title: Early telemedicine training and counselling after hospitalization in patients with severe chronic obstructive pulmonary disease: a feasibility study.
abstract: BACKGROUND
  An essential element in the treatment of patients with chronic obstructive pulmonary disease (COPD) is rehabilitation, of which supervised training is an important part. However, not all individuals with severe COPD can participate in the rehabilitation provided by hospitals and municipal training centres due to distance to the training venues and transportation difficulties. The aim of the study was to assess the feasibility of an individualized home-based training and counselling programme via video conference to patients with severe COPD after hospitalization including assessment of safety, clinical outcomes, patients' perceptions, organisational aspects and economic aspects.
  
  
  METHODS
  The design was a pre- and post-test intervention study. Fifty patients with severe COPD were included. The telemedicine training and counselling included three weekly supervised exercise sessions by a physiotherapist and up to two supervised counselling and training sessions in energy conservation techniques by an occupational therapist. The telemedicine videoconferencing equipment was a computer containing a screen, a microphone, an on/off switch and a volume control.
  
  
  RESULTS
  Thirty seven (74%) participants completed the programme, with improvements in health status assessed by the Clinical COPD Questionnaire and physical performance assessed by a sit-to-stand test and a timed-up-and-go test. There were no cases of patient fall or emergency contact with a general practitioner during the telemedicine training sessions. The study participants believed the telemedicine training and counselling was essential for getting started with being physically active in a secure manner. The business case showed that under the current financing system, the reimbursement to the hospital was slightly higher than the hospital expenditures. Thus, the business case for the hospital was positive. The organizational analysis indicated that the perceptions of the staff were that the telemedicine service had improved the continuity of the rehabilitation programme for the patients and enabled the patients' everyday lives to be included in the treatment.
  
  
  CONCLUSIONS
  This study showed that home-based supervised training and counselling via video conference is safe and feasible and that telemedicine can help to ensure more equitable access to supervised training in patients with severe COPD.
  
  
  BACKGROUND
  Clinical Trials NCT02085187 (Date of registration 10.03.2014).
authors.affiliation: Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, JB Winsløws Vej 19, 5000, Odense C, Denmark. lisbeth.minet@rsyd.dk.|Department of Rehabilitation, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. lisbeth.minet@rsyd.dk.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Rosenbek Minet
authors.affiliation: Department of Rehabilitation, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. line.willads.hansen2@rsyd.dk.
authors.forename: Line Willads
authors.initials: LW
authors.lastname: Hansen
authors.affiliation: Department of Clinical Innovation, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. claus.duedal.pedersen@rsyd.dk.
authors.forename: Claus Duedal
authors.initials: CD
authors.lastname: Pedersen
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. ingrid.titlestad@rsyd.dk.
authors.forename: Ingrid Louise
authors.initials: IL
authors.lastname: Titlestad
authors.affiliation: Department of Medicine, Odense University Hospital, Svendborg Hospital, Valdemarsgade 53, 5700, Svendborg, Denmark. jette.kroejgaard@rsyd.dk.
authors.forename: Jette Krøjgaard
authors.initials: JK
authors.lastname: Christensen
authors.affiliation: Department of Research and Health Technology Assessment, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. kristian.kidholm@rsyd.dk.
authors.forename: Kristian
authors.initials: K
authors.lastname: Kidholm
authors.affiliation: Department of Clinical Innovation, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. kathrine.rayce@rsyd.dk.
authors.forename: Kathrine
authors.initials: K
authors.lastname: Rayce
authors.affiliation: School of Applied Science, University of Stirling, FK9 4LA, Stirling, Scotland, UK. a.m.bowes@stir.ac.uk.
authors.forename: Alison
authors.initials: A
authors.lastname: Bowes
authors.affiliation: Department of Respiratory Medicine, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark. lilian.moellegaard@rsyd.dk.
authors.forename: Lilian
authors.initials: L
authors.lastname: Møllegård
mesh_terms: D000368:Aged; D003376:Counseling / Q000379:methods*; D005081:Exercise Therapy / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services; D006760:Hospitalization; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D017216:Telemedicine / Q000295:instrumentation / Q000379:methods*