ABSTRACT
Keywords: Digital;Improvement;Respiratory Purpose: In March 2020, all clinics and group sessions were suspended due to the COVID-19 pandemic and most of our respiratory clients were shielding. During our initial contact with these clients, they reported being less active than they were pre-lockdown. Reduced physical activity is directly related to quality of life (QoL). So, it became important for our team to look into innovative ways to engage with our clients. The aim was to find an effective alternative way for clients to participate in our Pulmonary Rehabilitation (PR) while the restrictions were in place. Methods: This service evaluation used a mixed method approach to investigate the effectiveness of Virtual PR (VPR). Both quantitative and qualitative data were collected during the initial assessment (IA) and post assessment (PA) for comparison. Informal feedbacks were collected from clients and staff during the VPR group sessions. Quantitative data: 1. COPD Assessment Tool (CAT), measures the impact of condition on client's health. 2. Patient Health Questionnaire (PHQ-9) for depression. 3. Generalised Anxiety Disorder (GAD-7) for anxiety. 4. Exercise Tolerance test (ET) Qualitative data: 1. Medical Research Council dyspnoea scale (MRC) 2. Client satisfactory survey during PA. Results: Of the 52 digitally enabled clients that were offered VPR, 88% completed the programme. 4% dropped out and the remaining 8% were expelled due to medical reasons. 11% of those who completed were housebound either due to their condition or lack of transport. 93% of the clients attended ten or more of the allocated 12 sessions. At the end of VPR, 13% of clients reported an improvement in MRC, and 65% of the clients had attained minimally important difference in ET. During IA, 86% reported to have medium to high impact on CAT. 43% of those clients had dropped to a lower impact level during post assessment. Initially, 63% reported to have psychological symptoms in at least one or both of the questionnaires (PHQ-9, GAD-7). Of these 29 clients who reported symptoms, 62% showed improvement at the end. 95% have said that VPR has motivated them to be active, 41% would have preferred face to face (F2F) sessions for the social aspects of the group, but all participants agreed that VPR was a good alternative. 95% of clients rated 8 or above for the quality of the sessions. During informal interviews, clients said VPR has saved them travel time and reduced dependency on family for transport. Staff reported lack of exercise equipment had an impact on the progress when compared to F2F. Conclusion(s): VPR as a digital solution has a positive effect on both physiological and psychological symptoms, thus improving QoL. Also, proved to be cost, time and clinically effective way to rehabilitate housebound clients. VPR is a good alternative to F2F sessions, but further work needs to be done to enable clients in digital and data poverty to uptake VPR to ensure fair access. Impact: VPR has been imbedded into our pathway and will be offered based on clinical decision and clients’ choice. Referral form will be revised to reflect the optional digital pathway. Funding acknowledgements: So far, this project has been funded at team level for the virtual platform licence. Funding has been secured for digital devices and data through the organisation (NELFT NHS trust) for a project on, ‘VPR for clients in digital/data poverty’.