Promoting exercise training and physical activity in daily life: a feasibility study of a virtual group intervention for behaviour change in COPD.

BACKGROUND: Physical inactivity is associated with poor health outcomes in chronic obstructive pulmonary disease (COPD). It is therefore crucial for patients to have a physically active lifestyle. The aims of this feasibility study were to assess a tablet-based physical activity behavioural intervention in virtual groups for COPD regarding 1) patients' acceptance 2) technology usability 3) patients' exercise programme adherence and 4) changes in patients' physical activity level. METHODS: We used an application with functionality for a virtual peer group, a digital exercise diary, a follow-along exercise video, and visual rewards on the home screen wallpaper. The exercise programme combined scheduled virtual group exercising (outdoor ground walking, indoor resistance and strength training) with self-chosen individual exercises. Ten participants with COPD were enrolled into two exercise training groups. Patients' acceptance was assessed by semi-structured interviews, technology usability was assessed by the System Usability Scale, and exercise programme adherence and level of physical activity by self-reporting. The interviews were also used for the latter three aspects. RESULTS: The virtual peer group was experienced as motivating, helping participants to get started and be physically active. They updated their own activity status and kept track of the others' status. Having a time schedule for the virtual group exercises helped them to avoid postponing the exercise training. All participants recorded individual exercises in the diary, the exercise video was well received and used, and most participants paid attention to the visual rewards. All participants found the technology easy both to learn and to use. The exercise programme adherence was good, with, on average, 77% attendance for the virtual group exercises, and all participants performed additional individual exercises. The average number of physical activity sessions per week was doubled from 2.9 (range 0-10, median 2) at baseline to 5.9 (range 3.3-10.33, median 4.8) during the intervention period. CONCLUSION: The results indicate that the tablet-based intervention may be feasible in COPD, and that it was acceptable, encouraged a sense of peer support and fellowship in the group and motivated participants to physical activity and exercise training in daily life. Further assessment is needed on patient outcomes.

Comprehensive pulmonary rehabilitation in home-based online groups: a mixed method pilot study in COPD.

BACKGROUND: Comprehensive multidisciplinary pulmonary rehabilitation is vital in the management of chronic obstructive pulmonary disease (COPD) and is considered for any stage of the disease. Rehabilitation programmes are often centre-based and organised in groups. However, the distance from the patient's home to the centre and lack of transportation may hinder participation. Rehabilitation at home can improve access to care for patients regardless of disease severity. We had previously studied the technology usability and acceptability of a comprehensive home rehabilitation programme designed for patients with very severe COPD receiving long-term oxygen therapy. The acceptability of such comprehensive home programmes for those with less severe COPD, who may be less homebound, is not known. The aims of this feasibility study were to assess patient acceptability of the delivery mode and components of a comprehensive pulmonary rehabilitation programme for any stage of COPD, as well as the technology usability, patient outcomes and economic aspects. METHODS: Ten participants with COPD in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade I-IV were enrolled in a 9-week home programme and divided into two rehabilitation groups, with five patients in each group. The programme included exercise training and self-management education in online groups of patients, and individual online consultations. The patients also kept a digital health diary. To assess the acceptability of the programme, the patients were interviewed after the intervention using a semi-structured interview guide. In addition the number of sessions attended was observed. The usability of the technology was assessed using interviews and the System Usability Scale questionnaire. The St George's Respiratory Questionnaire (SGRQ) was used to measure health-related quality of life. RESULTS: The mode of delivery and the components of the programme were well accepted by the patients. The programme provided an environment for learning from both healthcare professionals and peers, for asking questions and discussing disease-related issues and for group exercising. The patients considered that it facilitated health-enhancing behaviours and social interactions with a social group formed among the participants. Even participants who were potentially less homebound appreciated the home group and social aspects of the programme. The participants found the technology easy to learn and use. The acceptability and usability results were consistent with those in our previous study of patients with very severe COPD. Only the mean change in the SGRQ total score of -6.53 (CI 95 % -0.38 to -12.68, p = 0.04) indicates a probable clinically significant effect. Economic calculations indicated that the cost of the programme was feasible. CONCLUSIONS: The results of this study indicate that comprehensive pulmonary rehabilitation delivered in home-based online groups may be feasible in COPD. The mode of delivery and components of the programme appeared to be acceptable across patients with different disease severity. The results in terms of patient outcomes are inconclusive, and further assessment is needed.

Privacy and information security risks in a technology platform for home-based chronic disease rehabilitation and education.

BACKGROUND: Privacy and information security are important for all healthcare services, including home-based services. We have designed and implemented a prototype technology platform for providing home-based healthcare services. It supports a personal electronic health diary and enables secure and reliable communication and interaction with peers and healthcare personnel. The platform runs on a small computer with a dedicated remote control. It is connected to the patient's TV and to a broadband Internet. The platform has been tested with home-based rehabilitation and education programs for chronic obstructive pulmonary disease and diabetes. As part of our work, a risk assessment of privacy and security aspects has been performed, to reveal actual risks and to ensure adequate information security in this technical platform. METHODS: Risk assessment was performed in an iterative manner during the development process. Thus, security solutions have been incorporated into the design from an early stage instead of being included as an add-on to a nearly completed system. We have adapted existing risk management methods to our own environment, thus creating our own method. Our method conforms to ISO's standard for information security risk management. RESULTS: A total of approximately 50 threats and possible unwanted incidents were identified and analysed. Among the threats to the four information security aspects: confidentiality, integrity, availability, and quality; confidentiality threats were identified as most serious, with one threat given an unacceptable level of High risk. This is because health-related personal information is regarded as sensitive. Availability threats were analysed as low risk, as the aim of the home programmes is to provide education and rehabilitation services; not for use in acute situations or for continuous health monitoring. CONCLUSIONS: Most of the identified threats are applicable for healthcare services intended for patients or citizens in their own homes. Confidentiality risks in home are different from in a more controlled environment such as a hospital; and electronic equipment located in private homes and communicating via Internet, is more exposed to unauthorised access. By implementing the proposed measures, it has been possible to design a home-based service which ensures the necessary level of information security and privacy.

Internet-enabled pulmonary rehabilitation and diabetes education in group settings at home: a preliminary study of patient acceptability.

BACKGROUND: The prevalence of major chronic illnesses, such as chronic obstructive pulmonary disease (COPD) and diabetes, is increasing. Pulmonary rehabilitation and diabetes self-management education are important in the management of COPD and diabetes respectively. However, not everyone can participate in the programmes offered at a hospital or other central locations, for reasons such as travel and transport. Internet-enabled home-based programmes have the potential to overcome these barriers.This study aims to assess patient acceptability of the delivery form and components of Internet-enabled programmes based on home groups for comprehensive pulmonary rehabilitation and for diabetes self-management education. METHODS: We have developed Internet-enabled home programmes for comprehensive pulmonary rehabilitation and for diabetes self-management education that include group education, group exercising (COPD only), individual consultations, educational videos and a digital health diary. Our prototype technology platform makes use of each user's own TV at home, connected to a computer, and a remote control. We conducted a six-week home trial with 10 participants: one group with COPD and one with diabetes. The participants were interviewed using semi-structured interviews. RESULTS: Both home-based programmes were well accepted by the participants. The group setting at home made it possible to share experiences and to learn from questions raised by others, as in conventional group education. In the sessions, interaction and discussion worked well, despite the structure needed for turn taking. The thematic educational videos were well accepted although they were up to 40 minutes long and their quality was below TV broadcasting standards. Taking part in group exercising at home under the guidance of a physiotherapist was also well accepted by the participants. Participants in the COPD group appreciated the social aspect of group education sessions and of exercising together, each in their own home. The digital health diary was used as background information in the individual consultations and by some participants as a self-management tool. Participant retention was high, with no dropouts. None of the participants reported that the six-week duration of the home programmes was too long. CONCLUSIONS: The Internet-enabled programmes for home-based groups in pulmonary rehabilitation and diabetes education were generally well accepted by the participants. Our findings indicate that conventional programmes have the potential to be delivered in socially supportive group settings at home.

Personalized health applications in the Web 2.0: the emergence of a new approach.

Health consumers have embraced the web to obtain access to health information and to socialize and share knowledge with peers. Additionally, the web has become a more interactive and rich platform with the integration of health applications and services, such as Personal Health Records. Some of these applications provide personalized interactions based on user specific characteristics. In this paper we provide an overview of Personalized Health Applications in the Web 2.0. We reviewed the health applications integrated in Google Health, Microsoft HealthVault and Facebook. We studied the goals of the applications and also the personalized feedback they provided.

The MyHealthService approach for chronic disease management based on free open source software and low cost components.

In this paper we present an approach to building personal health services, supporting following-up, physical exercising, health education, and psychosocial support for the chronically ill, based on free open source software and low-cost computers, mobile devices, and consumer health and fitness devices. We argue that this will lower the cost of the systems, which is important given the increasing number of people with chronicle diseases and limited healthcare budgets.

Challenges and opportunities of using recommender systems for personalized health education.

The use of computers in health education started more than a decade ago, mainly for tailoring health educational resources. Nowadays, many of the computer-tailoring health education systems are using the Internet for delivering different types of health education. Traditionally, these systems are designed for a specific health problem, with a predefined library of educational resources. These systems do not take advantage of the increasing amount of educational resources available on the Internet. One of the reasons is that the high availability of content is making it more difficult to find the relevant one. The problem of information overload has been addressed for many years in the field of recommender systems. This paper is focused on the challenges and opportunities of merging recommender systems with personalized health education. It also discusses the usage of social networks and semantic technologies within this approach.

An easy to use and affordable home-based personal eHealth system for chronic disease management based on free open source software.

This paper describes an easy to use home-based eHealth system for chronic disease management. We present the design and implementation of a prototype for home based education, exercises, treatment and following-up, with the TV and a remote control as user interface. We also briefly describe field trials of the system for patients with COPD and diabetes, and their experience with the technology.