Cardiorespiratory fitness training sessions delivered via telehealth - - PowerPoint PPT Presentation

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Cardiorespiratory fitness training sessions delivered via telehealth - - PowerPoint PPT Presentation

Nov 26, 2023 941 likes •1.18k views

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

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@margygall

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

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2 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Background

1. People after stroke are not meeting physical activity guidelines 2. Cardiorespiratory fitness low after stroke 3. Barriers to exercise post-stroke:

  • logistical factors
  • psycho-social factors
  • stroke-related physical or cognitive impairments
  • 4. Fitness gains and adherence to exercise are

higher if exercise programs are supervised

5 10 15 20 25 30 35 40 45 Post-Stroke 75 yr old 50yr old ML/KG/MIN

Cardiorespiratory Fitness VO2peak

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3 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Background: Telehealth Interventions

  • programs aimed at increasing cardiorespiratory fitness

1. Other populations:

  • cardiac rehabilitation1
  • COPD2
  • cystic fibrosis3
  • the elderly4

“effective and safe”

  • 2. In stroke : less is known
  • Feasibility
  • Safety
  • User experience

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.

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4 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Background: Dose escalation trial (ExDose)

Doses (n=5/dose)

  • 3d/week
  • Mod-vigorous intensity
  • 8 weeks
  • Session duration increased by dose

(10, 15, 20, or 25 min)

  • Intervals: bodyweight/low impact

11% 13% 19% 6% 0.0 2.0 4.0 6.0 8.0 10 15 20 25 ΔVO2PEAK (ML/KG/MIN) SESSION DURATION (MIN)

INCREASE IN CRF

ANZCTR Trial ID: ACTRN12617000460303), Ethics approval HNEHREC Reference No: 16/10/19/4.09).

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5 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

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?
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6 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Methods

Inclusion Criteria

  • Community–dwelling adult
  • ≥ 3mo post-stroke
  • Ambulant (FAC>3)
  • Medical clearance

Telehealth eligibility

  • Suitable internet/device/computer
  • Responsible person present during

sessions Home Visit

  • 1. Risk Assessment
  • Exercise space
  • Exercises
  • Technique
  • Suitability
  • 2. Technical instructions
  • HR
  • RPE
  • Telehealth Platform/IT
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7 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Methods : Data Collection

Exercise instructor 1. Session details 2. Telehealth related factors 3. Participant safety Participant Feedback A: 23 MCQ*, 2 open ended Q’s

  • 1. Telehealth platform
  • reliability
  • quality
  • usability
  • 2. Participant preferences for

telehealth exercise dose

  • 3. Participant satisfaction with

the supervised telehealth B: Level of Technical Familiarity

  • 15 multiple choice questions**
  • Level of engagement with the

internet, computers, and mobile phones

  • 3 domains: internet,

computers, and mobile phones

  • Scored /100

* 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

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8 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

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) Score <50, n (%) Score 51-85, n (%) Score >85, n (%) 66 (25 ) 7 (33) 8 (38) 6 (29)

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9 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Recruitment, Adherence and Retention

Adherence 476 sessions completed

  • 94% adherence
  • 85% supervised by telehealth

Retention

  • 4 withdrawals from ExDose
  • None due to telehealth
  • n=1 swapped to face-to-face

supervision Recruitment 21 recruited out of 66 screened 17% ineligible to receive telehealth exercise delivery

  • No suitable person at home (14%)
  • No suitable internet access (3%)
  • No suitable device (0%)

4% declined telehealth delivery

  • Concerned about ability to manage telehealth/(IT)
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10 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Safety

Safety

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

Results: Reliability

5% of sessions

  • interrupted by internet drop out
  • failure, or
  • sub-optimal performance
  • f the internet

Missed sessions

  • r Face-to-face

supervsion Video Conference Phone Video Conference plus phone

Scheduled exercise sessions

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12 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Quality

25 50 75 100

Excellent Acceptable Poor

% of sessions

Video quality Audio Quality

Instructor ratings: each session

5 10 15 20 Video quality was acceptable Audio quality was acceptable

Participants: Overall

Neither agree or disagree # Disagree or strongly disagre # Agree or strongly agree

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13 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Participant Usability

5 10 15 20

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

# Agree or strongly agree # Disagree or strongly disagre Neither agree or disagree

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14 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Participant Satisfaction

5 10 15 20 Overall was satisfied with the telehealth exercise experience. Would recommend telehealth exercise sessions to

  • ther people who have had a stroke.

Would use telehealth exercise sessions again # Disagree or strongly disagre # Agree or strongly agree

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15 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Participant Satisfaction

Themes Comments Benefits for participant 26 Instructor 14 Convenience 13 Satisfaction 12 Altruistim 2

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16 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Discussion

Feasibility of delivering exercises: Participants

1. Recruitment affected 2. Adherence: high 3. Safety: low rate of adverse events “Liked being supervised,

  • therwise wouldn't have

done it, might take the short cut if not watched.”

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17 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Discussion

Feasibility of delivering exercises : Technical Factors

1. Reliability – acceptable 2. Quality- acceptable 3. Usability- highly rated.

Few barriers to successful delivery and uptake of telehealth exercise after stroke

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18 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Discussion

Feasibility of delivering exercises : Satisfaction and future use

“Enjoyed the program immensely.”. “Better than sleeping tablets”. “Didn't have to go out” “Immense application for rural and remote areas.”.

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19 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

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..

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@margygall

Acknowledgements

April 2019

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

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21 | The University of Newcastle www.newcastle.edu.au @margygall #ATC2019 #digitalhealth

Results: Preferred dose- remove

5 10 15 20 One Two Three Four ≥ 5 # Respondents

A: Exercise frequency (/week)

2 4 6 8 10 12 14 16 18 20 < 15 min 15-20 min 20-30 min 30-45 min > 45 min # Respondents

B: Session duration

2 4 6 8 10 12 14 16 18 20 < 4 wks 4-6 wks 6-8 wks 8-12 wks > 12 wks # Respondents

C: Program Length