Cardiorespiratory fitness training sessions delivered via telehealth - PowerPoint PPT Presentation

Cardiorespiratory fitness training sessions delivered via telehealth are safe, feasible and acceptable for community-dwelling stroke survivors. Margaret Galloway, Di Marsden, Robin Callister, Kirk Erickson, Michael Nilsson, Coralie English @margygall

Background 1. People after stroke are not meeting physical activity guidelines Cardiorespiratory Fitness VO 2peak 2. Cardiorespiratory fitness low after stroke 45 3. Barriers to exercise post-stroke: 40 35 • logistical factors 30 ML/KG/MIN • psycho-social factors 25 20 • stroke-related physical or cognitive impairments 15 10 4. Fitness gains and adherence to exercise are 5 higher if exercise programs are supervised 0 Post-Stroke 75 yr old 50yr old @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 2 | The University of Newcastle

Background: Telehealth Interventions -programs aimed at increasing cardiorespiratory fitness 1. Other populations: 2. In stroke : less is known • cardiac rehabilitation 1 • Feasibility • COPD 2 • Safety • cystic fibrosis 3 • User experience • the elderly 4 “effective and safe” 1. Clark et al, Eur Journal Prev Cardiol. 2015;22(1):35-74; 2.Hwang et al, JCardiopulm Rehab&Prev.2015;35(6):380-389; 3. Cox et al, Resp Care. 2015;60(3):422-429; 4.Crotty et al, J Telemed Telecare. 2014;20(7):370-376. @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 3 | The University of Newcastle

Background: Dose escalation trial (ExDose) Doses (n=5/dose) INCREASE IN CRF 8.0 Δ VO 2PEAK (ML/KG/MIN) • 3d/week 6.0 • Mod-vigorous intensity • 8 weeks 4.0 19% • Session duration increased by dose 13% 11% (10, 15, 20, or 25 min) 2.0 6% • Intervals: bodyweight/low impact 0.0 10 15 20 25 SESSION DURATION (MIN) ANZCTR Trial ID: ACTRN12617000460303), Ethics approval HNEHREC Reference No: 16/10/19/4.09). @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 4 | The University of Newcastle

Aims 1. How feasible was it to deliver of supervised exercise by telehealth, in terms of: • Recruitment, retention, and adherence • Safety • Reliability • Usability . 2. How satisfied were participants with; a. telehealth delivery of a home-based aerobic exercise program, b. the dose of exercise delivered? c. the content of exercise sessions? @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 5 | The University of Newcastle

Methods Inclusion Criteria Home Visit • Community – dwelling adult 1. Risk Assessment • ≥ 3mo post -stroke • Exercise space • Ambulant (FAC>3) • Exercises • Medical clearance • Technique • Suitability Telehealth eligibility 2. Technical instructions • Suitable internet/device/computer • HR • Responsible person present during • RPE sessions • Telehealth Platform/IT @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 6 | The University of Newcastle

Methods : Data Collection Exercise instructor Participant Feedback A: 23 MCQ * , 2 open ended B: Level of Technical Familiarity Q’s 1. Session details • 15 multiple choice questions ** 1. Telehealth platform 2. Telehealth related • Level of engagement with the • reliability factors internet, computers, and • quality 3. Participant safety mobile phones • usability • 3 domains: internet, computers, and mobile 2. Participant preferences for phones telehealth exercise dose • Scored /100 3. Participant satisfaction with the supervised telehealth * Adapted from TUQ (Parmanto et al, 2016 Int J Telerehabil 8(1); 3-10. ** Adapted from O’Brien et al . 2015 World Journal of Surgery,39(10), 2441 -9 @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 7 | The University of Newcastle

Results: Participant Characteristics Characteristic (n = 21) Age (yr) , mean (SD) 62 (11) Gender, number male (%) 12 (57) Stroke side, number right side (%) 10 (48) Time since stroke (yr) , mean (SD) 7 (7) Walking Ability Speed, comfortable (m/s) , mean (SD) 1.1 (0.3) Technical Familiarity Score, mean (SD) (0-100) 66 (25 ) Score <50, n (%) 7 (33) Score 51-85, n (%) 8 (38) Score >85, n (%) 6 (29) @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 8 | The University of Newcastle

Results: Recruitment, Adherence and Retention Recruitment Adherence 21 recruited out of 66 screened 476 sessions completed • 94% adherence 17% ineligible to receive telehealth exercise delivery • 85% supervised by telehealth • No suitable person at home (14%) • No suitable internet access (3%) Retention • No suitable device (0%) • 4 withdrawals from ExDose 4% declined telehealth delivery • None due to telehealth • Concerned about ability to manage telehealth/(IT) • n=1 swapped to face-to-face supervision @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 9 | The University of Newcastle

Results: Safety Safety • 1 adverse event in 476 sessions • No injuries • ADLS not affected @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 10 | The University of Newcastle

Results: Reliability Scheduled exercise sessions Missed sessions Video Conference or Face-to-face Phone plus phone supervsion 5% of sessions • interrupted by internet drop out • failure, or • sub-optimal performance of the internet Video Conference @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 11 | The University of Newcastle

Results: Quality Instructor ratings: each session Participants: Overall 100 Audio quality was acceptable 75 % of sessions 50 Video quality was acceptable 25 0 5 10 15 20 0 Excellent Acceptable Poor Video quality Audio Quality Neither agree or disagree # Disagree or strongly disagre # Agree or strongly agree @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 12 | The University of Newcastle

Results: Participant Usability The system was easy to learn After the first few sessions the system was easy to use I was able to use the technology on my own. I needed someone at home to help me use the system 0 5 10 15 20 # Agree or strongly agree # Disagree or strongly disagre Neither agree or disagree @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 13 | The University of Newcastle

Results: Participant Satisfaction Would use telehealth exercise sessions again Would recommend telehealth exercise sessions to other people who have had a stroke. Overall was satisfied with the telehealth exercise experience. 0 5 10 15 20 # Disagree or strongly disagre # Agree or strongly agree @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 14 | The University of Newcastle

Results: Participant Satisfaction Themes Comments Benefits for participant 26 Instructor 14 Convenience 13 Satisfaction 12 Altruistim 2 @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 15 | The University of Newcastle

Discussion Feasibility of delivering exercises: Participants “Liked being supervised, otherwise wouldn't have 1. Recruitment affected done it, might take the short cut if not watched.” 2. Adherence: high 3. Safety: low rate of adverse events @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 16 | The University of Newcastle

Discussion Feasibility of delivering exercises : Technical Factors Reliability – acceptable 1. 2. Quality- acceptable 3. Usability- highly rated. Few barriers to successful delivery and uptake of telehealth exercise after stroke @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 17 | The University of Newcastle

Discussion Feasibility of delivering exercises : Satisfaction and future use “Enjoyed the program “Didn't have immensely.”. to go out” “Immense “Better than application for rural sleeping and remote areas.”. tablets”. @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 18 | The University of Newcastle

Conclusions: Telehealth delivery of exercise sessions to people after stroke • Feasible and effective • Neither age nor prior familiarity with technology affected participants’ ability to participate. • Eliminated the need for transport • As access to higher speed internet increases over time, the user experience is likely to improve further. . @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 19 | The University of Newcastle

Acknowledgements Co-authors/supervisors Others Dr Di Marsden Stroke Foundation Grant Prof Robin Callister Prof Kirk Erickson Prof Trevor Russell (UQ) Prof Michael Nilsson www.neorehab.com A/Prof Coralie English April 2019 @margygall

Results: Preferred dose- remove C: Program Length A: Exercise frequency (/week) B: Session duration 20 20 20 18 18 16 16 # Respondents 14 # Respondents 15 14 # Respondents 12 12 10 10 8 10 8 6 6 4 4 5 2 2 0 0 < 4 wks 4-6 6-8 8-12 > 12 < 15 15-20 20-30 30-45 > 45 0 wks wks wks wks min min min min min ≥ 5 One Two Three Four @margygall #ATC2019 #digitalhealth www.newcastle.edu.au 21 | The University of Newcastle