Feasibility of a Real-World Digital Hybrid Pulmonary Rehabilitation Model Using a Smartphone App

Background There is interest in digital technology-enabled models of pulmonary rehabilitation (Digital-PR) as a means of increasing capacity, uptake and accessibility. However, there are little data on real-world implementation, or how Digital-PR could support other models of pulmonary rehabilitation delivery. Methods We conducted a mixed-methods, feasibility study to evaluate the acceptability of a hybrid model of pulmonary rehabilitation (Hybrid-PR) blending Digital-PR with traditional, supervised PR. To determine acceptability, we measured engagement and use of the App, and conducted patient interviews. We assessed differences in PR completion, number of scheduled sessions and staff time between Hybrid-PR and a propensity matched control group attending PR without Digital-PR (Control-PR). Results Of 69 people undergoing Hybrid-PR, 87% opted for in-person, centre-based care and 13% for home-based care (10% supported by video-teleconferencing, 3% supported by telephone). 86% activated Digital-PR at least once, but only 35% activated regularly (at least weekly for eight weeks). 88% never accessed the exercise components of Digital-PR. There were no significant differences in PR completion rates, number of supervised PR sessions, nor staff time in Hybrid-PR when compared to Control-PR. Both patients and staff identified digital literacy, limited flexibility to adapt/tailor Digital-PR, and increased time-commitment as potential barriers. Conclusion Hybrid-PR was not considered acceptable due to intervention fidelity and limited patient engagement with Digital-PR. Hybrid-PR was not associated with reduction in scheduled supervised sessions. Poor digital literacy is an important barrier to implementation of Digital-PR in the real-world setting.