Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial

Exercise training was not traditionally recommended for patients with pulmonary hypertension. However, recent work has demonstrated that exercise improves endurance and quality-of-life in patients with pulmonary hypertension. Unfortunately, patients with pulmonary hypertension are often sedentary. While some studies have examined patient attitudes to exercise, none have investigated physician perspectives on exercise in patients with pulmonary hypertension. This multinational survey of physicians involved in treating patients with pulmonary hypertension sought to ascertain physician attitudes to exercise and physician-identified barriers and enablers of exercise in this patient population. We collected cross-sectional survey data from a cohort of 280 physicians, including rehabilitation physicians, cardiologists, respiratory physicians and rheumatologists. We found that overall, 86% physicians recommended exercise, in line with current guidelines, although there were differences in the rationale for prescribing exercise and in the type of exercise prescription. Barriers to exercise included patient-related factors, such as patient ill health preventing exercise; poor patient motivation and lack of understanding regarding the benefits of exercise. Systemic barriers included cost/funding issues and limited availability of appropriate services. Perceived enablers of exercise included access to appropriate programmes, provision of education and supportive treating clinicians. Further research is required to identify and implement interventions to promote physical activity in patients with pulmonary hypertension.

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“…However, a small number of trials have shown potential benefit in patients with chronic obstructive pulmonary disease. 57,58…”

Section: Enablersmentioning

confidence: 99%

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

et al. 2020

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“…In a recent paper by Bernocchi et al the authors evaluated the effects of a combination of medical/ nursing telesurveillance and telerehabilitation on diseasespecific HRQoL. 41 Disease-specific HRQoL were assessed among CHF subjects by MLHFQ and among COPD subjects by the CAT. 41 Following a 4-month intervention, not only physical parameters but also the disease-specific HRQoL were improved in the telehealth intervention group compared to the control group.…”

Section: Discussionmentioning

confidence: 99%

“…41 Disease-specific HRQoL were assessed among CHF subjects by MLHFQ and among COPD subjects by the CAT. 41 Following a 4-month intervention, not only physical parameters but also the disease-specific HRQoL were improved in the telehealth intervention group compared to the control group. 41 Unlike the present study, the study by Bernocchi et al was an RCT and the telemonitoring applied was used for surveillance as well as home training purpose.…”

Section: Discussionmentioning

confidence: 99%

<p>The Health Diary Telemonitoring and Hospital-Based Home Care Improve Quality of Life Among Elderly Multimorbid COPD and Chronic Heart Failure Subjects</p>

Persson

Lyth

Lind

2020

COPD

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Background: Elderly, multimorbid patients with advanced chronic obstructive pulmonary disease (COPD) and/or chronic heart failure (CHF) exhibit poor health-related quality of life (HRQoL). Telemonitoring, based on digital pen technology, supported by hospital-based home care (HBHC) significantly reduces the number of hospitalizations. We hypothesized that the same intervention would prevent the deterioration of HRQoL that follows upon disease progression. Methods: Elderly computer-illiterate subjects with ≥2 hospitalizations the previous year were included. HRQoL was assessed at inclusion (baseline) and at 1, 6 and 12 months employing EuroQol-5 Dimensions (EQ-5D) and RAND-36 for general HRQoL, and Minnesota Living with Heart Failure Questionnaire (MLHFQ) and St. Georges Respiratory Questionnaire (SGRQ) for disease-specific HRQoL. Healthcare contacts, hospitalizations, asneeded medications, prescription changes and healthcare costs were registered. Results: Ninety-four patients were enrolled of which 53 subjects completed the 12-month study period. Compared to baseline, most domains of RAND-36 were improved significantly at 1 time-point or more. Only among COPD subjects, the disease-specific HRQoL was worsened at the 12 month evaluation. Measures of healthcare dependency were associated with poor HRQoL. Conclusion: The Health Diary system and HBHC together improve general HRQoL, and measures of healthcare dependency are associated with HRQoL variables.

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“…Recently, technology‐supported programmes have been proposed as an alternative. In a study context, such technology‐driven and often remotely supervised programmes have shown success . Tele‐rehabilitation is becoming a valid alternative for selected patients.…”

Section: The Present Of Pulmonary Rehabilitationmentioning

confidence: 99%

“…Also, patients need to be carefully selected, funding may not exist outside a project budget and the overall cost of the programme will not necessarily be favourable against conventional (high throughput) rehabilitation . Recent data, obtained in complex, elderly with chronic obstructive pulmonary disease (COPD) and heart failure convincingly showed that tele‐rehabilitation, in combination with a disease management programme, was successful in enhancing exercise tolerance and preventing readmission to hospital …”

Section: The Present Of Pulmonary Rehabilitationmentioning

confidence: 99%

The past, present and future of pulmonary rehabilitation

et al. 2019

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Abundant evidence supports the use of pulmonary rehabilitation as a treatment for stable and exacerbated chronic obstructive pulmonary disease. Several questions around the science base of rehabilitation in other patient groups as well as the role of rehabilitation as a component in other comprehensive care trajectories remain to be addressed. The impact of a rehabilitation programme could also perhaps be enhanced if clear guidance would be available on how to individualize the components of a rehabilitation programme in individual patients. The rehabilitation community, in an attempt to increase access to programmes, has developed less rigorous interventions. These may serve specific patients (e.g. less severe patients or may be used as a maintenance programme), but in order to have conceptual clarity they should not be called substitutes for rehabilitation if they do not meet the definition of rehabilitation. Reaching clarity on the best format for maintenance programmes in order to achieve long-lasting health benefits for patients is another challenge. Furthermore, as many patients as possible should be referred to adequate rehabilitation programmes within their reach with fair reimbursement. Programmes should take into account the burden of the disease of a patient, the required components to tackle the problems, adequate assessment to document the outcome and the patient's preference. In summary, pulmonary rehabilitation is one of the most potent evidence-based therapies for patients with respiratory diseases. Researchers should continue to fine tune the interventions, get clarity on terminology as well as the ultimate outcomes for rehabilitation to ensure sustainable health effects.

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Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial

Abstract: this 4-month Telereab-HBP was feasible and effective in older patients with combined COPD and CHF.

Cited by 147 publications

References 29 publications

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

Attitudes towards exercise among medical specialists who manage patients with pulmonary hypertension

<p>The Health Diary Telemonitoring and Hospital-Based Home Care Improve Quality of Life Among Elderly Multimorbid COPD and Chronic Heart Failure Subjects</p>

The past, present and future of pulmonary rehabilitation

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