The feasibility of an online platform delivery of pulmonary rehabilitation for individuals with chronic respiratory disease

Copyright © Author(s) (or their employer(s)) 2021. 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 semi-structured interviews were completed with PR staff and participants. Results Twenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and fourteen completed PR. Significant Pre-post online PR improvements were achieved in 1-minute sit-to-stand (Confidence interval (CI) 2.1 - 9 (p = 0.004)), Generalised Anxiety Disorder (CI -0.3 - -2.6(p = 0.023)), Primary Health Questionnaire-9 (CI -5.1 - -0.3 (p = 0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 - 1.3 (p = 0.001)), Fatigue (CI 0.7 - 2 (p = 0.0004)), Emotion (CI 0.7 - 1.7 (p = 0.0002)), Mastery (CI 0.4 - 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 to 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, 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.The University of Gloucestershire, Sport, Exercise, Health and Wellbeing Internal Research Grant Programme 2019-2020The University of Gloucestershire, Sport, Exercise, Health and Wellbeing Internal Research Grant Programme 2019-2020, for £8047