PMID- 34048354 OWN - NLM STAT- MEDLINE DCOM- 20210624 LR - 20210710 IS - 2291-5222 (Electronic) IS - 2291-5222 (Linking) VI - 9 IP - 6 DP - 2021 Jun 17 TI - Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation. PG - e28708 LID - 10.2196/28708 [doi] LID - e28708 AB - BACKGROUND: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. OBJECTIVE: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. METHODS: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. RESULTS: In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered >/=10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and >/=4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). CONCLUSIONS: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. CI - (c)Lisa Wickerson, Denise Helm, Chaya Gottesman, Dmitry Rozenberg, Lianne G Singer, Shaf Keshavjee, Aman Sidhu. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 17.06.2021. FAU - Wickerson, Lisa AU - Wickerson L AUID- ORCID: 0000-0001-6128-8966 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. FAU - Helm, Denise AU - Helm D AUID- ORCID: 0000-0001-8294-9794 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. FAU - Gottesman, Chaya AU - Gottesman C AUID- ORCID: 0000-0002-5480-3568 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Physical Therapy, University of Toronto, Toronto, ON, Canada. FAU - Rozenberg, Dmitry AU - Rozenberg D AUID- ORCID: 0000-0001-8786-9152 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Medicine, University of Toronto, Toronto, ON, Canada. FAU - Singer, Lianne G AU - Singer LG AUID- ORCID: 0000-0002-2693-8676 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Medicine, University of Toronto, Toronto, ON, Canada. FAU - Keshavjee, Shaf AU - Keshavjee S AUID- ORCID: 0000-0003-4547-8094 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Surgery, University of Toronto, Toronto, ON, Canada. FAU - Sidhu, Aman AU - Sidhu A AUID- ORCID: 0000-0002-4817-1533 AD - Toronto Lung Transplant Program, University Health Network, Toronto, ON, Canada. AD - Department of Medicine, University of Toronto, Toronto, ON, Canada. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210617 PL - Canada TA - JMIR Mhealth Uhealth JT - JMIR mHealth and uHealth JID - 101624439 SB - IM MH - *COVID-19 MH - Humans MH - *Lung Transplantation MH - Male MH - Middle Aged MH - Pandemics MH - Program Evaluation MH - Quality of Life MH - SARS-CoV-2 MH - *Telerehabilitation PMC - PMC8213059 OTO - NOTNLM OT - COVID-19 OT - app OT - lung OT - outcome OT - rehabilitation OT - satisfaction OT - telemedicine OT - telerehabilitation OT - transplant OT - usage COIS- Conflicts of Interest: DR receives financial support from the Sandra Faire and Ivan Fecan Professorship in Rehabilitation Medicine. The other authors have no conflicts to declare. EDAT- 2021/05/29 06:00 MHDA- 2021/06/25 06:00 PMCR- 2021/06/17 CRDT- 2021/05/28 17:17 PHST- 2021/03/11 00:00 [received] PHST- 2021/05/27 00:00 [accepted] PHST- 2021/04/30 00:00 [revised] PHST- 2021/05/29 06:00 [pubmed] PHST- 2021/06/25 06:00 [medline] PHST- 2021/05/28 17:17 [entrez] PHST- 2021/06/17 00:00 [pmc-release] AID - v9i6e28708 [pii] AID - 10.2196/28708 [doi] PST - epublish SO - JMIR Mhealth Uhealth. 2021 Jun 17;9(6):e28708. doi: 10.2196/28708.