Safety, feasibility and initial efficacy of an app-facilitated telerehabilitation (AFTER) programme for COVID-19 survivors: a pilot randomised study

• Published in: BMJ open 2022-07, Vol.12 (7), p.e061285-e061285
• Main Authors: Capin, Jacob John, Jolley, Sarah E, Morrow, Mary, Connors, Meghan, Hare, Kristine, MaWhinney, Samantha, Nordon-Craft, Amy, Rauzi, Michelle, Flynn, Sheryl, Stevens-Lapsley, Jennifer E, Erlandson, Kristine M
• Format: Article
• Language: English
• Subjects: Coronaviruses; COVID-19; Exercise; Feasibility Studies; Female; Humans; Informed consent; Intervention; Medical referrals; Middle Aged; Mobile Applications; Pandemics; Patients; Physical fitness; Physical therapists; Physical therapy; Pilot Projects; Rehabilitation; Rehabilitation Medicine; Software; Sports training; Strength training; Survivors; Telemedicine; Telerehabilitation; Ventilators
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-061285

ObjectivesDetermine the safety, feasibility and initial efficacy of a multicomponent telerehabilitation programme for COVID-19 survivors.DesignPilot randomised feasibility study.SettingIn-home telerehabilitation.Participants44 participants (21 female, mean age 52 years) discharged home following hospitalisation with COVID-19 (with and without intensive care unit (ICU) stay).InterventionsParticipants were block randomised 2:1 to receive 12 individual biobehaviourally informed, app-facilitated, multicomponent telerehabilitation sessions with a licenced physical therapist (n=29) or to a control group (n=15) consisting of education on exercise and COVID-19 recovery trajectory, physical activity and vitals monitoring, and weekly check-ins with study staff. Interventions were 100% remote and occurred over 12 weeks.Primary and secondary outcome measuresThe primary outcome was feasibility, including safety and session adherence. Secondary outcomes included preliminary efficacy outcomes including tests of function and balance; patient-reported outcome measures; a cognitive assessment; and average daily step count. The 30 s chair stand test was the main secondary (efficacy) outcome.ResultsNo adverse events (AEs) occurred during testing or in telerehabilitation sessions; 38% (11/29) of the intervention group compared with 60% (9/15) of the control group experienced an AE (p=0.21), most of which were minor, over the course of the 12-week study. 27 of 29 participants (93%; 95% CI 77% to 99%) receiving the intervention attended ≥75% of sessions. Both groups demonstrated clinically meaningful improvement in secondary outcomes with no statistically significant differences between groups.ConclusionFully remote telerehabilitation was safe, feasible, had high adherence for COVID-19 recovery, and may apply to other medically complex patients including those with barriers to access care. This pilot study was designed to evaluate feasibility; further efficacy evaluation is needed.Trial registration numberNCT04663945.