female who developed progressive bronchiectasis as a sequela of COVID-19 pneumonia evident on serial chest CT scans

Remote Teleassessment and Telerehabilitation of a Comprehensive Exercise Training Protocol for Older Adults: Design and Methodology of a Usability Protocol

ABSTRACT Purpose: The design, usability, safety, and feasibility of a telehealth protocol comprising teleassessment and tele rehabilitation to evaluate and improve physical and cognitive function among older adults was assessed. Methods: Healthy older adults (n=23) participated in a pre-post tele-assessment of a 4-week (3 sessions/week) telerehabilitation session. Tele-assessment was performed to evaluate balance, gait function, and cognition. Tele-rehabilitation sessions comprised of balance games, dancing, dual-tasking, yoga, and tai-chi exercises. Results: There were no adverse events reported to indicate concerns with the safety of the current telehealth protocol. Conclusion: The proposed telehealth protocol to assess and improve physical and cognitive function may be feasible for enrolling older adults into a home exercise trial

Key toolkits of non-pharmacological management in COPD: during and beyond COVID-19

Individuals with COPD are at higher risk of severe disease and mortality if they contract COVID-19. Shielding and social distancing have negatively impacted the delivery of routine care for COPD patients, which should be maintained to avoid further deterioration. We aimed to review the literature about the key toolkits of non-pharmacological treatments of COPD patients before and during the COVID-19 pandemic. In particular, we focused on smoking cessation, pulmonary rehabilitation, and telehealth delivery approaches during the COVID-19 crisis. Smoking cessation services are important to mitigate the spread of the virus, especially in people with chronic lung disease; the pandemic, in one way or another, has helped to enhance people's motivation to quit smoking. Also, tele-rehabilitation is considered as effective as conventional pulmonary rehabilitation in controlling symptoms of disease, promoting physical activity, and enhancing self-management of COPD. Telerehabilitation offers flexibility and it could be the dominant mode for providing a pulmonary rehabilitation programme. Finally, the use of telehealth (TH) modes has trended during the pandemic. Consensus about the effectiveness of TH in reducing exacerbation events is still inconclusive. In the context of COPD, further clinical research must concentrate on understanding attitudes, behaviours, and motivations towards smoking cessation. Further recommendations include gauging the feasibility of a long-term tele-rehabilitation programme in large COPD populations, designing more COPD-related mobile apps, and evaluating the feasibility of tele-rehabilitation in clinical practice

Physiological basis of cardiopulmonary rehabilitation in patients with lung or heart disease

Shortness of breath associated with cardiorespiratory abnormalities and peripheral muscle discomfort are the major factors that limit exercise capacity in patients with chronic obstructive pulmonary disease (COPD) and those with congestive heart failure (CHF). Both of these symptoms negatively impact on patients’ daily physical activity levels. In turn, poor daily physical activity is commonly associated with increased rates of morbidity and mortality. Cardiopulmonary rehabilitation programmes partially reverse muscle weakness and dysfunction and increase functional capacity in both COPD and CHF. However, benefits gained from participation in cardiopulmonary rehabilitation programmes are regressing soon after the completion of these programmes. Moreover, several barriers limit access and uptake of cardiopulmonary rehabilitation programmes by eligible patients. A potential solution to the underutilisation of cardiopulmonary rehabilitation is the implementation of tele-rehabilitation interventions at home using information and communications technologies. Thus, tele-rehabilitation may be useful to encourage and educate patients with COPD or CHF on how best to maintain and/or further enhance daily physical activity levels

Intelligent Therapy Assistant (ITA) for cognitive rehabilitation in patients with Acquired Brain Injury

This paper presents the design, development and first evaluation of an algorithm, named Intelligent Therapy Assistant (ITA), which automatically selects, configures and schedules rehabilitation tasks for patients with cognitive impairments after an episode of Acquired Brain Injury. The ITA is integrated in "Guttmann, Neuro Personal Trainer" (GNPT), a cognitive tele-rehabilitation platform that provides neuropsychological services

Assessment of human kinematic performance with non-contact measurements for tele-rehabilitation

&nbsp;Aging of population is challenging the traditional rehabilitation services for various movement disorders. In the foreseeable future, tele-rehabilitation will be a contributive factor for the well-being of the older generation. This research has tackled a series of problems in developing an automated assessment tool for human kinematic performance in tele-rehabilitation with optoelectronic bio-kinematic motion capture devices and preliminarily confirmed its applicability