Pandemic Transition of an Established Hospital-Based Pulmonary Rehabilitation Program
Bibliographic record
Abstract
Background: Pulmonary rehabilitation (PR) has demonstrated significant improvements in patients' exercise tolerance, quality of life, and mental health scores. These achievements have been obtained in traditional PR (t-PR) hospital-based, out-patient, in-person training programs. Recent evidence supports utilizing telehealth options to deliver standardized, rehabilitation programs to rural and remote communities without other access to PR. In March of 2020, an international pandemic was declared with regards to COVID-19. This forced t-PR programs to pause in-person patient contact, and consider dramatic changes to program delivery. Approach: We transformed our t-PR program into a completely full-fledged virtual PR (v-PR) programme that offered, via telephone and videoconferencing, education and exercise sessions. When it was deemed safe to resume inperson patient contact, specifically for PR exercise prescription determination, patients were brought in for exercise assessment only. This represented a complete transformation of our programme, and to our knowledge, was the first such offering in Ontario. Twice weekly regular video-based group exercise sessions, with a third being performed independently, was established while providing remote patients vital sign monitoring equipment throughout their enrollment to ensure safety. Education sessions were at first delivered by telephone, with the transitioning to video-lecturing by the end of 2020 occurring. Results: Enrollment data reveals the mean age for t-PR was 69.3 ± 9.2 years (n=164) compared to 69.9 ± 9.7 years for our v-PR (n=34). To date, completion data for six-minute walk distance (6MWD) improved in the t-PR (n=128) by 55.3 m (p < 0.001) and in the v-PR (n=8) 72.1 m (p < 0.001). General Anxiety Disorder-7 (GAD-7) questionnaire improved by 2 points in t-PR (n=129, p < 0.001) and by 3 points in the v-PR (n=8, p = 0.013). There was no change in the Patient Health Questionnaire (PHQ-9) score for the v-PR, whereas the t-PR had an improvement of 2 points (n=129, p < 0.001). COPD Assessment Test (CAT) scores in t-PR (n=130) improved by 4 points (p<0.001) and by 3 points (n=8, p= 0.013) in v-PR group. Discussion: Our current PR programme has demonstrated an important pivot during the current pandemic to provide a virtual curriculum. Preliminary data show that participants in v-PR improved significantly in their 6MWD, quality of life, and anxiety scores. This shift to the virtual option has allowed for continued care, despite the pandemic restrictions;and can be provided to other patients who otherwise would be unable to participate due to geographical restrictions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".