Telemonitoring of daily activities compared to the six-minute walk test further completes the puzzle of oximetry-guided interventions

Using Remote Technology to Engage Patients with Interstitial Lung Diseases in a Home Exercise Program: A Pilot Study

INTRODUCTION

The access and compliance of patients with interstitial lung diseases (ILDs) to exercise programs (EPs) remain challenges.

OBJECTIVES

We assessed the dropout rate, intervention completion, compliance with data acquisition and submission, safety, and satisfaction of a home EP delivered via video conference (EPVC group) or self-directed (EPSD group) to patients with ILD. Pre- and post-intervention changes in patient outcomes (dyspnea, fatigue, exercise capacity, lung function, and quality of life) were secondarily explored.

MATERIAL AND METHODS

Groups performed an eight-week virtual EP three times/week. Video conferences were led by a registered respiratory therapist, whereas self-directed exercises were completed following a pre-recorded video. Participants submitted spirometry, heart rate, and SpO2 results weekly to the research team.

RESULTS

Fourteen patients with ILD were equally assigned to the EPVC and EPSD groups, but three from the EPSD group dropped out after the initial assessment (dropout rate of 42.8% in the EPSD group). Eleven patients (mean age of 67 ± 12 years) completed 96.5% of sessions. Compliance with data acquisition and submission was optimal (≥97.6% in both groups), and no adverse events were reported. Changes in overall fatigue severity were significantly different between groups (p = 0.014, Cohen's r = 0.64).

CONCLUSIONS

The results suggest that a structured virtual EP delivered via video conference or pre-recorded video can be feasible, safe, and acceptable for patients with ILD.

Oxygen Desaturation and Persistence of Symptoms During Activities of Daily Living in Patients Following Hospital Discharge for COVID-19

BACKGROUND

COVID-19 can cause respiratory and multisystemic impairments, which lead to impaired activities of daily living (ADL). Telemonitoring after discharge from the hospital may help identify the persistence of such limitations during ADLs simulations. The aim of this study was to compare SpO2 , fatigue, and dyspnea through telemonitoring during a battery of 4 ADLs in patients following hospital discharge for COVID-19.

METHODS

An observational cross-sectional study was conducted by using teleconferencing for patients 30 d after hospital discharge for COVID-19. The subjects were assessed and performed a simulated ADL battery (ie, walking, bathing and dressing, floor sweeping, and folding towels). SpO2 , fatigue, and dyspnea were monitored immediately after the end of each ADL; also, the subjects were asked to show the pulse oximeter on camera and grade their symptoms by using the Borg scale score (0-10).

RESULTS

Sixty-six subjects were evaluated, all of whom were normoxic at rest. No significant difference in SpO2 was found among the ADLs. A portion of the subjects experienced desaturation on at least 1 ADL, which allowed subject grouping into the desaturated group, with highest portion of subjects who desaturated found during the walking task (18%), and the non-desaturated group. The subjects who desaturated were found to have more cardiovascular diseases (P = .031) and diabetes mellitus (P = .005) compared with those who did not desaturate. Both groups experienced mild symptoms; however, a percentage of the subjects with desaturation presented moderate-to-intense symptoms, with higher fatigue scores during walking, bathing and dressing, and floor sweeping. Increased dyspnea was also found during walking and during bathing and dressing in the subjects with desaturation.

CONCLUSIONS

SpO2 was similar among the ADLs but walking triggered desaturation in a larger number of subjects. The subjects presented with mild-to-intense fatigue and dyspnea during ADLs 30 d after discharge after hospitalization for COVID-19 regardless of desaturation status, which demonstrated that the persistence of symptoms is independent of hypoxemia during exercise.

Improving the management of patients with chronic cardiac and respiratory diseases by extending pulse-oximeter uses: the dynamic pulse-oximetry

Respiratory and cardio-vascular chronic diseases are among the most common noncommunicable diseases (NCDs) worldwide, accounting for a large portion of health-care costs in terms of mortality and disability. Their prevalence is expected to rise further in the coming years as the population ages. The current model of care for diagnosing and monitoring NCDs is out of date because it results in late medical interventions and/or an unfavourable cost-effectiveness balance based on reported symptoms and subsequent inpatient tests and treatments. Health projects and programs are being implemented in an attempt to move the time of an NCD's diagnosis, as well as its monitoring and follow up, out of hospital settings and as close to real life as possible, with the goal of benefiting both patients' quality of life and health system budgets. Following the SARS-CoV-2 pandemic, this implementation received additional impetus. Pulseoximeters (POs) are currently used in a variety of clinical settings, but they can also aid in the telemonitoring of certain patients. POs that can measure activities as well as pulse rate and oxygen saturation as proxies of cardio-vascular and respiratory function are now being introduced to the market. To obtain these data, the devices must be absolutely reliable, that is, accurate and precise, and capable of recording for a long enough period of time to allow for diagnosis. This paper is a review of current pulse-oximetry (POy) use, with the goal of investigating how its current use can be expanded to manage not only cardio-respiratory NCDs, but also acute emergencies with telemonitoring when hospitalization is not required but the patients' situation is debatable. Newly designed devices, both "consumer" and "professional," will be scrutinized, particularly those capable of continuously recording vital parameters on a 24-hour basis and coupling them with daily activities, a practice known as dynamic pulse-oximetry.

Home monitoring in interstitial lung diseases

The widespread use of smartphones and the internet has enabled self-monitoring and more hybrid-care models. The COVID-19 pandemic has further accelerated remote monitoring, including in the heterogenous and often vulnerable group of patients with interstitial lung diseases (ILDs). Home monitoring in ILD has the potential to improve access to specialist care, reduce the burden on health-care systems, improve quality of life for patients, identify acute and chronic disease worsening, guide treatment decisions, and simplify clinical trials. Home spirometry has been used in ILD for several years and studies with other devices (such as pulse oximeters, activity trackers, and cough monitors) have emerged. At the same time, challenges have surfaced, including technical, analytical, and implementational issues. In this Series paper, we provide an overview of experiences with home monitoring in ILD, address the challenges and limitations for both care and research, and provide future perspectives. VIDEO ABSTRACT.

Heart rate and oxygen uptake kinetics obtained from continuous measurements with wearable devices during outdoor walks of patients with COPD

Objective

Continuous physiological measurements during a laboratory-based exercise test can provide physiological biomarkers, such as heart rate (HR) and oxygen uptake (V̇O₂) kinetics, that carry clinically relevant information. In contrast, it is not clear how continuous data generated by wearable devices during daily-life routines could provide meaningful biomarkers. We aimed to determine whether valid HR and V̇O₂ kinetics can be obtained from measurements with wearable devices during outdoor walks in patients with chronic obstructive pulmonary disease (COPD).

Methods

HR (Polar Belt) and V̇O₂(METAMAX3B) were measured during 93 physical activity transitions performed by eight patients with COPD during three different outdoor walks (n_tr= 77) and a 6-minute walk test (n_tr= 16). HR and V̇O₂ kinetics were calculated every time a participant started a walk, finished a walk or walked upstairs. HR and V̇O₂ kinetics were considered valid if the response magnitude and model fit were adequate, and model parameters were reliable.

Results

Continuous measurements with wearable devices provided valid HR kinetics when COPD patients started or finished (range 63%-100%) the different outdoor walks and valid V̇O₂ kinetics when they finished (range 63%-100%) an outdoor walk. The amount of valid kinetics and kinetic model performance was comparable between outdoor walks and a laboratory-based exercise test (p > .05).

Conclusion

We envision that the presented approach could improve telemonitoring applications of patients with COPD by providing regular, unsupervised assessments of HR kinetics during daily-life routines. This could allow to early identify a decline in the patients' dynamic physiological functioning, physical fitness and/or health status.