Effects of Telehealth pulmonary rehabilitation on social isolation and quality of life among African American and Hispanic patients with advanced chronic obstructive pulmonary disease
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Abstract
BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a treatable disease that affects millions of people worldwide. Pulmonary rehabilitation (PR) is a treatment option for COPD patients, post exacerbation, with less than 20% referred due to lack of provider awareness and about 2% overall accessing the program. Socioeconomic barriers such as lack of insurance coverage, transportation costs, and access to transportation further prevent access to PR. African American and Hispanic individuals are more socioeconomically disadvantaged than non-Hispanic Whites. These disadvantages lead to poor health which ultimately leads to poorer quality of life and increased social isolation. Telehealth Pulmonary Rehabilitation (TelePR) is one way to bypass certain socioeconomic barriers presented with PR. Studies show that TelePR improves quality of life (QoL). Given the limited research on how TelePR affects social isolation (SI), we sought to explore this relationship, as group exercise during TelePR may help decrease SI. Implementation and maintenance of TelePR is important as it provides a way to bypass some barriers from standard pulmonary rehabilitation (SPR) while improving QoL and decreasing SI.Goal: To assess whether adopting a telehealth PR program can reduce SI and improve QoL among African American and Hispanic individuals with moderate to severe COPD.
METHODS: This study re-analyzed data from Polo et al., (2023) and Hajizadeh et al., (2021) through the lens of SI and QoL. The first step was to complete the onboarding process (taking CITI training, HIPAA training, and Northwell Health orientation) in order to be added to the Feinstein Institutes for Medical Research Institutional Review Board (IRB). Participants were recruited from 9 hospitals in the New York region and randomized into the TelePR arm or SPR arm. Data was collected from beginning of the program (day 1), end of the program (8 weeks), 6 months post program, and 12 months post program. CAT score (impact of COPD on individuals), BCKQ score (COPD knowledge), PROMIS-form fatigue score, functional capacity score, and resistance and duration (exercise capacity) on a bicycle (TelePR) or treadmill (SPR) were used to determine QoL for individuals in TelePR and SPR. PROMIS-form SI, companionship, instrumental support, and informational support scores were used to determine SI for individuals in TelePR and SPR. Qualitative interview transcripts were re-read to determine impact of TelePR on QoL and SI. Continuation of exercise post-program by participants was also recorded.
RESULTS: Of 729 initial potential participants, only 67 completed the program (47 for TelePR and 20 for SPR). Contrary to our hypothesis, participants in the TelePR arm had a significant increase in SI as depicted by the PROMIS SI score (P = 0.03). However, TelePR participants also experienced an improvement in QoL, as depicted by the CAT score (P = 0.04), BCKQ score (P = 0.003), PROMIS fatigue score (P = 0.02), and assessments of functional capacity (P = 0.001), and exercise capacity (P = 0.0001 and P = 0.028). With the exception of exercise capacity, SPR had no significant improvement (P > 0.05) in QoL or SI. Most participants did not continue to exercise after the program ended and all improvements in scores reverted back to pre-program levels 12 months post-program. Qualitative interviews provided support that individuals in TelePR felt the program helped them cope and manage their COPD while allowing them to make friendships (in some way decrease SI), but felt abandoned when the program ended.
CONCLUSION: Telehealth Pulmonary Rehabilitation improves QoL and can improve SI but needs to be maintained as seen by the reversion from progress after the Tele-PR finished, the increase in PROMIS SI scores, and specific statements from qualitative interviews with participants.
Funding for PCORI Study: Research reported in this work was funded through a Patient-Centered Outcomes Research Institute® (PCORI®) Award (1511-33066). The statements presented in this work are solely the responsibility of the author(s) and do not necessarily represent the views of the Patient-Centered Outcomes Research® (PCORI®), its Board of Governors or Methodology Committee.
Description
2024
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Attribution-NonCommercial-NoDerivatives 4.0 International