Authors (including presenting author) :
Kwan HY(1), Choi PY(1), Lau WLC(2), Tsui AYY(3), Alex Lau(4), Chan RWY(3), Ko WN(2), Ho HW(1), Tommy Ng(4), Cheng RYF(1), Yau APY(1), Yim CW(1), Ng PK(1), Chan YLD(2), Chau RMW(3), Ling SO(1)
Affiliation :
(1)Department of Respiratory Medicine, Kowloon Hospital; (2)Occupational therapy Department, Kowloon Hospital; (3)Physiotherapy Department, Kowloon Hospital; (4)Information Technology, Kowloon Central Cluster
Introduction :
The benefits of pulmonary rehabilitation(PR) are well documented. Due to COVID-19 pandemics, PR was suspended in all public hospitals in HK since July 2020. Tele-PRP has been studied in many countries with promising results. To meet service demand, we explored the feasibility of adopting Tele-PRP as an alternative way to deliver PR.
Objectives :
To pilot run a home-based supervised Tele-PRP in KH RMD.
Methodology :
Our home-based supervised tele-PRP consisted of 14 sessions performed over three months. Apart from the usual inclusion criteria for PR, eligible patients must have basic web literacy and stable network at home. Each patient was given a tele-PRP package containing an IPAD, “Smart cards” with instructions on web-access, thermometer, pulse-oximeter and sphygmomanometer. They were appropriately trained on handling the devices and measuring vitals. All the essential components of PR (exercise, education, and support) were delivered through video-conferencing by a multidisciplinary PR team consisted of doctors, nurses, physiotherapists, and occupational therapists. Patients only need to return hospital twice for initial and post-PR assessments. Their exercise capacity (by 6-minute walk test: 6MWT), muscle strength (quadriceps and handgrip strength), and health-related quality of life (by Chronic Respiratory Disease Questionnaire: CRQ) before and after PR were compared. Upon completion of Tele-PRP, patients were asked to complete a patient satisfaction survey to evaluate our program. Staff feedback were collected.
Result & Outcome :
We piloted Tele-PRP since June 2021. Up to December 2022, eight patients with chronic respiratory diseases were recruited. Three of them have completed the program with 100% attendance rates while five of them were still on-going. Among the three patients who have completed Tele-PRP, significant improvement in exercise capacity (mean improvement in 6MWT 65m), quadriceps strength (right: 5.6kg mean improvement; left: 5.8kg mean improvement), and health-related quality of life (>0.5 increment in all domains) were observed after PR. All patients were extremely satisfied with the overall design and arrangement of tele-PRP. No significant technical problem has been encountered. With limited resources, we could only offer small-scale Tele-PRP with handy exercise equipment to selected patient group. Real-time vital sign monitoring was not feasible. The focus of patient’s camera and size of our monitor limited the view and made it difficult to fine-tune patient’s posture during exercise training. Yet, our initial experiences in Tele-PRP were encouraging. Sustainable funding and IT support to enhance the service should be explored.
