Using a digital moodle platform to deliver pulmonary rehab - a service evaluation

ABSTRACT

Keywords Digital, Respiratory, Rehabilitation Purpose: SARS-CoV-2 restricted access to face-to-face delivery of Pulmonary Rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR but studies had not evaluated an approach encompassing virtual assessment in addition to delivery. Gloucestershire Health and Care PR team worked in partnership with the University of Gloucestershire (UoG) to deliver a virtual-only PR service for patients who had attended face-to-face sessions prior to lockdown. Initial evaluation of two groups showed this approach was feasible with outcome measures exceeding the MCID for face to face groups (Lewis, A., Knight, E., Bland, M., et al 2021). More data were required to understand if these results would be replicated with patients who had no prior experience of PR;this submission evaluates the outcomes of seven additional groups where participants had no prior experience of PR. Methods: Patients on the waiting list for PR were contacted to be offered an assessment for virtual PR between September and December 2020. All participating patients were issued pulse oximeters and IPads were issued to patients who did not have an appropriate device at home. Assessments took place remotely using ‘Attend Anywhere’ software and consisted of history taking, Rockwood frailty scoring and a one minute sit to stand test. Patients received login details for the ‘eLearn’ moodle platform for the UoG and completed two live streamed exercise classes/week for six weeks and were asked to watch 12 educational videos in their own time with support phone calls from a clinician at two and four weeks. Patients completed the Medical Research Council Score Breathlessness scale (MRC), Chronic Respiratory Disease Questionnaire (CRQ), Generalised Anxiety Disorder-7 scale (GAD7) and Patient Health Questionnaire-9 (PHQ9) on eLearn at the start and finish of the course. Completion was set at attendance for 9/12 exercise sessions and at least nine educational videos watched. Results: One hundred and thirty patients were invited to participate of which 63 underwent pre assessment and started on the course. Twenty three people declined any form of PR and were discharged, and 44 declined remote classes. Forty-five patients completed the course. Reasons for drop out were too unwell to continue (5), technical issues (7), poor attendance (4) and other/unknown (2). Statistically significant improvements were achieved in all outcome domains of the CRQ dyspnoea CI 0.4(0.3-0.9) p 0.001**, fatigue CI 0.25(0.2-0.8) p0.025** mastery CI 0.25(0.3-0.9) p0.0003** emotion 0.3(0.2-0.7) p0.0002**, GAD7 0(-2.9- -0.2) p0.019**,PHQ9 -1(-3.5 - -0.8) p0.002**, MRC -1(-3.5 - -0.8) p0.002**and the one minute sit to stand CI 2.6(0.89-4.3)p 0.004*. Conclusion(s) These results reinforce our previous findings that PR can be delivered effectively using an entirely virtual approach for appropriate patients. Further research is warranted to investigate the MCID for tele-rehabilitation physical and patient reported outcome measures. Impact These results demonstrate the potential of Moodle as a platform to deliver tele-conferencing rehabilitation programmes;Cardiac Rehabilitation colleagues have started to deliver online rehab via the same platform, and there is potential for numerous other rehabilitation services to replicate this model. This collaboration with UoG offers potential for virtual placement models. Funding acknowledgements The feasibility study was supported by a grant of £8000 from the University Of Gloucestershire Sport, Nutrition and Exercise programme.