Tele-Health Pulmonary Rehabilitation: Lessons from Alberta Mike Stickland, PhD CIHR New Investigator...
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Transcript of Tele-Health Pulmonary Rehabilitation: Lessons from Alberta Mike Stickland, PhD CIHR New Investigator...
Tele-Health Pulmonary Rehabilitation:Lessons from Alberta
Mike Stickland, PhD
CIHR New Investigator
Assistant Professor
Pulmonary Division
Faculty of Medicine
U of Alberta
Co-Director
Centre for
Lung Health
Edmonton General
Conflict of Interest Disclosure
Educational Grant:• Glaxo-Smith Klein• Astrazeneca
Speakers Honoriarium • Glaxo-Smith Klein
Canadian Situation
• A recent national survey revealed that only 98 programs exist in Canada (Brooks et al. Can Resp J, 2007)
• These programs combined have the capacity to serve only 1.2% of the COPD population in Canada
(Brooks et al. Can Resp J, 2007)
Grande Prairie (pop.50000)
- 400 km / 250 m
Peace River (pop.7000 )
- 480 km / 300 m
Fort McMurray (pop.88000 )
- 400 km / 250 m
High Level (pop.4000)
- 775 km / 480 m
Canadian Situation
‘An urgent need exists to increase access to Pulmonary Rehabilitation programs across Canada’
(O’Donnell et al., CTS Guidelines, Can Resp J, 2007)
Purpose
• To develop a pulmonary rehabilitation program using Tele-Health technology to provide PR services in rural Alberta
• Is rehab delivered via Tele-Health as effective as standard out-patient rehab?
Patient Referral:• Physician Referral• Full lung function test• Chest X-ray• ABG (if on O2)• Any additional cardiac info appreciated
•All pts seen by pulmonologist at enrollment
6 – 8 week outpatient program for ambulatory patients
Chronic Respiratory Disease
Breathe Easy ProgramCentre for Lung Health (Covenant Health)
Rehab Classes• 31 classes• M/W/F or Tue/Thur • Daytime & evening classes• ~ 500 pts enrolled / year
Components of Pulmonary Rehabilitation
Education Exercise Support
Standard Outcomes
All conducted before and after:• Cardiopulmonary exercise test• Walk test*• Quality of life
– SF-36*– St-George’s Respiratory
Questionnaire (SGRQ)** Conducted at 6 and 12 month follow-up
Tele-Health involves the use of communications and information technology to deliver health services and information over large and small distances.
ClinicalEducationalAdministrative
TELE-HEALTH
Remote sites required:
• A local health care coordinator (typically RT)
• An exercise facility
• Telehealth capabilities
Tele-Health Pulmonary Rehabilitation
Pre Program consult w/ Pulmonologist
Edmonton Site Telehealth
MD Consult In Person Via Tele-Health
w/ RT @ remote site
Chest X-ray Yes Yes
Lung Function Full Pulmonary Function Test
Minimum Spirometry
Exercise Test Cardiopulmonary Exercise Test
6min walk w/ SpO2
and resting EKG
Telehealth Pulmonary Rehab
North:Grande Prairie Peace River Athabasca Bonnyville Cold LakeElk PointBarrheadFort McMurray
Central:Camrose Drayton Valley Killam VermillionWainwright
Edmonton:Sherwood ParkFort SaskatchewanLeduc
15 Sites Total:
Is Telehealth PR as effective as standard PR for COPD?
(non-inferiority trial)
Edmonton Site
Patients N=147
Age 69 ± 10
% Female 50%
FEV1 (% predicted) 49.1 ± 18
Quality of Life (SGRQ, %) 46.0 ± 17
12-minute walk (m) 627 ± 238
Drop-outs 17
(Stickland, Jourdain, Wong, Rodgers, Jendzjowsky, MacDonald In Press)
Is Telehealth PR as effective as standard PR for COPD?
(non-inferiority trial)
Edmonton Site Telehealth
Patients N=147 N=147
Age 69 ± 10 69 ± 9
% Female 50% 53%
FEV1 (% predicted) 49.1 ± 18 48.1 ± 25
Quality of Life (SGRQ, %) 46.0 ± 17 50.9 ± 16 *
12-minute walk (m) 627 ± 238 507 ± 241 *
Drop-outs 17 20
(Stickland, Jourdain, Wong, Rodgers, Jendzjowsky, MacDonald In Press)
Change in SGRQ (%)
-6 -4 -2 0 2 4 6
MCID MCID
Main Program
Telehealth
Main - Tele
Non-Inferiority Analysis
Similar results seen w/ per-protocol analysis
(Intention-to-treat)
Responses similar across GOLD category
Change in Walk Distance (m)
-150 -100 -50 0 50 100 150
Main Program
Telehealth
Main - TelehealthΔ
Non-Inferiority Analysis
(Intention-to-treat)
Change in SGRQ (%)
-6 -4 -2 0 2 4 6
MCID MCID
Main Program
Telehealth
Main - TelehealthΔ
6 Month DataPre vs. Post
Pre vs. 6mo(n=45)
(n=47)
Key Findings
• Tele-Health PR as effective as standard pulmonary rehabilitation– Similar responses seen across GOLD stage– Safe, no difference in drop-outs / adverse events– Does not need to be complicated
• Excellent way to provide pulmonary services/support to rural regions
Lessons Learned
• Need for key central coordinator– Standardize referral data for MDs– Ensure scheduling & delivery– IT support– Ensure proper discharge reporting– Track Health outcomes
• Flexibility for Education delivery– Varying Tele-Health equipment– Limited telehealth facilities– Ability to podcast education sessions
Thanks to:
M. Pratley
R. Hamir
T. Jourdain
S. Olson
L. Simmonds
B. Gendron
S. Martin
B. Yee
CFLH Staff: Pulmonologists:Dr. F. MacDonaldDr. J. ArchibaldDr. M. Bhutani Dr. T. BryanDr. A. LiuDr. S. MarcushamerDr. L. MelenkaDr. W. RameshDr. D. StolleryDr. E. Wong
Dr. F. MacDonaldT. JourdainDr. W. RodgersDr. E. Wong
Co-investigators
Funding for this project was obtained from the Alberta Health Services Telehealth Clinical Grant Fund & Covenant Health Research Foundation.
Tele-Health Pulmonary Rehab
• Pre Program consult w/ Pulmonologist via Tele-Health
• The following test results are reviewed at the initial consult:• 6 minute walk with oximetry • Pulmonary Function Test (minimum spirometry)• Baseline Electrocardiogram• Chest X-Ray
• Education given via Tele-Health • Patients exercise at local site under supervision
Tele-Health Pulmonary Rehab
• Pre Program consult w/ Pulmonologist via Tele-Health
• The following test results are reviewed at the initial consult:• 6 minute walk with oximetry • Pulmonary Function Test (minimum spirometry)• Baseline Electrocardiogram• Chest X-Ray
• Education given via Tele-Health • Patients exercise at local site under supervision
Is Telehealth PR as effective as standard PR for COPD?
(non-inferiority trial)
Telehealth
Patients N=147
Age 69 ± 9
% Female 53%
FEV1 (% predicted) 48.1 ± 25
Quality of Life (SGRQ, %) 50.9 ± 16 *
12-minute walk (m) 507 ± 241 *
Drop-outs 20
(Stickland, Jourdain, Wong, Rodgers, Jendzjowsky, MacDonald In Press)
Is Telehealth PR as effective as standard PR for COPD?
(non-inferiority trial)
Telehealth Edmonton Site
Patients N=147 N=147
Age 69 ± 9 69 ± 10
% Female 53% 50%
FEV1 (% predicted) 48.1 ± 25 49.1 ± 18
Quality of Life (SGRQ, %) 50.9 ± 16 * 46.0 ± 17
12-minute walk (m) 507 ± 241 * 627 ± 238
Drop-outs 20 17
(Stickland, Jourdain, Wong, Rodgers, Jendzjowsky, MacDonald In Press)
Is Telehealth PR as effective as standard PR for COPD?
(non-inferiority trial)
Telehealth Edmonton Site
Patients N=147 N=147
Age 69 ± 9 69 ± 10
% Female 53% 50%
FEV1 (% predicted) 48.1 ± 25 49.1 ± 18
Quality of Life (SGRQ, %) 50.9 ± 16 * 46.0 ± 17
12-minute walk (m) 507 ± 241 * 627 ± 238
Drop-outs 20 17
(Stickland, Jourdain, Wong, Rodgers, Jendzjowsky, MacDonald In Press)