title: Comprehensive pulmonary rehabilitation in home-based online groups: a mixed method pilot study in COPD.
abstract: 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.
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway. tatjana.m.burkow@telemed.no.
authors.forename: Tatjana M
authors.initials: TM
authors.lastname: Burkow
authors.affiliation: Norut, P.O. Box 6434, Forskningsparken, 9294, Tromsø, Norway. lars.vognild@norut.no.
authors.forename: Lars K
authors.initials: LK
authors.lastname: Vognild
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway. elin.johnsen@telemed.no.
authors.forename: Elin
authors.initials: E
authors.lastname: Johnsen
authors.affiliation: University Hospital of North Norway, P.O. Box 100, 9291, Tromsø, Norway. marijke.e.jongsma.risberg@unn.no.
authors.forename: Marijke Jongsma
authors.initials: MJ
authors.lastname: Risberg
authors.affiliation: University Hospital of North Norway, P.O. Box 100, 9291, Tromsø, Norway. a.brat@online.no.
authors.forename: Astrid
authors.initials: A
authors.lastname: Bratvold
authors.affiliation: Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, P.O. Box 35, 9038, Tromsø, Norway. elin.breivik@telemed.no.
authors.forename: Elin
authors.initials: E
authors.lastname: Breivik
authors.affiliation: Helse Nord FIKS, Northern Norway Regional Health Authority, Tromsø, Norway. trine.krogstad@fiks.helsenord.no.
authors.forename: Trine
authors.initials: T
authors.lastname: Krogstad
authors.affiliation: Department of Clinical Medicine, UiT The Arctic University of Norway, 9037, Tromsø, Norway. audhild.hjalmarsen@unn.no.
authors.forename: Audhild
authors.initials: A
authors.lastname: Hjalmarsen
mesh_terms: D000368:Aged; D003194:Computer-Assisted Instruction / Q000379:methods*; D034742:Electronic Mail; D005260:Female; D006699:Home Care Services; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D029424:Pulmonary Disease, Chronic Obstructive / Q000534:rehabilitation*; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods