The coronavirus (COVID-19) pandemic has had a considerable impact on many NHS and social care services; one particular area affected is pulmonary rehabilitation, an exercise and education-based treatment programme for people with lung conditions such as Chronic Obstructive Pulmonary Disease (COPD).
With many pulmonary rehab staff being diverted to intensive care units (ICU) to support coronavirus patients, group or one-to-one sessions being suspended, and vulnerable patients being advised to shield, delivering this service became challenging, to say the least; it presented us with the real risk of patients’ health significantly deteriorating.
By necessity, pulmonary rehab teams throughout the country had to explore alternative ways to offer the programme, and digital solutions were the only way forward.
In the North West, the Innovation Agency has been supporting several sites across the Cheshire and Merseyside Integrated Care System (ICS) to offer Rehab Guru to patients, this is one example of the solutions that AHSNs have collaborated on across the country.
Rehab Guru is a home exercise prescription platform with an extensive library that can be used to create individually tailored exercise programmes for patients to follow. Crucially, the platform also provides the ability to deliver educational content and videos, monitor participants and record outcomes. It also provides the functionality to send secure and private patient forms to their inbox within the platform so that these can be completed securely at home. The patient feels supported through the virtual contact, and if needed, this is supplemented with a weekly phone call.
The app and web versions are very user friendly – no need for passwords or login details; the patient simply clicks on a link. You can input MRC scores (measures breathlessness), GAD7 scores (measures generalised anxiety disorder), CRDQ scores (Chronic Respiratory Disease Questionnaire), PHQ9 (depression test questionnaire), HADS (Hospital Anxiety and Depression Scale), CAT (COPD Assessment Test) and exercise scores onto each patient’s profile page. This helps you quickly assemble a bespoke exercise programme and send this to the patient’s email.
The Innovation Agency team has been working collaboratively with the Rehab Guru team and the pulmonary rehab sites to develop and tailor the platform to the specific needs of Cheshire and Merseyside’s pulmonary rehab services. This effort is now bearing fruit with four sites adopting the technology; those clinical teams can now manage more patients. The technology is now being spread to other PR sites across the ICS.
The question of digital inclusivity is always essential to consider when offering digital services; we cannot afford to widen the health inequalities gap. Working with the ICS, the Innovation Agency has recently secured funding to run a pilot project with O2 so that if patients do not have hardware or data access at home, we can provide them with an iPad and online access for the duration of their pulmonary rehab programme. We are linking up with local initiatives to support patients accessing online services for the first time and have secured funding for each service to access a staff member who can help patients.
A menu-based approach to offering Pulmonary Rehabilitation
Today, digital solutions should be an important component of a menu-based approach to providing pulmonary rehab services. One size does not fit all, and we know from national audit data that pulmonary rehab services are utilised by only a tiny proportion of patients who could benefit from the intervention.
We have been innovative in trying to deliver services differently to meet the specific needs of our local population. By offering a range of pulmonary rehab solutions for patients, we are experiencing better uptake and completion rates of our services.
In other regions, AHSNs have been supporting clinical teams with innovative solutions such as Cambridgeshire-based Aseptika, whose integrated Activ8rlives platform and monitoring devices help people self-manage their health. This is coupled with tailored exercise programmes specifically designed to cater for the needs of people with respiratory conditions.
Concept Health is another exciting company combining virtual reality technology with machine learning to help offer new options for digital rehabilitation. The service combines virtual reality with sensor technology, and it is all stitched together using artificial intelligence (AI). Patients can switch on the system whenever they want to do their exercises, and one member of staff working on-call can monitor multiple patients simultaneously.
Spirit Digital‘s CliniTouch Vie app helps patients monitor their condition at home and connects them with their clinicians so that they can spot trends, pick up on health deterioration and intervene when necessary. The use of this technology has seen a 67.5% reduction in unscheduled hospital admissions and improved CAT (COPD Assessment Test) scores.
Despite all of the difficulties it has presented, the coronavirus pandemic has also provided us with a driver to investigate digital alternatives for pulmonary rehab. The challenge now is to review and work out how digital services can complement the traditional approach to continue to improve the future offering and outcomes for patients.