Telerehabilitation in people with Chronic Obstructive Pulmonary Disease (COPD)

Telerehabilitation Group (TG) Training Program: Written instructions will be provided reinforcing the requirements for the exercise training sessions. In the TG group, training will run for a total of eight weeks, twice a week for one hour. The session will include aerobic exercises utilising cycle ergometry and walking training. The initial intensity, duration and frequency of the participant’s exercise program will be prescribed by the assessor (RM) following the initial assessments. The primary researcher (LLT) will be conducting all TG training sessions. During the hourly training session participants will be asked to perform a total of 30 minutes of aerobic training including 15 minutes on the cycle ergometer and 15 minutes walking. Participants will be monitored via collection of oxygen saturation (SpO2), Heart Rate, Borg Dyspnoea Score and Rate of Perceived Exertion (RPE) at the start of the sessions, seven minutes into cycle ergometer training session and seven minutes into the walking training session as well as at the end of each session. Oxygen saturation (SpO2) and heart rate will be monitored by using the finger tip oximeter provided to participants. Exercise intensity, duration and frequency will be progressed and recorded during the eight weeks of TG training according to the Borg Dyspnoea Score and Rate of Perceived Exertion (RPE) readings obtained during the sessions in order to maintain a Borg Dyspnoea Score of Moderate to Somewhat Severe (Score 3-4) and Rate of Perceived Exertion of Moderate to Somewhat Severe (Score 12-13). The primary researcher (LLT) will remain in contact with the participants for the duration of the trial and will be responsible for trouble-shooting any problems as they arise. A physiotherapist will only be visiting participants before the first session of the project to set up the cycle ergometer and laptop computer and at the end of the eight week training period to collect the cycle ergometer and laptop computer. Participants will be instructed clearly that physiotherapists will not be doing home visits unless there is a technical issue that cannot be resolved over the phone or during the videoconferencing session. The number of participants receiving the Telerehabilitation at the same time will range from 2 to 4 participants. All the participants randomized to the telerehabilitation group will receive a Telerehabilitation Education Booklet with information on all the technology they need to know how to use as well as information on the exercise program. In order to deliver telerehabilitation the following will be required: A laptop computer provides a screen for the participants to be able to see the physiotherapist in order for their exercise program to be supervised. Each laptop computer will be installed with videoconferencing software and an internet connection will be provided. The computer to be used in this study will be the “hp EliteBook 8560p” which is provided by NSW Health South Eastern Sydney Local Health District. The laptop computer has an inbuilt camera; the angle of which can be easily adjusted by moving the screen. Participants in the Telerehabilitation group (TG) will be educated about how to use this computer to ensure they can operate the device independently. This will include understanding how to turn the computer on/off and how to charge the computer device. A wireless audio headset “Logitech ClearChat PC Wireless” headset which participants will wear during the telerehabilitation sessions. This ensures participants will be able to hear and talk to the physiotherapists easily. Participants will be trained on how to charge the device and how to operate the headset with training and demonstration. A pre-paid internet connection will be provided to participants (wireless Telstra 4G USB modem device) that can be plugged into the laptop. 4G device from Telstra has been purchased as it is ten times faster than 3G with fast download speed. Videoconferencing software Vsee (www.vsee.com) which will be installed on the computer provided to participants and will be used during the TG training sessions. This software has been shown to be secure and safe (please visit http://vsee.com/hipaa for security information). The Director of Operations at the Prince of Wales Hospital Mr Andrew Bernard has also approved this software to be installed to the computer laptops. Participants will be reminded to log onto Vsee 15 minutes prior to the commencement of the TG training sessions to ensure the exercise class starts at the given time. Participants will be notified during the first assessment day of the time of the telerehabilitation exercise training. The participant will also be reminded of the start date and time of telerehabilitation exercise training during delivery of the equipment. During the telerehabilitation session participants will exercise on a stationary cycle ergometer (Tunturi E60 cycle ergometer). The cycle ergometer will be adjusted so that the seat height and the foot straps are correct for each participant. The physiotherapist will demonstrate to the participants how to use the cycle ergoemeter. Finger tip pulse oximeter: Oxygen saturation and heart rate will be measured during TG training sessions using a pulse oximeter (Nonin-9590). It is easily operated by the participant placing a “clip” probe onto their index finger. Patient instruction on home training: Participants will receive two one hour Telerehabiliation exercise sessions supervised remotely by the experienced physiotherapist, twice a week either Monday and Wednesday or Tuesday and Thursday for eight weeks. Participants will be asked to participate in independent walking training for a total of half an hour a day at least one day a week in addition to the telerehabilitation exercise sessions.