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Article Dans Une Revue Respiratory Medicine and Research Année : 2021

Feasibility, safety and effectiveness of remote pulmonary rehabilitation during COVID-19 pandemic.

Résumé

1. Introduction As a result of COVID-19 pandemic, pulmonary rehabilitation (PR) programs were impeded for patients with non-COVID-19 conditions such as those with chronic respiratory diseases (CRD). Remote interventions are feasible and have demonstrated similar outcomes to traditional centre-based PR, mostly in chronic obstructive pulmonary disease (COPD) [1], [2]. We previously demonstrated the feasibility and effectiveness of face-to-face home-based PR in patients with CRD [3], [4], but due to the pandemic, we transitioned to an intervention combining face-to-face supervised home sessions and telehealthcare. We briefly report the feasibility, safety and effectiveness of this combined intervention conducted in France during the lockdown from March 17 to May 11, 2020. 2. Patients and methods We retrospectively included all participants that were referred to the 8-week home-based PR program, without other specific criteria than those previously described [3], [4], [5]. Details regarding the ethical approval, informed consent of participants, and PR program can be found elsewhere [3], [4], [5]. The program included an initial educational needs assessment, performed at home or by telehealthcare after March 17, followed by a home visit to provide training equipment, supervise the first exercise session and perform the evaluations. During the lockdown, only two members of the PR team conducted home visits, using personal protective equipment, physical distancing and hand hygiene. After which, the program consisted of once- or twice-weekly structured telehealth calls to achieve 90 minutes of individually supervised intervention weekly. Participants were expected to perform a personalized action plan the rest of the week. Telehealth sessions were promoted through phone or video calls (WhatsApp® and Doctolib®) depending on the resources available to the patient. Dyspnea (modified medical research council, mMRC), fatigue (fatigue assessment scale, FAS), anxiety and depressive symptoms (hospital anxiety and depression scale, HAD), health-related quality of life (visual-analogue scale (VAS) of the EQ-5D-3L questionnaire) and exercise tolerance (6-minute stepper test, 6MST) were assessed at the beginning (M0) and at the end of the intervention (M2). Data were analysed with SAS V9.4 (SAS Institute, Cary NC, USA). The changes in study outcomes over time were analysed using paired Wilcoxon test and Bonferroni post hoc procedure. 3. Results 3.1. Feasibility Before March 17, 55 patients were participating in the home-based intervention. Amongst them, 7 (12.7%) delayed the program after the lockdown. During the lockdown, 65 new patients were referred for PR. Amongst them, 8 (12.3%) patients refused to participate. Of the 105 patients managed during this period, 13 (12.4%) suspended the intervention after one visit, and 9 (8.6%) did not complete the program (13 refusal related to COVID-19 pandemic, three deaths, three exacerbations, three others causes) (Fig. 1). There was no significant difference between participants who delayed or suspended the intervention and those who completed PR (n = 83). Among these 83 participants, 62 received telehealthcare through phone calls and 21 through video calls. Twenty-seven participants did not performed the 6MST because they refused the home visit or team members were unavailable. All participants performed the others outcomes either by face-to-face home visits or telehealthcare.

Dates et versions

hal-03616984 , version 1 (23-03-2022)

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Jean-Marie Grosbois, Sarah Gephine, Olivier Le Rouzic, Cécile Chenivesse. Feasibility, safety and effectiveness of remote pulmonary rehabilitation during COVID-19 pandemic.. Respiratory Medicine and Research, 2021, Respiratory Medicine and Research, 80, pp.100846. ⟨10.1016/j.resmer.2021.100846⟩. ⟨hal-03616984⟩
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