Centre for Innovative Medical Technology (CIMT), Odense University Hospital, Odense, Denmark.
Department of Psychology, University of Southern Denmark, Odense, Denmark.
Disabil Rehabil. 2022 Aug;44(17):4784-4793. doi: 10.1080/09638288.2021.1921063. Epub 2021 May 13.
The aim of this study was to characterize the practice of telemediated training for patients with very severe Chronic Obstructive Pulmonary Disease (COPD) and to inform the development of clinical/professional practice.
Inspired by ethnographic methodology, participating observation, informal and formal interviews were conducted with patients (11), their partners (4), and physiotherapists (6) at sites where the telemediated training was practiced. Postphenomenology was used as theoretical and analytical framework.
Telemediated training in the homes of the patients takes place where most daily activities happen, and together with activities in the rehabilitation units they are included in the training in a reduced or amplified version that may compromise the privacy of the patients. The mediated image and sound challenge the training and communication activities and the possibility for the physiotherapists to estimate the condition of the patients. Consequently, the physiotherapists lower how much they push the patients in the exercises.
Making training accessible to very severely ill patients with COPD through homebased telemediation comes with several trade-offs. This study can be used to educate clinical practice before and during the practicing of telemediated services, which need to be organized in a way that allows continuous adjustment.IMPLICATIONS FOR PRACTICEThe technology itself is not a neutral device in online health care provision. Health professionals should therefore:Play an active role in structuring the content, communication, and inclusion of the patients' context during online health care provision.Receive training in how to spot ways in which online health care provision transforms traditional practice and to how to work around its limitations.Organize online health care practices in ways that allow for continuous adjustment (for which they need back up from management).
本研究旨在描述远程培训在极重度慢性阻塞性肺疾病（COPD）患者中的应用情况，并为临床/专业实践提供信息。
本研究受民族志方法的启发，对接受远程培训的患者（11 人）、患者的伴侣（4 人）和物理治疗师（6 人）进行了参与性观察、非正式和正式访谈。后现象学被用作理论和分析框架。
患者家中的远程培训发生在日常活动最常进行的地方，与康复单元中的活动一起，它们以缩小或放大的形式纳入培训中，这可能会损害患者的隐私。中介的图像和声音挑战了培训和交流活动，以及物理治疗师评估患者病情的可能性。因此，物理治疗师降低了对患者练习的推动程度。
通过家庭远程中介为极重度 COPD 患者提供培训存在一些权衡。本研究可用于在远程服务实施之前和期间对临床实践进行教育，需要以允许持续调整的方式组织远程服务。
技术本身并不是在线医疗服务提供中的中立设备。因此，卫生专业人员应：在在线医疗服务提供中积极参与构建内容、沟通和患者背景的纳入。接受培训，了解在线医疗服务如何改变传统实践，并了解如何克服其局限性。以允许持续调整的方式组织在线医疗实践（为此他们需要管理层的支持）。
