TELEREHABILITATION APP-BASED EXERCISE PROGRAM FOR DISCHARGED OLDER ADULTS ON WAITING LIST FOR OUTPATIENT PHYSIOTHERAPY: A FEASIBILITY STUDY

R. Resende¹, P. Borges¹, J. Dias¹, M. Mancini², J. Ocarino¹, R. Sampaio²

¹Universidade Federal de Minas Gerais, Physiotherapy, Belo Horizonte, Brazil, ²Universidade Federal de Minas Gerais, Rehabilitation Sciences, Belo Horizonte, Brazil

Background: The inactivity while waiting for outpatient physical therapy worsens the physical deconditioning of older adults after hospital discharge. Exercise programs can minimize the progression of deconditioning. In developing countries, telerehabilitation for older adults on the waiting list is still in the early stages.

Purpose: Evaluate the feasibility of a multicomponent telerehabilitation program using a smartphone app for older adults waiting for outpatient physical therapy after hospital discharge.

Methods: This feasibility pragmatic randomized controlled clinical trial recruited older adults on the waiting list for outpatient physical therapy in the Brazilian public health system after hospital discharge between May and September 2021. The telerehabilitation group (n=17) received a personalized program of multicomponent remote exercises using a smartphone app. The control group (n=17) followed the usual waiting list. Feasibility measures included recruitment and dropout rates, safety, adherence, and satisfaction with the telerehabilitation program. The preliminary effects of the telerehabilitation program were verified on clinical outcomes collected at baseline and start of outpatient physical therapy: timed up and go, 30-s chair stand test, pain, physical health, health-related quality of life, perceived performance and satisfaction. Sample characteristics were descriptively analyzed and the mean differences in clinical variables in the telerehabilitation group were calculated using the pair t-test and the Wilcoxon test.

Results: The sample (n=34) was composed mostly of females (61.8%) with mean age of 66 years (95% CI= 60; 79) and with a mean of six years of education (SD=4.50). Participants remained hospitalized for 10.59 (SD=11.27) days, mostly due to musculoskeletal diseases in the lower limbs that resulted in surgeries (44.1%). Participants in the control group spent 21.41 days (SD=21.11) in the study, whereas those in the telerehabilitation group spent 53 days (SD=37.14). We recruited 5.6 older adults monthly; dropouts were 12%. No serious adverse events were associated with the telerehabilitation program, and weekly adherence was 2.85 (SD=1.43) days. Older adults rated the telerehabilitation program as 9.71 (SD=0.21) on a satisfaction scale from 0 to 10. The mean difference between baseline and start of outpatient physiotherapy showed a tendency for non-progression of deconditioning in older adults from the telerehabilitation group. The telerehabilitation program also reduced the time to perform the Timed Up and Go test in -1.73 (95%CI: -6.82;-0.03) seconds and improved the perceived performance in 2.19 (95%CI: 0.40; 3.97) points and satisfaction in 3.64 (95%CI: 1.00; 6.50) points.

Conclusions: The telerehabilitation exercise program using a smartphone app was safe and presented high participants’ satisfaction and adequate adherence, recruitment, and dropout rates. Preliminary results suggested that the program was effective; however, a definitive study is needed to confirm this finding.

Implications: Deconditioning is related to poor health outcomes, and multicomponent exercises can improve physical function in older adults. The telerehabilitation multicomponent exercise program seems to contribute to maintaining the conditioning of older adults discharged from hospitals at risk of deconditioning.

Funding acknowledgements: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Fundação de Amparo à Pesquisa do Estado de Minas Gerais.

Keywords:
telerehabilitation
geriatrics
deconditioning

Topics:
Older people
Service delivery/emerging roles

Did this work require ethics approval? Yes

Institution: Universidade Federal de Minas Gerais

Committee: Ethics committee of the Universidade Federal de Minas Gerais

Ethics number: 30673820.8.0000.5149