Padhye Rashmi, Sahasrabudhe Shruti D, Orme Mark W, Pina Ilaria, Dhamdhere Dipali, Borade Suryakant, Bhakare Meenakshi, Ahmed Zahira, Barton Andy, Modi Mahavir, Malcolm Dominic, Salvi Sundeep, Singh Sally J
Clinical Research Department, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed University), Pune, India.
Department of Respiratory Sciences, University of Leicester, Leicester, United Kingdom.
JMIR Form Res. 2023 Nov 7;7:e45624. doi: 10.2196/45624.
Chronic respiratory diseases (CRDs) contribute significantly to morbidity and mortality worldwide and in India. Access to nonpharmacological options, such as pulmonary rehabilitation (PR), are, however, limited. Given the difference between need and availability, exploring PR, specifically remotely delivered PR, in a resource-poor setting, will help inform future work.
This study explored the perceptions, experiences, needs, and challenges of patients with CRDs and the potential of and the need for PR from the perspective of patients as well as medical professionals involved in the referral (doctors) and delivery (physiotherapists) of PR.
In-depth qualitative semistructured interviews were conducted among 20 individuals diagnosed with CRDs and 9 medical professionals. An inductive thematic analysis approach was used as we sought to identify the meanings shared both within and across the 2 participant groups.
The 20 patients considered lifestyle choices (smoking and drinking), a lack of physical activity, mental stress, and heredity as the triggering factors for their CRDs. All of them equated the disease with breathlessness and a lack of physical strength, consulting multiple doctors about their physical symptoms. The most commonly cited treatment choice was an inhaler. Most of them believed that yoga and exercise are good self-management strategies, and some were performing yoga postures and breathing exercises, as advised by friends or family members or learned from a televised program or YouTube videos. None of them identified with the term "pulmonary rehabilitation," but many were aware of the exercise component and its benefits. Despite being naive to smartphone technology or having difficulty in reading, most of them were enthusiastic about enrolling in an application-based remotely delivered digital PR program. The 9 medical professionals were, however, reluctant to depend on a PR program delivered entirely online. They recommended that patients with CRDs be supported by their family to use technology, with some time spent with a medical professional during the program.
Patients with CRDs in India currently manage their disease with nonguided strategies but are eager to improve and would benefit from a guided PR program to feel better. A home-based PR program, with delivery facilitated by digital solutions, would be welcomed by patients and health care professionals involved in their care, as it would reduce the need for travel, specialist equipment, and setup. However, low digital literacy, low resource availability, and a lack of expertise are of concern to health care professionals. For India, including yoga could be a way of making PR "culturally congruent" and more successful. The digital PR intervention should be flexible to individual patient needs and should be complemented with physical sessions and a feedback mechanism for both practitioners as well as patients for better uptake and adherence.
慢性呼吸道疾病（CRD）在全球和印度都对发病率和死亡率有重大影响。然而，获得诸如肺康复（PR）等非药物治疗选择的机会有限。鉴于需求与可及性之间的差异，在资源匮乏的环境中探索PR，特别是远程提供的PR，将有助于为未来的工作提供参考。
本研究从患者以及参与PR转诊（医生）和实施（物理治疗师）的医学专业人员的角度，探讨了CRD患者的认知、体验、需求和挑战，以及PR的潜力和必要性。
对20名被诊断为CRD的个体和9名医学专业人员进行了深入的定性半结构化访谈。我们采用归纳主题分析方法，试图识别两个参与者群体内部和之间共有的意义。
20名患者认为生活方式选择（吸烟和饮酒）、缺乏体育活动、精神压力和遗传是其CRD的触发因素。他们都将疾病等同于呼吸急促和体力不足，并就身体症状咨询了多位医生。最常提及的治疗选择是吸入器。他们中的大多数人认为瑜伽和运动是很好的自我管理策略，有些人按照朋友或家人的建议，或从电视节目或YouTube视频中学到的，正在进行瑜伽姿势和呼吸练习。他们中没有人认同“肺康复”这个术语，但许多人知道运动部分及其益处。尽管对智能手机技术不熟悉或阅读有困难，但他们中的大多数人都热衷于参加基于应用程序的远程数字PR项目。然而，9名医学专业人员不愿完全依赖在线提供的PR项目。他们建议CRD患者的家人支持他们使用技术，并且在项目期间花一些时间与医学专业人员在一起。
印度的CRD患者目前通过无指导的策略管理他们的疾病，但渴望改善，并且将从有指导的PR项目中受益，从而感觉更好。一个由数字解决方案辅助实施的居家PR项目，将受到参与患者护理的患者和医疗保健专业人员的欢迎，因为它将减少出行需求、专业设备需求和设施需求。然而，低数字素养、资源匮乏和缺乏专业知识是医疗保健专业人员所关注的问题。对于印度来说，纳入瑜伽可能是使PR“文化契合”并更成功的一种方式。数字PR干预应根据患者的个体需求灵活调整，并应辅以面对面的课程以及针对从业者和患者的反馈机制，以实现更好的接受度和依从性。
