Challenges of usability and access to a digital tool in a telerehabilitation program for COVID- 19 survivors in a developing country
DOI:
https://doi.org/10.11606/issn.2317-0190.v31i4a225410Keywords:
Coronavirus Infections, Telerehabilitation, Exercise Therapy, Quality of Life, Developing CountriesAbstract
Objective: The outbreak of COVID-19 brought many challenges for health system, including for rehabilitation facilities. To supply the high amount of patients with disabilities and functional impairments, telerehabilitation might be a feasible strategy. The aim of this prospective clinical trial is to present a practical experience of a 3-month physical telerehabilitation program, for post COVID-19 patients from a public health system, after hospital discharge. Method: The sample was recruited from a list of 407 patients, to be enrolled up to eight weeks after discharge. Primary outcome measures: Two-minute step test (2MST), Time to Five repetition in the Sit-To-Stand Test, EuroQol (EQ5D). This virtual-wise program consisted of customized videos for respiratory and functional exercises, on a 3-times a week basis. Results: Out of 407 patients, only 19 were enrolled, and 14 completed the program. Main sample losses were due to lack of phone contact, internet and technological constraints and in-person return to work needs. Participants mean age was 56 ± 16.8, 57.9% men; 12 (63.2%) lost weight during hospitalization. Patients increased the 2MST (p= 0.004), a reduction in the five repetitions in the sit and stand test (p= 0.002) and health status score (p= 0.007). Conclusion: Telerehabilitation is a promising option for the treatment of post-discharge COVID-19, physically disabled patients. However, socioeconomical barriers must be taken into account during the development of remote programs for rehabilitation, in order to ensure population access, especially to unequal countries.
Downloads
References
McCloskey B, Zumla A, Ippolito G, Blumberg L, Arbon P, Cicero A, et al. Mass gathering events and reducing further global spread of COVID-19: a political and public health dilemma. Lancet. 2020;395(10230):1096-1099. Doi: https://doi.org/10.1016/S0140-6736(20)30681-4
Haleem A, Javaid M, Vaishya R. Effects of COVID-19 pandemic in daily life. Curr Med Res Pract. 2020;10(2):78-79. Doi: https://doi.org/10.1016/j.cmrp.2020.03.011
Guest JL, Sullivan PS, Valentine-Graves M, Valencia R, Adam E, Luisi N, et al. Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study. JMIR Public Health Surveill. 2020;6(2):e19731. Doi: https://doi.org/10.2196/19731
Hermann M, Pekacka-Egli AM, Witassek F, Baumgaertner R, Schoendorf S, Spielmanns M. Feasibility and Efficacy of Cardiopulmonary Rehabilitation After COVID-19. Am J Phys Med Rehabil. 2020;99(10):865-869. Doi: https://doi.org/10.1097/PHM.0000000000001549
Organization PAH. Rehabilitation considerations during the COVID-19 outbreak. PAHO Washington, DC; 2020.
Barker-Davies RM, O'Sullivan O, Senaratne KPP, Baker P, Cranley M, Dharm-Datta S, et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med. 2020;54(16):949-959. Doi: https://doi.org/10.1136/bjsports-2020-102596
Zhai Y, et al. (2021). From Isolation to Coordination: How Can Telemedicine Help Combat the COVID-19 Outbreak?. In: Wang Y, Wang WYC, Yan Z, Zhang D. (eds) Digital Health and Medical Analytics. DHA 2020. Communications in Computer and Information Science, vol 1412. Springer, Singapore. Doi: https://doi.org/10.1007/978-981-16-3631-8_12
Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585-1592. Doi: https://doi.org/10.1056/NEJMsr1503323
Stickland M, Jourdain T, Wong EY, Rodgers WM, Jendzjowsky NG, Macdonald GF. Using Telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients. Can Respir J. 2011;18(4):216-20. Doi: https://doi.org/10.1155/2011/640865
Tousignant M, Marquis N, Pagé C, Imukuze N, Métivier A, St-Onge V, et al. In-home Telerehabilitation for Older Persons with Chronic Obstructive Pulmonary Disease: A Pilot Study. Int J Telerehabil. 2012;4(1):7-14. Doi: https://doi.org/10.5195/ijt.2012.6083 11
Neubeck L, Redfern J, Fernandez R, Briffa T, Bauman A, Freedman SB. Telehealth interventions for the secondary prevention of coronary heart disease: a systematic review. Eur J Cardiovasc Prev Rehabil. 2009;16(3):281-9. Doi: https://doi.org/10.1097/HJR.0b013e32832a4e7
Hailey D, Roine R, Ohinmaa A, Dennett L. The status of telerehabilitation in neurological applications. J Telemed Telecare. 2013;19(6):307-10. Doi: https://doi.org/10.1177/1357633X13501775
Galea MD. Telemedicine in Rehabilitation. Phys Med Rehabil Clin N Am. 2019;30(2):473-483. Doi: https://doi.org/10.1016/j.pmr.2018.12.002
Howard IM, Kaufman MS. Telehealth applications for outpatients with neuromuscular or musculoskeletal disorders. Muscle Nerve. 2018;58(4):475-485. Doi: https://doi.org/10.1002/mus.26115
Caetano R, Silva AB, Guedes ACCM, Paiva CCN, Ribeiro GDR, Santos DL, et al. Challenges and opportunities for telehealth during the COVID-19 pandemic: ideas on spaces and initiatives in the Brazilian context. Cad Saude Publica. 2020;36(5):e00088920. Doi: https://doi.org/10.1590/0102-311x00088920
McCue M, Fairman A, Pramuka M. Enhancing quality of life through telerehabilitation. Phys Med Rehabil Clin N Am. 2010;21(1):195-205. Doi: https://doi.org/10.1016/j.pmr.2009.07.005
Bohannon RW, Crouch RH. Two-Minute Step Test of Exercise Capacity: Systematic Review of Procedures, Performance, and Clinimetric Properties. J Geriatr Phys Ther. 2019;42(2):105-112. Doi: https://doi.org/10.1519/JPT.0000000000000164
Bohannon RW. Five-repetition sit-to-stand test: usefulness for older patients in a home-care setting. Percept Mot Skills. 2011;112(3):803-6. Doi: https://doi.org/10.2466/15.26.PMS.112.3.803-806
EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199-208. Doi: https://doi.org/10.1016/0168-8510(90)90421-9
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81. Doi: https://doi.org/10.1016/j.jbi.2008.08.010
Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O'Neal L, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208. Doi: https://doi.org/10.1016/j.jbi.2019.103208
Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, et al. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Arch Intern Med. 2007;167(12):1312-20. Doi: https://doi.org/10.1001/archinte.167.12.1312
Hui DS, Joynt GM, Wong KT, Gomersall CD, Li TS, Antonio G, et al. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax. 2005;60(5):401-9. Doi: https://doi.org/10.1136/thx.2004.030205
Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, Shahjouei S, et al. Racial, Economic, and Health Inequality and COVID-19 Infection in the United States. J Racial Ethn Health Disparities. 2021;8(3):732-742. Doi: https://doi.org/10.1007/s40615-020-00833-4
Hruschak V, Flowers KM, Azizoddin DR, Jamison RN, Edwards RR, Schreiber KL. Cross-sectional study of psychosocial and pain-related variables among patients with chronic pain during a time of social distancing imposed by the coronavirus disease 2019 pandemic. Pain. 2021;162(2):619-629. Doi: https://doi.org/10.1097/j.pain.0000000000002128
Ribeiro KB, Ribeiro AF, Veras MASM, Castro MC. Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil. Int J Epidemiol. 2021;50(3):732-742. Doi: https://doi.org/10.1093/ije/dyab022
Katzow MW, Steinway C, Jan S. Telemedicine and Health Disparities During COVID-19. Pediatrics. 2020;146(2):e20201586. Doi: https://doi.org/10.1542/peds.2020-1586
Leochico CF. Adoption of telerehabilitation in a developing country before and during the COVID-19 pandemic. Ann Phys Rehabil Med. 2020;63(6):563-564. Doi: https://doi.org/10.1016/j.rehab.2020.06.001
Boschiero MN, Palamim CVC, Ortega MM, Mauch RM, Marson FAL. One Year of Coronavirus Disease 2019 (COVID-19) in Brazil: A Political and Social Overview. Ann Glob Health. 2021;87(1):44. Doi: https://doi.org/10.5334/aogh.3182
Thorpe J, Viney K, Hensing G, Lönnroth K. Income security during periods of ill health: a scoping review of policies, practice and coverage in low-income and middle-income countries. BMJ Glob Health. 2020;5(6):e002425. Doi: https://doi.org/10.1136/bmjgh-2020-002425
Dhingra D, Dabas A. Global Strategy on Digital Health. Indian Pediatr. 2020;57(4):356-358.
Downloads
Published
Issue
Section
License
Copyright (c) 2024 Acta Fisiátrica
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
