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      Adherence and factors affecting satisfaction in long-term telerehabilitation for patients with chronic obstructive pulmonary disease: a mixed methods study

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          Abstract

          Background

          Telemedicine may increase accessibility to pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD), thus enhancing long-term exercise maintenance. We aimed to explore COPD patients’ adherence and experiences in long-term telerehabilitation to understand factors affecting satisfaction and potential for service improvements.

          Methods

          A two-year pilot study with 10 patients with COPD was conducted. The intervention included treadmill exercise training at home and a webpage for telemonitoring and self-management combined with weekly videoconferencing sessions with a physiotherapist. We conducted four separate series of data collection. Adherence was measured in terms of frequency of registrations on the webpage. Factors affecting satisfaction and adherence, together with potential for service improvements, were explored through two semi-structured focus groups and an individual open-ended questionnaire. Qualitative data were analysed by systematic text condensation. User friendliness was measured by the means of a usability questionnaire.

          Results

          On average, participants registered 3.0 symptom reports/week in a web-based diary and 1.7 training sessions/week. Adherence rate decreased during the second year. Four major themes regarding factors affecting satisfaction, adherence and potential improvements of the intervention emerged: (i) experienced health benefits; (ii) increased self-efficacy and independence; and (iii) emotional safety due to regular meetings and access to special competence; (iv) maintenance of motivation. Participants were generally highly satisfied with the technical components of the telerehabilitation intervention.

          Conclusions

          Long-term adherence to telerehabilitation in COPD was maintained for a two-year period. Satisfaction was supported by experienced health benefits, self-efficacy, and emotional safety. Maintenance of motivation was a challenge and might have affected long-term adherence. Four key factors of potential improvements in long-term telerehabilitation were identified: (i) adherence to different components of the telerehabilitation intervention is dependent on the level of focus provided by the health personnel involved; (ii) the potential for regularity that lies within the technology should be exploited to avoid relapses after vacation; (iii) motivation might be increased by tailoring individual consultations to support experiences of good health and meet individual goals and motivational strategies; (iv) interactive functionalities or gaming tools might provide peer-support, peer-modelling and enhance motivation.

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          Most cited references 39

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              Self Efficacy the exercise of control

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                Author and article information

                Contributors
                Hanne.Hoaas@telemed.no
                Hege.Andreassen@telemed.no
                Linda.Aaroen.Lien@lhl-klinikkene.no
                Audhild.Hjalmarsen@unn.no
                Paolo.Zanaboni@telemed.no
                Journal
                BMC Med Inform Decis Mak
                BMC Med Inform Decis Mak
                BMC Medical Informatics and Decision Making
                BioMed Central (London )
                1472-6947
                25 February 2016
                25 February 2016
                2016
                : 16
                Affiliations
                [ ]Norwegian Centre for E-health Research, University Hospital of North Norway, P.b 35, 9038 Tromsø, Norway
                [ ]Faculty of Health Science, Department of Clinical Medicine, UiT The Arctic University of Norway, P.b 6050, Langnes, Tromsø, 9037 Norway
                [ ]LHL- klinikkene Skibotn, 9143 Skibotn, Norway
                [ ]Department of Clinical Medicine, University Hospital of North Norway, Tromsø, Norway
                Article
                264
                10.1186/s12911-016-0264-9
                4766676
                26911326
                © Hoaas et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100007137, Helse Nord RHF;
                Award ID: HST1014-11
                Award Recipient :
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2016

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