Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb 25:16:26.
doi: 10.1186/s12911-016-0264-9.

Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study

Hanne Hoaas  1   2 , Hege Kristin Andreassen  3 , Linda Aarøen Lien  4 , Audhild Hjalmarsen  5   6 , Paolo Zanaboni  7
Affiliations

Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study

Hanne Hoaas et al. BMC Med Inform Decis Mak. .

Abstract

Background: Telemedicine may increase accessibility to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), thus enhancing long-term exercise maintenance. We aimed to explore COPD patients' adherence and experiences in long-term telerehabilitation to understand factors affecting satisfaction and potential for service improvements.

Methods: A two-year pilot study with 10 patients with COPD was conducted. The intervention included treadmill exercise training at home and a webpage for telemonitoring and self-management combined with weekly videoconferencing sessions with a physiotherapist. We conducted four separate series of data collection. Adherence was measured in terms of frequency of registrations on the webpage. Factors affecting satisfaction and adherence, together with potential for service improvements, were explored through two semi-structured focus groups and an individual open-ended questionnaire. Qualitative data were analysed by systematic text condensation. User friendliness was measured by the means of a usability questionnaire.

Results: On average, participants registered 3.0 symptom reports/week in a web-based diary and 1.7 training sessions/week. Adherence rate decreased during the second year. Four major themes regarding factors affecting satisfaction, adherence and potential improvements of the intervention emerged: (i) experienced health benefits; (ii) increased self-efficacy and independence; and (iii) emotional safety due to regular meetings and access to special competence; (iv) maintenance of motivation. Participants were generally highly satisfied with the technical components of the telerehabilitation intervention.

Conclusions: Long-term adherence to telerehabilitation in COPD was maintained for a two-year period. Satisfaction was supported by experienced health benefits, self-efficacy, and emotional safety. Maintenance of motivation was a challenge and might have affected long-term adherence. Four key factors of potential improvements in long-term telerehabilitation were identified: (i) adherence to different components of the telerehabilitation intervention is dependent on the level of focus provided by the health personnel involved; (ii) the potential for regularity that lies within the technology should be exploited to avoid relapses after vacation; (iii) motivation might be increased by tailoring individual consultations to support experiences of good health and meet individual goals and motivational strategies; (iv) interactive functionalities or gaming tools might provide peer-support, peer-modelling and enhance motivation.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The steps of analysis in systematic text condensation with examples
Fig. 2
Fig. 2
Monthly adherence rate for training sessions and diary registrations with three-month intervals
Fig. 3
Fig. 3
Seasonality of adherence rate for training sessions and diary registrations
See this image and copyright information in PMC

References

    1. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: Global initiative for chronic obstructive lung disease, Inc.; 2015 [05.01.2015]. Available from: http://www.goldcopd.org/uploads/users/files/GOLD_Report_2014_Jan23.pdf. - PubMed
    1. Spruit MA, Singh S, Garvey C, Zuwallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society Statement: Key consepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013;188(8):e13–e64. doi: 10.1164/rccm.201309-1634ST. - DOI - PubMed
    1. Andrianopoulos V, Klijn P, Franssen FME, Spruit MA. Exercise training in pulmonary rehabilitation. Clin Chest Med. 2014;35(2):313–22. doi: 10.1016/j.ccm.2014.02.013. - DOI - PubMed
    1. NHS Right Care. Introducing the atlas of variation in healthcare for people with respiratory disease 2012 [23.03.2015]. Available from: http://www.rightcare.nhs.uk/index.php/atlas/respiratorydisease/.
    1. Rasekaba TM, Williams E, Hsu-Hage B. Can a chronic disease management pulmonary rehabilitation program for COPD reduce acute rural hospital utilization? Chron Respir Dis. 2009;6(3):157–63. doi: 10.1177/1479972309104419. - DOI - PubMed

Publication types