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

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 16(th) and September 1(st) 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.