P81 The feasibility and acceptability of delivering virtual pulmonary rehabilitation during the covid-19 pandemic

• Published in: Thorax Vol. 76; no. Suppl 1; p. A131
• Main Authors: Lound, A, De Luca, BC, Kennedy, ZA, Maguire, MC, Goodman, E, Shavji, K, Spurway, RL, Hinkins, L, Padmanaban, V, Mak, V, Elkin, SL
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.02.2021
• Subjects: Anxiety; Coronaviruses; COVID-19; Feedback; Patients; Questionnaires; Rehabilitation; Respiratory diseases
• ISSN: 0040-6376; 1468-3296
• DOI: 10.1136/thorax-2020-BTSabstracts.226

IntroductionPulmonary Rehabilitation (PR) services have been unable to provide face-to-face PR due to covid-19. Our service developed a virtual PR (VPR) programme and sought to understand its feasibility and acceptability.MethodsOur PR programme was adapted to an online format in conjunction with patients. Multiple video conferencing platforms were trialled with both clinicians and patients preferring Zoom. Exercise intensity was pragmatically prescribed using the BORG scale. One clinician demonstrated exercises and another provided feedback. Education consisted of facilitated group discussions.We recruited patients from PR classes and waitlists. One-to-one assessments took place over a video platform (AccuRx). Exercise capacity was assessed using the 1-minute sit to stand (1STS). Health status was measured using the Chronic Respiratory Disease Questionnaire (CRQ) and COPD Assessment Test (CAT). Other measures included the Hospital Anxiety and Depression scale (HADS) and Lung Information Needs Questionnaire (LINQ). We collected patient and clinician feedback.ResultsWe screened 58 patients for VPR- 18 (31%) accepted, 21 (36%) were unsuitable (20-unwell, 1- language barrier), 19 (33%) had no internet access or declined. The participants (10 male) had an average age of 69 years (37–84). Respiratory pathology included COPD (11), Asthma (3), Bronchiectasis (2) and Interstitial lung disease (2). Average MRC was 3 (2–4) and FEV166% (29%–114%).We undertook VPR in 3 cohorts (2x/week for 6 weeks). 18 (100%) patients completed. No adverse events occurred. Over 50% of patient’s achieved the MCID for exercise capacity, health status (CRQ) and learning needs (see figure 1).10 patients responded to our post-VPR survey. 100% found VPR beneficial with 80% stating Zoom was ‘very easy’ or ‘easy to use’. Benefits included reduced social isolation, not having to travel and confidence in home-based exercise. Clinician feedback was positive, but challenges were noted. VPR increased staff time for IT support and individualised exercise prescription proved difficult. The cohort model used may increase wait times but could allow for pathology specific groups.Abstract P81 Figure 1Virtual Pulmonary Rehabilitation Outcomes Outcome Measure Mean change (range) % meeting MCID (number) % meeting MCID in PR Clinical Audit 2019 1-minute Sit to Stand (1STS) 2 (-10 – 9) 56% (10) 59.8%1 CRQ- Dyspnoea 0.65 (-0.8 – 3) 56% (10) 58.6% CRQ- Emotional Function 0.75 (-1.29 -3.6) 56% (10) 53.7% CRQ- Fatigue 0.75 (-1.50–3.25) 61% (11) 59.0% CRQ- Mastery 0.51 (-2.25–3) 44% (8) 58.2% CAT 0 (-6 -8) 28% (5) 58% LINQ -3 (-8 -2) 83% (15) * HADS (Anxiety) 1 (-3 -7) 11% (2) * HADS (Depression) 0 (-4 – 8) 28% (5) * 1 as per the minimal clinically important difference (MCID) for incremental shuttle walk test (ISWT)/6-minute walk test (6MWT) *No audit data available. CRQ-Chronic Respiratory Disease Questionnaire, CAT- COPD Assessment Test, LINQ-Lung Information needs questionnaire, HADS-Hospital Anxiety and Depression scale.ConclusionVPR was feasible and acceptable during the closure of face-to-face PR. The future role of VPR warrants further investigation- particularly around remote assessment, who can access VPR and exercise prescription.