Description and Reliability of Internet Resources on Pulmonary Rehabilitation for Individuals with Chronic Lung Disease

ABSTRACT

RATIONALE Pulmonary rehabilitation (PR) is an important management modality in individuals with chronic lung disease. The internet is commonly used as a source of health information by individuals with lung disease. Given the ongoing COVID-19 pandemic and closure of in-person PR programs, many patients with lung disease rely on online resources for exercise training;however, the quality and reliability of online information on PR has not been evaluated. Thus, the objective of this study is to characterize internet resources on PR, and to assess the readability, content and quality of patient-directed PR resources. METHODS The first 200 websites for the search term 'pulmonary rehabilitation resources and exercise' were analyzed in Google, Yahoo and Bing. Website content was evaluated based on a predefined scoring system of the key components of PR, as described in the most recent international consensus guidelines. Website quality and reliability were determined using the validated DISCERN instrument and the Global Quality Scale (GQS). RESULTS A total of 70 unique websites were identified with the two most common categories being academic resources (63%) and foundation/advocacy organizations (33%). The average reading grade level of PR websites was equivalent to grade 11. There was significant heterogeneity in content (Table 1) across websites related to exercise training, education, and behaviour change (17.7 ± 5.1 out of 30). Most websites focused on traditional modalities of aerobic (96%) and resistance training (87%), in contrast to balance exercises (16%) and inspiratory muscle training (19%). A small majority of websites provided education focused on smoking cessation (59%), breathing strategies (59%), and nutrition (54%), with fewer websites addressing self-efficacy (37%) and motivation (13%). Website quality was good across PR websites (DISCERN median score 4.0 IQR (3.0-4.0) and GQS 4.0 IQR (2.0-4.0) out of 5 for both measures). CONCLUSIONS PR content varied significantly across websites and only partially captured items outlined in the PR international consensus guidelines. Website quality was good, suggesting that most PR websites were overall useful for patients;however, the higher-than-recommended reading level of patient education materials may compromise utilization and comprehension of PR resources. Efforts need to be made to better tailor online PR resources to the general lung population. (Figure Presented).