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Is Virtual Autonomous Physiotherapist Tele-rehabilitation Program in Chronic Obstructive Pulmonary Disease equal to Hospital-Based Pulmonary Rehabilitation?

Poster · September 2020

DOI: 10.13140/RG.2.2.34559.23203

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Jose Cerdan de Las Heras

Aarhus University Hospital

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Fernanda Balbino

Universidade Federal do Paraná

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Main Finding

• Pulmonary rehabilitation in COPD is recommended.• Long distance to hospitals and frailty of COPD are barriers and

can decrease patient participation in hospital-based pulmonary rehabilitation (HBPR).

• Tele-rehabilitation (TR) can reach patients in remote areas.

• To investigate if a new TR solution: Virtual Autonomous Physiotherapist Agent Platform (VAPA) is equally effective as HBPR.

Introduction

Is Virtual Autonomous Physiotherapist Tele-rehabilitation Program in Chronic Obstructive

Pulmonary Disease equal to Hospital-Based Pulmonary

Rehabilitation?

●Tele-rehabilitation with VAPA is feasible for COPD

●Exercise capacity in VAPA patients improved after 8 weeks tele- rehabilitation, 3 and 6 months follow up

●No change in Quality of Life ●VAPA is non-inferior to HBPR and a

potential future tool for COPD rehabilitation

● Single-center, prospective, non-inferiority, 2 arms, 1:1, randomized study including stable COPD patients.

● 8 weeks of TR: video and chat-consultations with a real physiotherapist and workout sessions with a VAPA.

● Control patients had 8 weeks of standard HBPR. ● Endpoints were 6-minute-walk-test distance (6MWTD) and

quality of life by St. Georges Respiratory questionnaire (SGRQ) at baseline, 8W, 3 and 6 months follow up.

● Mean differences in 6MWTD between groups and 95% confidence interval of the differences were estimated.

● The difference margin acceptable for this study was 35 meters and quantifies the maximum efficiency loss clinically acceptable to the treatment to be declared non-inferior to the control. Margin was determined based on previous work.

Methods

In total, 54 patients (age 69.2±9.5 years, male 73.8%, FEV1% 34.91±12.12, FVC% 68.72±18.42, 6MWT 377.80±94.42) were included. 6MWTD non-inferiority test at 8W, 3 and 6M is shown in figure 1 and differences between groups regarding 6MWT distance and SGRQ in Figure 2 and 3:

Results

Acknowledgement

A big thanks to the Department of Respiratory Diseases and Allergy at Aarhus University Hospital in Denmark and to all the COPD patients that proactively participated in the clinical trial. Thanks also to EUROSTARS, the founders of this project and the SMEs members of the VAPA consortium as Physio R&D Ltd, bookBeo and Cortrium who created the telerehab platform used in this study for the patients to experience this new technology. Special thanks to The Danish Pulmonary Association for their support.

J. Cerdán de las Heras1,F. Balbino1,O. Hilberg2, A. Løkke2, E. Bendstrup1

1Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark,

2Department of Medicine, Vejle, Little Belt Hospital, Denmark.

Real Physiotherapist Online

Virtual Autonomous Physiotherapist Agent

José Cerdán V Card

Aim

Statistics

Figure 1: 6MWTD mean difference and

95% confidence interval in 8W, 5

and 8 months follow up of total

trial COPD.

Figure 2: Mean ± SD for 6MWTD in meters over

time.

Figure 3: Mean ± SD for SGRQ

overtime

Virtual Autonomous Physiotherapist Tele-rehabilitation Program in Chronic Obstructive Pulmonary Disease equal to Hospital-Based Pulmonary Rehabilitation?

J. Cerdán de las Heras1,F. Balbino1,O. Hilberg2, A. Løkke2, E. Bendstrup1

1Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark, 2Department of Medicine, Vejle, Little Belt Hospital, Denmark.

Conflict of interest disclosure

❑ I have no real or perceived conflicts of interest that relate to this presentation.X I have the following real or perceived conflicts of interest that relate to this presentation:

Affiliation / Financial interest Commercial companyGrants/research support:

Honoraria or consultation fees:

Participation in a company sponsored bureau:

Physio R&D ApS

Stock shareholder:

Spouse / partner:

Other support / potential conflict of interest:

This event is accredited for CME credits by EBAP and EACCME and speakers are required to disclose their potential conflict of interest. The intent of this disclosure is not to prevent a speaker with a conflict of interest (any significant financial relationship a speaker has with manufacturers or providers of any commercial products or services relevant to the talk) from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remains for audience members to determine whether the speaker’s interests, or relationships may influence the presentation. The ERS does not view the existence of these interests or commitments as necessarily implying bias or decreasing the value of the speaker’s presentation. Drug or device advertisement is forbidden.

Intro

Chronic Obstructive Pulmonary Disease

Pulmonary Rehabilitation: Recommended to improve exercise capacity and quality of life

Challenge: Not all patients with COPD can participate in hospital based Pulmonary Rehabilitation due to frailty and long travelling distances.

Hypothesis: Can Tele-rehabilitation (TR) with Virtual Autonomous Physiotherapist Agent be an alternative solution?

Aim: To investigate the feasibility and efficacy of Tele-rehabilitation program on Exercise Capacity with COPD.

Method

Single-center, prospective, non-inferiority, 2 arms, 1:1 randomized study.

Participants: Stable COPD patients.

Intervention: 2 months of Tele-rehabilitation. Video and chat-consultations with a real physiotherapist . Workout sessions with Virtual Autonomous Physiotherapist Agent (VAPA).

Control: Standard hospital-based pulmonary rehabilitation.

Study parameters: Exercise Capacity: 6-minute-walk-test distanceQoL: St. George's Respiratory Questionnaire, Instrumental Activity of Daily Living and The

General Anxiety Disorder Score.Lung Function: FEV1,FVC

Follow up: baseline, 2, 5 and 8 months after training.

Results

6 Meter Walk Test Distance (m) after 8 weeks, 5 and 8 months in patients with COPD(mean difference and 95% confidence interval)

Cohort: 54 patients

Control TR with VAPA

50% 50%

Age 72,5 ± 7.4 Yrs 67.6 ± 10.2 Yrs

Lung Function and QoL:

No difference between groups

Results

6 Minute Walk Test Distance, m (mean and SD)

EXERCISE CAPACITY (6MWT DISTANCE)

8 weeks +47.5 m (P=0.14)

5 month +56 m (P=0.15)

8 month+95.2 m (P=0.06)

Results

Quality of life measured bySt. Georges Respiratory Questionnaire (mean and SD)

• Tele-rehabilitation with VAPA is feasible for COPD

• Tele-rehabilitation with VAPA is non-inferior to hospital based pulmonary rehabilitation

• Exercise capacity improved 6MWTD after 8 weeks tele- rehabilitation, 3 and 6 months follow up

• No change in Quality of Life

• VAPA is a potential future tool for COPD rehabilitation

Conclusions

CV at : https://bit.ly/Ajcerdan Jose CerdanPhD student at Aarhus University Hospital

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