Telerehabilitation’s Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation

Abstract

Background Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. Objective Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. Methods A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. Results The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus $1104 (US $790). Conclusions Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation.

Telehealth Delivery of a Multi-Disciplinary Rehabilitation Programme for Upper Gastro-Intestinal Cancer: ReStOre@Home Feasibility Study

“…Attendance rates were high for all programme components apart from supervised exercise, which was 78% (unsupervised was 85%). This is similar to findings of the in-person ReStOre feasibility trial (supervised 82%; unsupervised 78%), and a multi-component cancer rehabilitation programme conducted by Dennett et al (2021), [ 74 ] which had 80% attendance to one-to-one telehealth sessions.…”

Virtual Reality Rehabilitation Systems for Cancer Survivors: A Narrative Review of the Literature

“…This area of research is particularly crucial for cancer survivors: as previously discussed, one of the factors contributing to the limited access that cancer patients have to rehabilitative care seems to be represented by the transportation issues resulting from the patients' disability [16,23,73]. For this reason, many studies have been investigating the potential role of telerehabilitation in improving cancer patients' access to rehabilitative care [29]. Furthermore, the previous literature has addressed how virtual reality may more generally improve and facilitate remote-assisted and home-based healthcare interventions [26,33,74,75].…”

“…Indeed, many cancer survivors suffer from disabilities or transportation issues which may limit their attendance at rehabilitation facilities. Therefore, in the last years, many studies have been investigating the role of telerehabilitation in the rehabilitative care of cancer survivors to improve adherence and as a safe and more accessible alternative to traditional rehabilitation [27][28][29]. One of the latest technologies proposed to remotely connect patients and rehabilitation professionals is Virtual Reality (VR) [26,[30][31][32][33][34].…”

Efficacy of Group Exercise–Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial

“…The feasibility of telerehabilitation has been established in a cancer context. Telerehabilitation interventions are safe, have good adherence, and provide a positive patient experience among cancer survivors [15,16]. Individual telerehabilitation improves physical activity levels and quality of life of cancer survivors when compared to usual care without exercise [17][18][19].…”

“…There is potential for exercise groups to be delivered via telehealth as videoconferencing technology can enable the supervision of multiple participants. Since the COVID-19 pandemic, there has been a surge in the use of telehealth such as for the provision of group exercise [ 16 , 27 ]. Therefore, robust trials of group telerehabilitation including exercise for cancer survivors are required to determine their efficacy and effectiveness.…”