Satisfaction and Experience with a Supervised Home-Based Real-Time Videoconferencing Telerehabilitation Exercise Program in People with Chronic Obstructive Pulmonary Disease (COPD)

Telerehabilitation, consisting of supervised home-based exercise training via real-time videoconferencing, is an alternative method to deliver pulmonary rehabilitation with potential to improve access. The aims were to determine the level of satisfaction and experience of an eight-week supervised home-based telerehabilitation exercise program using real-time videoconferencing in people with COPD. Quantitative measures were the Client Satisfaction Questionnaire-8 (CSQ-8) and a purpose-designed satisfaction survey. A qualitative component was conducted using semi-structured interviews. Nineteen participants (mean (SD) age 73 (8) years, forced expiratory volume in 1 second (FEV1) 60 (23) % predicted) showed a high level of satisfaction in the CSQ-8 score and 100% of participants reported a high level of satisfaction with the quality of exercise sessions delivered using real-time videoconferencing in participant satisfaction survey. Eleven participants undertook semi-structured interviews. Key themes in four areas relating to the telerehabilitation service emerged: positive virtual interaction through technology; health benefits; and satisfaction with the convenience and use of equipment. Participants were highly satisfied with the telerehabilitation exercise program delivered via videoconferencing.

Research priorities to address the global burden of chronic obstructive pulmonary disease (COPD) in the next decade

Background The global prevalence of chronic obstructive pulmonary disease (COPD) has increased markedly in recent decades. Given the scarcity of resources available to address global health challenges and respiratory medicine being relatively under-invested in, it is important to define research priorities for COPD globally. In this paper, we aim to identify a ranked set of COPD research priorities that need to be addressed in the next 10 years to substantially reduce the global impact of COPD. Methods We adapted the Child Health and Nutrition Research Initiative (CHNRI) methodology to identify global COPD research priorities. Results 62 experts contributed 230 research ideas, which were scored by 34 researchers according to six pre-defined criteria: answerability, effectiveness, feasibility, deliverability, burden reduction, and equity. The top-ranked research priority was the need for new effective strategies to support smoking cessation. Of the top 20 overall research priorities, six were focused on feasible and cost-effective pulmonary rehabilitation delivery and access, particularly in primary/community care and low-resource settings. Three of the top 10 overall priorities called for research on improved screening and accurate diagnostic methods for COPD in low-resource primary care settings. Further ideas that drew support involved a better understanding of risk factors for COPD, development of effective training programmes for health workers and physicians in low resource settings, and evaluation of novel interventions to encourage physical activity. Conclusions The experts agreed that the most pressing feasible research questions to address in the next decade for COPD reduction were on prevention, diagnosis and rehabilitation of COPD, especially in low resource settings. The largest gains should be expected in low- and middle-income countries (LMIC) settings, as the large majority of COPD deaths occur in those settings. Research priorities identified by this systematic international process should inform and motivate policymakers, funders, and researchers to support and conduct research to reduce the global burden of COPD

Effect of water-based exercise in people with COPD with physical comorbidities

People with chronic obstructive pulmonary disease (COPD) and physical comorbidities such as obesity, musculoskeletal, orthopaedic and neurological conditions have reduced free-living daily physical activity compared to people with COPD and healthy age-matched individuals. Less time is spent in light and moderate intensity physical activity and greater time is spent in sedentary behaviours. Water-based exercise training (WBET) may be an alternative to traditional land-based exercise training (LBET) for people with COPD and physical comorbidities (COPD+PC). Previous studies have shown positive outcomes for exercise capacity and quality of life following WBET, however these results were inconclusive given the trials were low in quality. In a prospective randomised controlled trial comparing an eight-week supervised WBET program to an equivalent eight-week supervised LBET program and a control group of no exercise training, WBET was found to be significantly more effective than LBET and no exercise training in increasing peak and endurance exercise capacity and improving aspects of quality of life in people with COPD+PC. In addition, obese participants randomised to the WBET program lost a greater amount of weight over the eight-week training period than participants in the LBET and no exercise training groups. WBET was found to be well accepted by people with COPD+PC, with no adverse events occurring during the training period. Furthermore, high satisfaction with the aquatic environment was reported. In a Cochrane review examining the effect of WBET in people with COPD, WBET was found to significantly improve exercise capacity (functional, peak and endurance exercise capacity) and quality of life compared to no exercise training. Compared to LBET, WBET was found to significantly improve endurance exercise capacity and fatigue. Limited quality evidence exists that WBET in people with COPD is safe and effective

Lung Support Service: Implementation of a Nationwide Text Message Support Program for People with Chronic Respiratory Disease during the COVID-19 Pandemic

Background: COVID-19 pandemic lockdowns led to the closure of most in-person pulmonary rehabilitation programs in Australia. Text message programs are effective for delivering health support to aid the self-management of people with chronic diseases. This study aimed to evaluate the implementation of a six-month pre-post text message support program (Texting for Wellness: Lung Support Service), and the enablers and barriers to its adoption and implementation. Methods: This mixed-methods pre-post study used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate the Texting for Wellness: Lung Support Service, which is an automated six-month text message support program that included evidence-based lifestyle, disease-self management and COVID-19-related information. Reach was measured by the proportion of participant enrolments and demographic characteristics. Adoption enablers and barriers were measured using text message response data and a user feedback survey (five-point Likert scale questions and free-text responses). Implementation was evaluated to determine fidelity including text message delivery data, opt-outs, and intervention costs to promote and deliver the program. Results: In total, 707/1940 (36.4%) participants enrolled and provided e-consent, with a mean age (±standard deviation) of 67.9 (±9.2) years old (range: 23–87 years). Of participants who provided feedback, (326/707) most ‘agreed’ or ‘strongly agreed’ that the text messages were easy to understand (98.5%), helpful them to feel supported (92.3%) and helped them to manage their health (88.0%). Factors influencing engagement included a feeling of support and reducing loneliness, and its usefulness for health self-management. Messages were delivered as planned (93.7% successfully delivered) with minimal participant dropouts (92.2% retention rate) and low cost ($AUD24.48/participant for six months). A total of 2263 text message replies were received from 496 unique participants. There were no reported adverse events. Conclusion: Texting for Wellness: Lung Support Service was implemented quickly, had a broad reach, with high retention and acceptability among participants. The program was low cost and required minimal staff oversight, which may facilitate future implementation. Further research is needed to evaluate the efficacy of text messaging for the improvement of lung health outcomes and strategies for long-term pulmonary rehabilitation program maintenance

Differences in content and organizational aspects of pulmonary rehabilitation programs

To study the overall content and organizational aspects of pulmonary rehabilitation programs from a global perspective to get an initial appraisal on the degree of heterogeneity worldwide.A twelve-question survey on content and organizational aspects was completed by representatives of pulmonary rehabilitation programs that previously participated in the European Respiratory Society (ERS) COPD Audit. Moreover, all ERS members affiliated with the ERS Scientific Groups 01.02 (Rehabilitation and Chronic Care) and/or 09.02 (Physiotherapy), all members of the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), and all ATS Pulmonary Rehabilitation Assembly members were asked to complete the survey via multiple e-mailings.The survey has been completed by representatives of 430 centres from 40 countries. The findings demonstrate large differences among pulmonary rehabilitation programs across continents for all aspects that were surveyed, including the setting, the case-mix of individuals with a chronic respiratory disease, composition of the pulmonary rehabilitation team, completion rates, methods of referral, and types of reimbursement.The current findings stress the importance of future development of process and performance metrics to monitor pulmonary rehabilitation programs, to be able to start international benchmarking, and to provide recommendations for international standards based on evidence and best practice.status: publishe