App-based Telerehabilitation Program for Older Adults on Waiting List for Physiotherapy After Hospital Discharge: a Feasibility Pragmatic Randomized Trial

Overview

Journal Pilot Feasibility Stud

Publisher Biomed Central

Date 2024 Jul 3

PMID 38961470

Authors

Pollyana Ruggio Tristao Borges

Rosana Ferreira Sampaio

Jane Fonseca Dias

Marisa Cotta Mancini

Juliana Melo Ocarino

Renan Alves Resende

Affiliations

Soon will be listed here.

Abstract

Background: Inactivity while waiting for outpatient physiotherapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages. This study aimed to evaluate the feasibility of the study procedures of a telerehabilitation program for older adults waiting for outpatient physiotherapy after hospital discharge.

Methods: This pragmatic randomized controlled trial recruited older adults (≥ 60 years) with several clinical diagnoses on the waiting list for outpatient physiotherapy in the Brazilian public health system after hospital discharge. The telerehabilitation group (n = 17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n = 17) followed the usual waiting list. We assessed recruitment and dropout rates, safety, adherence, and satisfaction. The preliminary effects were verified on clinical outcomes.

Results: We recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program. The weekly adherence was 2.85 (1.43) days, and in 63.3% of the weeks the participants were enrolled, they performed the exercise program at least twice a week. Participants rated the telerehabilitation program as 9.71 (0.21), and the safety of remote exercises without professional supervision as 8.6 (2.2) on a 0-10 scale.

Conclusions: The telerehabilitation program using a smartphone app was safe and presented high participants' satisfaction and adequate adherence, recruitment, and dropout rates. Therefore, the definitive study can be conducted with few modifications.

Trial Registration: Brazilian Registry of Clinical Trials (ReBEC), RBR-9243v7. Registered on 24 August 2020. https://ensaiosclinicos.gov.br/rg/RBR-9243v7 .

References

Gautschi O, Stienen M, Corniola M, Joswig H, Schaller K, Hildebrandt G . Assessment of the Minimum Clinically Important Difference in the Timed Up and Go Test After Surgery for Lumbar Degenerative Disc Disease. Neurosurgery. 2016; 80(3):380-385. DOI: 10.1227/NEU.0000000000001320. View

Chun Y, Patterson P . A usability gap between older adults and younger adults on interface design of an Internet-based telemedicine system. Work. 2012; 41 Suppl 1:349-52. DOI: 10.3233/WOR-2012-0180-349. View

Ojha H, Wyrsta N, Davenport T, Egan W, Gellhorn A . Timing of Physical Therapy Initiation for Nonsurgical Management of Musculoskeletal Disorders and Effects on Patient Outcomes: A Systematic Review. J Orthop Sports Phys Ther. 2016; 46(2):56-70. DOI: 10.2519/jospt.2016.6138. View

Young J, Snodgrass S, Cleland J, Rhon D . Timing of physical therapy for individuals with patellofemoral pain and the influence on healthcare use, costs and recurrence rates: an observational study. BMC Health Serv Res. 2021; 21(1):751. PMC: 8320186. DOI: 10.1186/s12913-021-06768-8. View

Krumholz H . Post-hospital syndrome--an acquired, transient condition of generalized risk. N Engl J Med. 2013; 368(2):100-2. PMC: 3688067. DOI: 10.1056/NEJMp1212324. View

Paganini S, Terhorst Y, Sander L, Catic S, Balci S, Kuchler A . Quality of Physical Activity Apps: Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth. 2021; 9(6):e22587. PMC: 8262667. DOI: 10.2196/22587. View

Covinsky K, Pierluissi E, Johnston C . Hospitalization-associated disability: "She was probably able to ambulate, but I'm not sure". JAMA. 2011; 306(16):1782-93. DOI: 10.1001/jama.2011.1556. View

Eldridge S, Chan C, Campbell M, Bond C, Hopewell S, Thabane L . CONSORT 2010 statement: extension to randomised pilot and feasibility trials. Pilot Feasibility Stud. 2016; 2:64. PMC: 5154046. DOI: 10.1186/s40814-016-0105-8. View

Bertolucci P, Brucki S, Campacci S, Juliano Y . [The Mini-Mental State Examination in a general population: impact of educational status]. Arq Neuropsiquiatr. 1994; 52(1):1-7. View

10.

Ozden F, Sari Z, Karaman O, Aydogmus H . The effect of video exercise-based telerehabilitation on clinical outcomes, expectation, satisfaction, and motivation in patients with chronic low back pain. Ir J Med Sci. 2021; 191(3):1229-1239. DOI: 10.1007/s11845-021-02727-8. View

11.

Whitehead A, Julious S, Cooper C, Campbell M . Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable. Stat Methods Med Res. 2015; 25(3):1057-73. PMC: 4876429. DOI: 10.1177/0962280215588241. View

12.

Aguado H, Ventura-Wichner P, Perez-Hickman L, Polo-Perez I, Alonso-Olmo J, Bragado M . Patient Satisfaction Using a Home-Based Rehabilitation Protocol for the Non-Surgical Treatment of Proximal Humeral Fractures: A Prospective Longitudinal Cohort Study. Geriatr Orthop Surg Rehabil. 2021; 12:21514593211040293. PMC: 8404618. DOI: 10.1177/21514593211040293. View

13.

Wright A, Cook C, Baxter G, Dockerty J, Abbott J . A comparison of 3 methodological approaches to defining major clinically important improvement of 4 performance measures in patients with hip osteoarthritis. J Orthop Sports Phys Ther. 2011; 41(5):319-27. DOI: 10.2519/jospt.2011.3515. View

14.

Reis F, Fernandes L, Saragiotto B . Telehealth in low- and middle-income countries: Bridging the gap or exposing health disparities?. Health Policy Technol. 2021; 10(4):100577. PMC: 8561751. DOI: 10.1016/j.hlpt.2021.100577. View

15.

Picorelli A, Pereira L, Pereira D, Felicio D, Sherrington C . Adherence to exercise programs for older people is influenced by program characteristics and personal factors: a systematic review. J Physiother. 2014; 60(3):151-6. DOI: 10.1016/j.jphys.2014.06.012. View

16.

Podsiadlo D, Richardson S . The timed "Up & Go": a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991; 39(2):142-8. DOI: 10.1111/j.1532-5415.1991.tb01616.x. View

17.

Seron P, Oliveros M, Gutierrez-Arias R, Fuentes-Aspe R, Torres-Castro R, Merino-Osorio C . Effectiveness of Telerehabilitation in Physical Therapy: A Rapid Overview. Phys Ther. 2021; 101(6). PMC: 7928601. DOI: 10.1093/ptj/pzab053. View

18.

Wang X, Hunter D, Vesentini G, Pozzobon D, Ferreira M . Technology-assisted rehabilitation following total knee or hip replacement for people with osteoarthritis: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2019; 20(1):506. PMC: 6825714. DOI: 10.1186/s12891-019-2900-x. View

19.

Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios L . A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010; 10:1. PMC: 2824145. DOI: 10.1186/1471-2288-10-1. View

20.

Fusco F, Turchetti G . Telerehabilitation after total knee replacement in Italy: cost-effectiveness and cost-utility analysis of a mixed telerehabilitation-standard rehabilitation programme compared with usual care. BMJ Open. 2016; 6(5):e009964. PMC: 4874124. DOI: 10.1136/bmjopen-2015-009964. View