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Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study
Open accessAbstract
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.
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“In addition, previous research has found that telerehabilitation may result in lower patient adherence or confidence, which may decrease the treatment’s effectiveness [24].”
From Behavior Modification Techniques on Patients with Chronic Pain in the Context of COVID-19 Telerehabilitation: An Umbrella Review (2022) · cites this paper as [24]
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“They express a desire for specialist knowledge; concern that exercising may exacerbate symptoms; and transport issues (7, 14– 17).”
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Are Physical Activity and Benefits Maintained After Long-Term Telerehabilitation in COPD?
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“(38), poor knowledge of using the computer was mentioned as a challenge in implementing remote services.”
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“Smaller studies of longterm exercise-based telerehabilitation solutions in COPD have shown improvement in exercise behaviour and quality of life [1,12,13].”
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“High adherence is affected by increased independence, experience of health benefits, and motivation maintenance, which are essential for long-term home-based rehabilitation (39).”
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Acceptance of telerehabilitation in chronic pain: the patients' perspective
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“Regular interaction between health professional and patients has shown to enhanced motivation and increase compliance during telerehabilitation (26, 27).”
BackgroundUche-Okoye, D., Ajemba, M. N., Bendall, A., Arene, E. C., Ugo, C. H., Eze, N., Anyadike, I. K., Onuorah, U. M., & Chiwenite, C. M. (2023) · Bulletin of the National Research Centre/Bulletin of the National Research Center · doi:10.1186/s42269-023-00980-8 · Cited by 12
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“29 The family member had the physiotherapist ’ s telephone number to notify of any setback during the telerehabilitation programme.”
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Althobiani, M. A., Khan, B., Shah, A., Ranjan, Y., Mendes, R. G., Folarin, A., Mandal, S., Porter, J. C., & Hurst, J. R. (2023) · International Journal of COPD · doi:10.2147/copd.s405386 · Cited by 12
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“%) having <20 participants or lasting only a few weeks [12,15].”
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Videoconferencing interventions and COPD patient outcomes: A systematic review
Bowman, M., Jalink, M., Sharpe, I., Srivastava, S., & Wijeratne, D. T. (2023) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x231158140 · Cited by 9
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“In this context, ideas that could increase the participation of may be more effective on satisfaction and usability [35].”
Organização e oferta da assistência fisioterapêutica em resposta à pandemia da COVID-19 no Brasil
Souza, T. S., Aleluia, Í. R. S., Pinto, E. B., Pinto, E. P., Pedreira, R. B. S., Fraga-Maia, H., & Pinto, J. M. (2022) · Ciência & Saúde Coletiva · doi:10.1590/1413-81232022276.00752022 · Cited by 8
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“, 2020), safer and more confident (Hoaas et al., 2016).”
ResultRyan, D., Rio, E., O’Donoghue, G., & O'Sullivan, C. M. (2023) · Journal of Foot and Ankle Research · doi:10.1186/s13047-023-00619-x · Cited by 11
“Previously, the regularity of contact has also been described as important factor for maintaining a commitment to exercise in adherence levels in telehealth for patients with chronic pulmonary disease [53] and Achilles Tendinopathy [3].”
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“In addition, previous research has found that telerehabilitation may result in lower patient adherence or confidence, which may decrease the treatment’s effectiveness [24].”
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A home-based hand rehabilitation platform for hemiplegic patients after stroke: A feasibility study
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“The high adherence to the intervention shows that the participant actively engaged, indicating the feasibility of the intervention [27].”
A Review of Success/Failure Factors Influencing Healthcare Personnel for Telerehabilitation
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BackgroundEmerging models of pulmonary rehabilitation
Hanssen, H., & Nolan, C. M. (2021) · European Respiratory Society eBooks · doi:10.1183/2312508x.10019220 · Cited by 7
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Otolaryngology Patient Satisfaction with In-Office Appointments and Virtual Visits Due to COVID-19
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Metadata
- Authors
- Hoaas, H., Andreassen, H. K., Lien, L. A., Hjalmarsen, A., & Zanaboni, P.
- Affiliations
- University Hospital of North Norway (NO)
- Corresponding author
- Hoaas, Hanne
- Venue
- BMC Medical Informatics and Decision Making
- Published
- 2016-02-25
- Volume
- 16
- Issue
- 1
- Pages
- 26-26
- ISSN
- 1472-6947 (ISSN-L)
- PMC
- PMC4766676
- OpenAlex
- W2285434670
- Cited by
- 152
- References
- 53
- Citations by year
- 2026: 5 · 2025: 13 · 2024: 13 · 2023: 24 · 2022: 29 · 2021: 18 · 2020: 11 · 2019: 8 · 2018: 12 · 2017: 12 · 2016: 6
- FWCI
- 12.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Medical Informatics and Decision Making (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Funders
- Helse Nord RHF (HST1014-11)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- chronic obstructive pulmonary disease, telerehabilitation, pulmonary rehabilitation, exercise adherence, patient satisfaction, remote patient monitoring, self-management, self-efficacy, motivation, emotional safety, videoconferencing, usability, service improvement
- MeSH terms
- Telerehabilitation, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Patient Compliance, Pilot Projects, Self Care, Patient Satisfaction, Pulmonary Disease, Chronic Obstructive
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