Australian physiotherapy research shows telerehabilitation is just as effective for improving exercise capacity, strength and quality of life in chronic heart failure patients as traditional hospital outpatient-based rehabilitation.

A randomised trial, conducted through Brisbane’s Princess Alexandra Hospital and The Prince Charles Hospital, also found another significant benefit of telerehabilitation - patients were much more likely to attend most of their sessions.

The pioneering study, published in the Australian Physiotherapy Association’s Journal of Physiotherapy, is the first to test a group-based video telerehabilitation program delivered into patients’ homes against a traditional centre-based rehabilitation program for people with chronic heart failure.

The control group received a traditional heart failure physiotherapy-led rehabilitation program spanning 12 weeks, with patients completing 60 minutes of prescribed exercise twice weekly, plus education sessions delivered by a multidisciplinary team, including a nurse, dietitian, physiotherapist, occupational therapist, social worker and pharmacist.

In comparison, the telerehabiliation group’s program was delivered twice-weekly for 12 weeks via a synchronous videoconferencing platform to groups of up to four participants in their own homes. Educational topics were delivered as electronic slide presentations with embedded audio files. Patients were asked to watch the presentations in their own time, which were followed up with online group discussions.

Lead researcher Rita Hwang, a physiotherapist with the Heart Recovery Service at the PAH who is undertaking a PhD at the University of Queensland, says telehealth technology enabled patients to not only remain in the comfort of their own homes, reducing the time and costs of transportation to hospital, but enabled them to participate in group sessions where they could interact with the physiotherapist as well as the other participants.

“The patients would be talking to each other and encouraging each other - like what you see in a normal exercise class,” she says.

“When we do this telehealth virtual class, we still saw a lot of that coming through. I was pretty surprised to see that.”

As part of the telerehabilitation approach, participants were guided to self-monitor and verbally report their blood pressure, heart rate and oxygen saturation levels at the start of each rehabilitation session. Patients were also asked to monitor their weight, blood sugar levels, peripheral oedema and general wellbeing.

In the 53 participants, who were mostly male patients aged about 67 years, researchers found no major differences when it came to six-minute walk distance gains.

Ms Hwang, who delivered the telerehabilitation sessions through the PAH, says the study shows the health outcomes of delivering rehabilitation are mostly the same, regardless of whether the rehabilitation is held in a traditional group setting or through an online videoconferencing platform.

“It was very similar - there were comparable improvements in their function and quality of life across both groups, but the ones attending the telerehabilitation program had higher attendance rates.”

Ms Hwang says she was prompted to embark on research into the benefits of telerehabilitation after realising transportation time and travel costs to hospital were a major hurdle to patient participation in traditional group classes.

“Some of my patients just live too far to come to our exercise program at the hospital, so I wondered if I could find another way for them to be exercising under the right environment,” she says.

“In the past, I might get them to exercise at home and I’ll just do some follow up. I thought there must be another way to deliver an exercise program where the patients can see one another and provide some peer support - I thought telehealth might be a solution.

“We really need to find other ways to connect more patients to this fantastic heart failure rehabilitation program. I think telehealth might be one of the ways to try and get patients to come in.”

Despite some initial reservations about how physiotherapy practice would translate via an online telerehabiliation system, Ms Hwang says the physiotherapists were able to watch participants perform exercises and deliver feedback in real time.

She says the initiative was such a success, PAH is now considering ways to translate some of the research findings into clinical practice.

“I’ve also had interest from other colleagues looking at implementing a similar program for their service but it’s still early stages.”

The study, which received funding from The Heart Foundation and hospital foundations, also delivered some unexpected benefits for patients in the telerehabilitation group, Ms Hwang adds.

“As you can imagine, some of our patients are older, have never had any computer experience before, so for them this is a challenge to take up using telehealth to come to an exercise program - so they are learning new skills and they are learning how to use a computer,” she says.

“One of my patients, he said - ‘this is the way of the future, give it a go.’”