IntroductionSARS-CoV-2 has restricted access to face-to-face delivery of pulmonary rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR. However, it is unknown whether patients who have been referred to face-to-face programmes can feasibly complete an online-PR programme.MethodsThis service evaluation used a mixed-methods approach to investigate a rapid PR service remodelling using the University of Gloucestershire eLearn Moodle platform. Quantitative baseline demographic and PR outcome data were collected from online-PR participants, and semistructured interviews were completed with PR staff and participants.ResultsTwenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and 14 completed PR. Significant pre-post online PR improvements were achieved in 1 min sit-to-stand (CI 2.1 to 9 (p=0.004)), Generalised Anxiety Disorder (CI −0.3 to −2.6 (p=0.023)), Primary Health Questionnaire-9 (CI −0.3 to −5.1 (p=0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 to 1.3 (p=0.001)), fatigue (CI 0.7 to 2 (p=0.0004)), emotion (CI 0.7 to 1.7 (p=0.0002)), mastery (CI 0.4 to 1.3 (p=0.001)). Interviews indicated that patient PR inclusion was made possible with digital support and a PR introduction session improved participant engagement and safety. Incremental progression of exercise was perceived as more successful online compared with face-to-face PR. However, perceptions were that education sessions were less successful. Online-PR required significant staff time resource.DiscussionOnline-PR improves patient outcomes and is feasible and acceptable for individuals referred for face-to-face PR in the context of a requirement for social distancing. Face-to-face programmes can be adapted in a rapid fashion with both staff and participants perceiving benefit. Future pragmatic trials are now warranted comparing online-PR including remote assessments to centre-based PR with suitably matched outcomes, and patient and staff perceptions sought regarding barriers and facilitators of online delivery.
Objectives: To investigate the experience of playing the harmonica for individuals with COPD. Methods: A qualitative, phenomenological study using semi-structured interviews and reflexive thematic analysis. Results: Eight people living with COPD (six females, two males) were recruited, who had attended at least six weeks of harmonica group sessions, either face-to-face prior to the COVID-19 pandemic or remotely. Five themes were generated. Themes included ‘hard in the beginning’, ‘holding the condition’, ‘breathing control’, ‘gives you a high’ and ‘needing the Zoom class’. Discussion: Playing the harmonica with COPD is difficult at first, particularly drawing a breath through the harmonica. With practice, experience in a fun activity and quality teaching, individuals were able to become more attuned and embodied with their breathing, and playing the harmonica offered a breathing control strategy. Songs, rather than breathing, became the focus, and participants were able to escape living with respiratory disease when playing. Participants reported the harmonica helped mucous expectoration. The group was a priority in the weekly lives of participants, even though the ‘buzz’ of being part of a group was lost when participating online. Further mechanistic studies and randomised controlled trials are needed to investigate the biopsychosocial benefits of playing the harmonica with COPD.
IntroductionPulmonary Rehabilitation (PR) is the gold standard, group-based intervention for individuals with Chronic Obstructive Pulmonary Disease (COPD). However, accessibility and adherence to PR is sub-optimal. Arts in Health interventions also improve health outcomes for people living with long term conditions. Playing the harmonica with COPD could be clinically beneficial. However, little is known about the patient experiences of playing the harmonica.MethodsA qualitative, interpretivist, phenomenological study was undertaken, exploring COPD patient experiences of harmonica playing with a group of others living with chronic respiratory disease. Semi-structured interviews were completed, transcribed, and reflexive inductive thematic analysis performed.ResultsEight people with COPD were interviewed. Thematic analysis generated five themes. Themes included “Hard in the beginning”, “Holding the condition”, “Breathing control”, “Gives you a high” and “Needing the Zoom class”. Playing the harmonica with COPD is difficult at first, particularly drawing a breath through the harmonica. With practice, experience in a fun activity, and quality teaching, individuals were able to become more attuned and embodied with their breathing. As breathing became easier the songs, rather than breathing, became the focus, and participants were able to escape living with respiratory disease when playing. The group was a priority in the weekly lives of participants, even though the buzz of being part of a group was lost.DiscussionPlaying the harmonica requires a different way of breathing and offers a breathing control strategy. Participants also reported the harmonica helped airway clearance and enabled a continued, regular social interaction through COVID-19. The results of this study compliment previous quantitative results and are relevant to physiotherapy. Further mechanistic studies and randomised controlled trials are needed to investigate the biopsychosocial benefits of playing the harmonica with COPD.
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