Tele-Rehabilitation during the COVID-19 Pandemic: Experience of a Large Lung Transplant Program

Wickerson, L.; Helm, D.; Gottesman, C.; Rozenberg, D.; Singer, L. G.; Keshavjee, S.; Sidhu, A.

Purpose The COVID-19 pandemic resulted in a rapid shift from centre-based to tele-rehabilitation. Experience with this delivery model on a large scale has not been described. Methods A program evaluation of usage and satisfaction of lung transplant (LTx) candidates and recipients who used a web-based, remote monitoring App for a least 4 weeks between March 16th and September 1st 2020. Within-subjects analysis was performed for self-efficacy for exercise (SEE) and physical activity pre-LTx at baseline and after 4 weeks and exercise volumes between at baseline and last entry. Results 78 LTx candidates and 30 recipients were included (50% male, 58 ± 12 years, 50% ILD, 31% COPD). 90% of LTx candidates had oximeters, 35% a treadmill and 75% weights. 34% reported being alone when exercising. 64% of LTx candidates and 50% of recipients entered ≥ 10 prescribed exercise sessions. Pre-LTx, non-treadmill walking was recorded as steps (range 230-4847), distance (18m-3.2km) or time (3-80 mins), n=48. 26 patients used a treadmill (range 0.5 - 2.8 mph) for 5-45 minutes. Walking increased in duration (16-22mins, p=0.002) but not speed (1.7-1.75mph, p=0.31). Quadriceps weight used for leg extension did not change (3.6-3.9lbs, p=0.08, n=37). On the Rapid Assessment of Physical Activity (RAPA), 57% scored as active which improved to 87% (p=0.02, n=23). On the SEE, confidence for exercising regularly when alone increased (46%), decreased (14%) or remained the same (40%), n=37. LTx recipients increased treadmill speed (1.9 - 2.7mph, p=0.003) but not time (19-26 minutes, p=0.07, n=9). Non-treadmill walking was recorded as time (range 11-90 mins) and steps (1902-15903). Quadriceps weight increased (2.3 - 5.7lbs, p=0.0002, n=12). At 3 months post-transplant, 76 % scored as active (n=17) with a high total SEE score of 74 ± 11 (n=12). Patients engaged in 365 physiotherapy video visits. 83% of LTx candidates agreed the App helped prepare them for surgery and 85% of LTx recipients agreed that asynchronous texting was helpful to their recovery. Patients accessed the App's exercise card (278 views), pre-LTx exercise video (116 views) and guidelines for exercising after LTx (89 views). Conclusion Exercise participation and progression occurred despite issues around equipment access. This early experience will inform the development of a robust, effective and equitable remote/hybrid rehabilitation model.