Pulmonary Telerehabilitation for People With Chronic Obstructive Pulmonary Disease in Brazil: A Mixed-Methods Feasibility Study

Authors

  • Luis H. G. Neves Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0002-2094-9331
  • Carla Malaguti Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0002-6619-136X
  • Marissa R. Santos Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil; Post-Graduate Research Program on Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil. https://orcid.org/0000-0003-3323-5087
  • Laura A. Cabral Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0002-8315-4114
  • Laura B. D. da Silva Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0002-9777-3899
  • Hugo H. de Oliveira Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0001-6187-1844
  • Alessa S. S. Brugiolo Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0003-3525-840X
  • Anderson José Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil https://orcid.org/0000-0002-3611-0098
  • Anne E. Holland Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Heidelberg, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia. https://orcid.org/0000-0003-2061-845X
  • Cristino C. Oliveira 1 Post-Graduate Research Program on Rehabilitation Sciences and Physical Function Performance, Faculty of Physiotherapy, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil; Post-Graduate Research Program on Rehabilitation Sciences, School of Physical Education, Physical Therapy, and Occupational Therapy. Department of Physical Therapy, Federal University of Minas Gerais, Belo Horizonte, Brazil. https://orcid.org/0000-0001-6546-0225

DOI:

https://doi.org/10.5195/ijt.2023.6555

Keywords:

Chronic Obstructive Pulmonary Disease, Feasibility studies, Telerehabilitation

Abstract

This study assessed the feasibility of pulmonary telerehabilitation’s (PTR) acceptability, implementation, practicality, and adaptation for people with Chronic Obstructive Pulmonary Disease (COPD) in Brazil. It also explored associations with clinical and socioeconomic features of Brazilians with COPD. This mixed-method study included thirty-one participants with COPD (age 62±10 years; FEV1= 72±14% predicted). Most participants (74.2%) reported good PTR session acceptability on the System Usability Scale and scores of ​4.6±0.3 and 4.5±0.6 on a 1-5 Likert-type scale of implementation and practicality, respectively. Participants suggested adaptations for better comfort on the exercise bike and varying exercise modalities. PTR acceptability was associated with participants’ younger age (rS=-0.57, p<0.01) and higher education (rS=0.51, p<0.01). PTR is feasible for people with COPD in Brazil regarding acceptability, implementation, practicality, and adaptation. Younger age and higher educational level are associated with greater PTR acceptability.

  

References

Agustí, A. G. N., Noguera, A., Sauleda, J., Sala, E., Pons, J., & Busquets, X. (2003). Systemic effects of chronic obstructive pulmonary disease. European Respiratory Journal, 21(2), 347–360. https://doi.org/10.1183/09031936.03.00405703

Almojaibel, A. A., Munk, N., Goodfellow, L. T., Fisher, T. F., Miller, K. K., Comer, A. R., Bakas, T., & Justiss, M. D. (2019). Development and validation of the Tele-Pulmonary Rehabilitation Acceptance Scale. Respiratory Care, 64(9), 1057–1064. https://doi.org/10.4187/respcare.06432

Almojaibel, A.A., Munk, N., Goodfellow, L.T., Fisher, T.F., Miller, K.K., Comer, A.R., Bakas, T., Justiss, M.D. (2021). Determinants of telerehabilitation acceptance among patients attending pulmonary rehabilitation programs in the United States. Saudi Journal of Medicine and Medical Sciences, 9(3), 230-234. https://doi:10.4103

/sjmms.sjmms_10_21

Associação brasileira de empresas de pesquisa | ABEP. (n.d.). http://www.abep.org/

Barreto, G. Z., Ivanaga, I. T., Chiavegato, L., Gazzotti, M. R., Nascimento, O. A., & Jardim, J. R. (2021). Perspective of pulmonary rehabilitation centers in Latin America. COPD: Journal of Chronic Obstructive Pulmonary Disease, 18(4), 401–405. https://doi.org/10.1080/15412555.2021.1934822

Bedra, M., McNabney, M., Stiassny, D., Nicholas, J., & Finkelstein, J. (2013). Defining patient-centered characteristics of a telerehabilitation system for patients with COPD. Studies in Health Technology and Informatics, 190, 24–26. https://doi.org/10.3233/978-1-61499-276-9-24

Blackstock, F. C., & Evans, R. A. (2019). Rehabilitation in lung diseases: “Education” component of pulmonary rehabilitation. Respirology, 24(9), 863–870. https://doi.org/10.1111/resp.13582

Bonnevie, T., Smondack, P., Elkins, M., Gouel, B., Medrinal, C., Combret, Y., Muir, J.-F., Cuvelier, A., Prieur, G., & Gravier, F.-E. (2021). Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: A systematic review. Journal of Physiotherapy, 67(1), 27–40. https://doi.org/10.1016/j.jphys.2020.12.006

Borg, G. A. (1982). Psychophysical bases of perceived exertion. Medicine and Science in Sports and Exercise, 14(5), 377–381.

Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., Bakken, S., Kaplan, C. P., Squiers, L., Fabrizio, C., & Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. https://doi.org/10.101/j.amepre.2009.02.002

Brakema, E.A., Vermond, D., Pinnock, H., Lionis, C., Kirenga, B., An, P.L., Sooronbaev, T., Chavannes, N.H., van der Kleij, M.J.J.R. (2020). FRESH AIR collaborators. Implementing lung health interventions in low- and middle-income countries – a FRESH AIR systematic review and meta-synthesis. European Respiratory Journal, 56(1), 2000127. https://doi:10.1183/13993003.00127-2020

Byrom, B., & Rowe, D. A. (2016). Measuring free-living physical activity in COPD patients: Deriving methodology standards for clinical trials through a review of research studies. Contemporary Clinical Trials, 47, 172–184. https://doi.org/10.1016/j.cct.2016.01.006

Cox, N. S., Dal Corso, S., Hansen, H., McDonald, C. F., Hill, C. J., Zanaboni, P., Alison, J. A., O’Halloran, P., Macdonald, H., & Holland, A. E. (2021). Telerehabilitation for chronic respiratory disease. The Cochrane Database of Systematic Reviews, 1(1), CD013040. https://doi.org/10.1002/14651858.CD013040.pub2

Cox, N. S., Oliveira, C. C., Lahham, A., & Holland, A. E. (2017). Pulmonary rehabilitation referral and participation are commonly influenced by environment, knowledge, and beliefs about consequences: A systematic review using the Theoretical Domains Framework. Journal of Physiotherapy, 63(2), 84–93. https://doi.org/10.1016/j.jphys.2017.02.002

da Silva, G.P.F., Morano, M.T.A.P., Viana, C.M.S., Magalhães, C.B.A., Pereira, E.D.B. (2013). Portuguese-language version of the COPD Assessment Test: Validation for use in Brazil. Jornal Brasileiro de Pneumologia, 39(4), 402–408. https://doi:10.1590/S1806-37132013000400002

de Souza Minayo, M.C. Análise qualitativa: Teoria, passos e fidedignidade. (2012). Ciência & Saúde Coletiva, 17, 621–626. https://doi:10.1590/s1413-81232012000300007

Desveaux, L., Janaudis-Ferreira, T., Goldstein, R., & Brooks, D. (2014). An international comparison of pulmonary rehabilitation: A systematic review. COPD: Journal of Chronic Obstructive Pulmonary Disease, 12(2), 144–153. https://doi.org/10.3109/15412555.2014.922066

Freedson, P. S., Melanson, E., & Sirard, J. (1998). Calibration of the Computer Science and Applications, Inc. accelerometer. Medicine & Science in Sports & Exercise, 30(5), 777–781. https://doi.org/10.1097/00005768-199805000-00021

Gardiner, L., & Singh, S. (2022). Inequality in pulmonary rehabilitation – The challenges magnified by the COVID-19 pandemic. Chronic Respiratory Disease, 19, 147997312211040. https://doi.org/10.1177/14799731221104098

Global Initiative for Chronic Obstructive Lung Disease [GOLD]. (n.d.). Global Initiative for Chronic Obstructive Lung Disease. http://goldcopd.org/

Graham, B. L., Steenbruggen, I., Miller, M. R., Barjaktarevic, I. Z., Cooper, B. G., Hall, G. L., Hallstrand, T. S., Kaminsky, D. A., McCarthy, K., McCormack, M. C., Oropez, C. E., Rosenfeld, M., Stanojevic, S., Swanney, M. P., & Thompson, B. R. (2019). Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200(8), e70–e88. https://doi.org/10.1164/rccm.201908-1590st

Halpin, D. M. G., Celli, B. R., Criner, G. J., Frith, P., López Varela, M. V., Salvi, S., Vogelmeier, C. F., Chen, R., Mortimer, K., Montes de Oca, M., Aisanov, Z., Obaseki, D., Decker, R., & Agusti, A. (2019). The GOLD Summit on chronic obstructive pulmonary disease in low- and middle-income countries. The International Journal of Tuberculosis and Lung Disease, 23(11), 1131–1141. https://doi.org/10.5588/ijtld.19.0397

Holland, A. E., Hill, C. J., Rochford, P., Fiore, J., Berlowitz, D. J., & Mcdonald, C. F. (2013). Telerehabilitation for people with chronic obstructive pulmonary disease: Feasibility of a simple, real-time model of supervised exercise training. Journal of Telemedicine and Telecare, 19(4), 222–226. https://doi.org/10.1177/1357633x13487100

Hollander, J. E., & Carr, B. G. (2020). Virtually perfect? Telemedicine for Covid-19. New England Journal of Medicine, 382(18), 1679-1681. https://doi.org/10.1056/nejmp2003539

Instituto Brasileiro de Geografia e Estatística (IBGE). (2018, March 2nd). Continuous PNAD - ICT 2016: 94.2% of the persons who used the Internet did it to exchange messages. Pesquisa Nacional por Amostra de Domicílios Contínua. https://agenciadenoticias.ibge.gov.br/en/agencia-press-room/2185-news-agency/releases-en/20098-continuous-pnad-ict-2016-94-2-of-the-persons-who-used-the-internet-did-it-to-exchange-messages

Jordan, P. W., & Al, E. (1996). Usability evaluation in industry. Taylor & Francis.

King, D., Khan, S., Polo, J., Solomon, J., Pekmezaris, R., & Hajizadeh, N. (2020). Optimizing telehealth experience design through usability testing in Hispanic American and African American patient populations: Observational study. JMIR Rehabilitation and Assistive Technologies, 7(2), e16004. https://doi.org/10.2196/16004

Klug, B. (2017). An overview of the System Usability Scale in library website and system usability testing. Weave: Journal of Library User Experience, 1(6). https://doi.org/10.3998/weave.12535642.0001.602

Lacasse, Y., Cates, C.J., McCarthy, B., Welsh, E.J. (2015). This Cochrane Review is closed: Deciding what constitutes enough research and where next for pulmonary rehabilitation in COPD. Cochrane database of systematic reviews, 11, ED000107. https://doi:10.1002/14651858.ED000107

Liacos, A., Burge, A. T., Cox, N. S., & Holland, A. E. (2018). Promoting physical activity using the internet: Is it feasible and acceptable for patients with chronic obstructive pulmonary disease and bronchiectasis? Journal of Aging and Physical Activity, 26(3), 372–381. https://doi.org/10.1123/japa.2017-0123

Mahler, D. A., & Wells, C. K. (1988). Evaluation of clinical methods for rating dyspnea. Chest, 93(3), 580–586. https://doi.org/10.1378/chest.93.3.580

Martins, A. I., Rosa, A. F., Queirós, A., Silva, A., & Rocha, N. P. (2015). European Portuguese Validation of the System Usability Scale (SUS). Procedia Computer Science, 67, 293–300. https://doi.org/10.1016/j.procs.2015.09.273

Mason, M. Sample size and saturation in PhD studies using qualitative interviews. (2010). Forum Qualitative Social Research, 11(3), 1-19. https://doi:10.17169/fqs-11.3.1428

Michaelchuk, W., Oliveira, A., Marzolini, S., Nonoyama, M., Maybank, A., Goldstein, R., & Brooks, D. (2022). Design and delivery of home-based telehealth pulmonary rehabilitation programs in COPD: A systematic review and meta-analysis. International Journal of Medical Informatics, 162, 104754. https://doi.org/10.1016/j.ijmedinf.2022.104754

O’Brien, B. C., Harris, I. B., Beckman, T. J., Reed, D. A., & Cook, D. A. (2014). Standards for reporting qualitative research. Academic Medicine, 89(9), 1245–1251. https://doi.org/10.1097/acm.0000000000000388

O’cathain, A., Murphy, E., & Nicholl, J. (2008). The quality of mixed methods studies in health services research. Journal of Health Services Research & Policy, 13(2), 92–98. https://doi.org/10.1258/jhsrp.2007.007074

Paneroni, M., Colombo, F., Papalia, A., Colitta, A., Borghi, G., Saleri, M., Cabiaglia, A., Azzalini, E., & Vitacca, M. (2015). Is telerehabilitation a safe and viable option for patients with COPD? A feasibility studies. COPD: Journal of Chronic Obstructive Pulmonary Disease, 12(2), 217–225. https://doi.org/10.3109/15412555.2014.933794

Pulmonary Rehabilitation Toolkit | Lung Foundation Australia. (n.d.). Retrieved March 31, 2022, from http://www.pulmonaryrehab.com.au

Rochester, C. L., Vogiatzis, I., Holland, A. E., Lareau, S. C., Marciniuk, D. D., Puhan, M. A., Spruit, M. A., Masefield, S., Casaburi, R., Clini, E. M., Crouch, R., Garcia-Aymerich, J., Garvey, C., Goldstein, R. S., Hill, K., Morgan, M., Nici, L., Pitta, F., Ries, A. L., & Singh, S. J. (2015). An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 192(11), 1373–1386. https://doi.org/10.1164/rccm.201510-1966st

PNAD Contínua TIC 2016: 94,2% das pessoas que utilizaram a Internet o fizeram para trocar mensagens | Agência de Notícias. (2018, February 21). Agência de Notícias - IBGE. https://agenciadenoticias.ibge.gov.br/agencia-sala-de-imprensa/2013-agencia-de-noticias/releases/20073-pnad-continua-tic-2016-94-2-das-pessoas-que-utilizaram-a-internet-o-fizeram-para-trocar-mensagens

Sociedade Brasileira de Pneumologia e Tisiologia. Diretrizes para teste de função pulmonar. (2002). Jornal Brasileiro de Pneumologia, 28(3), S1–S238.

Sönnerfors, P., Wadell, K., Dohrn, I.-M., Nyberg, A., Runold, M., & Halvarsson, A. (2020). Use of an eHealth tool for exercise training and online contact in people with severe chronic obstructive pulmonary disease on long-term oxygen treatment: A feasibility study. Health Informatics Journal, 26(4), 3184–3200. https://doi.org/10.1177/1460458220945429

Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D.-C., Pitta, F., Sewell, L., Raskin, J., Bourbeau, J., Crouch, R., Franssen, F. M. E., Casaburi, R., Vercoulen, J. H., Vogiatzis, I., & Gosselink, R. (2013). An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13–e64. https://doi.org/10.1164

/rccm.201309-1634st

Steiner, M. C., Lowe, D., Beckford, K., Blakey, J., Bolton, C. E., Elkin, S., Man, W. D.-C., Roberts, C. M., Sewell, L., Walker, P., & Singh, S. J. (2017). Socioeconomic deprivation and the outcome of pulmonary rehabilitation in England and Wales. Thorax, 72(6), 530–537. https://doi.org/10.1136/thoraxjnl-2016-209376

Zanaboni, P., Lien, L. A., Hjalmarsen, A., & Wootton, R. (2013). Long-term telerehabilitation of COPD patients in their homes: Interim results from a pilot study in Northern Norway. Journal of Telemedicine and Telecare, 19(7), 425–429. https://doi.org/10.1177/1357633X13506514

Downloads

Published

2023-05-11

How to Cite

H. G. Neves, L., Malaguti , C., R. Santos , M., A. Cabral , L., B. D. da Silva , L., H. de Oliveira , H., S. S. Brugiolo , A., José, A., E. Holland , A., & C. Oliveira, C. (2023). Pulmonary Telerehabilitation for People With Chronic Obstructive Pulmonary Disease in Brazil: A Mixed-Methods Feasibility Study. International Journal of Telerehabilitation, 15(1). https://doi.org/10.5195/ijt.2023.6555

Issue

Section

Pulmonary Telerehabilitation