As the aging population grows, the number of people living with chronic diseases will continue to rise. Because medical advancements have increased the lifespan of these individuals, there is a consistent need for healthcare efforts directed toward disease management. By addressing the morbidity and mortality associated with chronic diseases, healthcare providers can improve quality of life and reduce hospital readmissions for the aging population.
The Demand for Healthcare Efficiency
At a time when our healthcare system is demanding greater cost efficiency and improved care quality, healthcare providers must find a way to effectively provide disease management interventions to the chronic disease population. Telehealth has the potential to facilitate just this type of care delivery by allowing providers to reach more patients and consistently monitor those patients.
A 2017 randomized controlled trial examined the benefits of using telehealth with the chronic disease population by testing the efficacy of a 4 month telerehabilitation program for patients with combined COPD and CHF. The authors specifically studied patients with co-existing COPD and CHF because these two diseases often occur together in older adults. Having both diseases results in further diminished quality of life, increased risk of hospitalization, and rising medical costs. Therefore, this patient population stands to gain numerous benefits from telerehabilitation interventions.
Using Telehealth to Provide Multidisciplinary Care
A combined presentation of COPD and CHF is accompanied by a variety of symptoms, including dyspnea, orthopnea, exercise intolerance, fatigue, and muscle weakness. The multivariate nature of these diseases calls for a multidisciplinary management approach, including physical therapy, nursing, and physician follow up. Telehealth is well suited for this type of approach, as it facilitates communication not only between patients and providers, but also between providers from various health disciplines.
The authors of the study understand that rehabilitation is a requirement for proper management of combined COPD and CHF, but they argue that telehealth physical therapy and rehabilitation can be effectively delivered to patients after hospital discharge. To bolster this argument, the researchers compared telerehabilitation to usual care for patients with combined COPD and CHF.
Study participants were randomized to an intervention group or a control group after undergoing inpatient hospital rehabilitation for combined COPD and CHF. Patients in the control group received usual care, which included medication and O2 prescriptions, visits with a general practitioner, and in-hospital checkups. Patients in the control group were also educated on the importance of maintaining a healthy lifestyle and they were encouraged to engage in regular physical activity.
Patients in the intervention group received care from a nurse and a physical therapist throughout the 4 month telerehabilitation program. Both the nurse and the PT provided the participants with patient education that was unique to their disciplines.
The nurse conducted weekly phone calls with the patients to review disease status, discuss symptoms, and address diet, lifestyle, and medication adherence. The PT also called the patients on a weekly basis to discuss the training level of physical activity, establish weekly rehab goals, and provide motivation for exercise participation. Additionally, patients used a pulse oximeter and a portable electrocardiograph, allowing for real time monitoring of cardiorespiratory biometrics.
Effectively Managing Chronic Disease With Telerehabilitation
The primary outcome of the study was exercise tolerance, which was measured with the 6-Minute Walk Test. Secondary outcomes included time to hospitalization or death, dyspnea, physical activity profile, disability, and quality of life. Researchers examined the difference between groups and within groups before the program, at the end of the program, and 2 months after the intervention was completed.
After completion of the 4-month program, the intervention group demonstrated improved exercise tolerance by walking significantly further during the 6-Minute Walk Test. The control group, however, failed to demonstrate a significant improvement in distance walked.
The median time to hospitalization or death was significantly higher in the intervention group, meaning that they experienced longer lengths of time without a significant medical event. This length of time continued to increase during the next 2 months of follow-up. The other secondary outcomes, dyspnea, physical activity profile, disability, and quality of life, were also significantly improved in the intervention group compared to the control group.
These beneficial outcomes were maintained at 6 months follow-up, demonstrating the long-term benefits of a telerehabilitation program. Also of note, no major side effects were reported in the intervention group and the patients reported a high level of satisfaction with the telerehabilitation program.
The findings from this study highlight the need for continued care for chronic disease patients after hospital discharge. Proper management of chronic conditions lowers medical costs and significantly improves quality of life for this patient population. By using telehealth to reach more patients in a more effective way, healthcare providers can ease the burden of living with a chronic disease.
Bernocchi P, Vitacca M, La Rovere MT. Home-based telerehabilitation in older patients with chronic obstructive pulmonary disease and heart failure: a randomised controlled trial. Age Ageing. 2017 Aug 30:1-7.