Health Sciences, Brunel University London, London, UK
Gloucestershire Health and Care NHS Foundation Trust, Brockworth, UK.
BMJ Open Respir Res. 2021 Mar;8(1). doi: 10.1136/bmjresp-2021-000880.
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 semistructured interviews were completed with PR staff and participants. RESULTS: Twenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and 14 completed PR. Significant pre-post online PR improvements were achieved in 1 min sit-to-stand (CI 2.1 to 9 (p=0.004)), Generalised Anxiety Disorder (CI -0.3 to -2.6 (p=0.023)), Primary Health Questionnaire-9 (CI -0.3 to -5.1 (p=0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 to 1.3 (p=0.001)), fatigue (CI 0.7 to 2 (p=0.0004)), emotion (CI 0.7 to 1.7 (p=0.0002)), mastery (CI 0.4 to 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 with 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 and 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.
简介:SARS-CoV-2 限制了面对面的肺康复(PR)服务。有证据表明,远程医疗 PR 与门诊 PR 相比不劣效。然而,尚不清楚已经被转介到面对面项目的患者是否能够切实完成在线 PR 项目。
方法:本服务评估采用混合方法,调查了使用格鲁斯特大学 eLearn Moodle 平台快速重塑的 PR 服务。从在线 PR 参与者那里收集了定量基线人口统计学和 PR 结果数据,并对 PR 工作人员和参与者进行了半结构化访谈。
结果:从 PR 候补名单中选出了 25 名符合条件的个体。13 人拒绝参与,14 人完成了 PR。在线 PR 后显著改善:1 分钟坐立起身(CI 2.1 至 9,p=0.004)、广泛性焦虑障碍(CI-0.3 至-2.6,p=0.023)、初级健康问卷-9(CI-0.3 至-5.1,p=0.029)、慢性呼吸问卷呼吸困难(CI 0.5 至 1.3,p=0.001)、疲劳(CI 0.7 至 2,p=0.0004)、情绪(CI 0.7 至 1.7,p=0.0002)、掌控感(CI 0.4 至 1.3,p=0.001)。访谈表明,数字支持使得患者 PR 的纳入成为可能,并且 PR 介绍会提高参与者的参与度和安全性。与面对面 PR 相比,在线 PR 中运动的逐步增加被认为更成功。然而,有人认为教育课程不太成功。在线 PR 需要大量的员工时间资源。
讨论:在线 PR 可改善患者的预后,并且在需要保持社交距离的情况下,对于转介至面对面 PR 的个体而言,是可行且可接受的。可以快速调整面对面的项目,工作人员和参与者都能从中受益。现在需要进行未来的实用试验,将包括远程评估在内的在线 PR 与基于中心的 PR 进行比较,并获得患者和工作人员对在线交付的障碍和促进因素的看法。
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