Learning to breathe with Tai Chi online - qualitative data from a randomized controlled feasibility study of patients with cystic fibrosis

Abstract

Introduction: Tai Chi (TC), a gentle exercise, incorporates meditative movement and respiratory control. The high risk of cross infection for people with cystic fibrosis (CF) requires close management in healthcare settings, limiting group activities such as TC. A mixed-methods randomized controlled feasibility study compared teaching TC over the internet with in-person, face to face TC tuition provided to CF patients. This article explores qualitative data from patients and TC instructors on their attitudes, acceptability and engagement with the two modes of TC delivery. Methods: Qualitative data from CF patients (>6 years) were collected using Skype interviews/focus groups and written feedback. TC instructors provided weekly written feedback, and took part in interviews/ focus groups at the end of the study. Patients and instructors interviews explored their experiences and engagement with TC online delivery and ability to practice. Results: Irrespective of the type of TC delivery, all CF participants interviewed (n=28) practiced between lessons and most wanted to continue TC. Teenagers were more likely to miss TC appointments. Internet delivery was well received by both patients and TC instructors. Two patients reported difficulties with screen size/camera and one with internet connectivity. Conclusion: Both face-to-face and internet delivery of Tai Chi lessons were equally well received and perceived as beneficial. In the current COVID-19 pandemic, CF patients self-isolating may find this intervention provides important support, therefore the programme was made available on YouTube in April 2020 and linked to the websites of the CF charities funding the research.

Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

“…Occurrence, n (%) References Themes/observations 12 (9.1) [27,30,35,37,38,40,41,45,46,49,57,58] Increased self-management 11 (8.3) [23,25,31,33,41,43,47,51,52,61,62] Pandemic created acceptance of technology 10 (7.6) [32,34,35,37,38,40,43,46,58,67] Increased adherence 9 (6.8) [24,[27][28][29][30]41,52,53,60] Increased access 8 (6.1) [49,50,54,55,[62][63][64]66] Increased social support 7 (5.3) ...…”

“…The remaining five observations made up a total of 6% of the total occurrences: decrease in quality of life after intervention, discomfort for wearing monitors, workflow issues for providers, lack of data infrastructure, and interoperability. [23,25,26,[28][29][30][31]35,37,[41][42][43][44]49,57,60,62,65,66] Technical literacy 12 ( 14) [26,27,29,30,[36][37][38][39]45,49,57,62] Technology needs further development 8 ( 9) [22,28,35,41,43,51,60,62] Availability of technology 7 (8) [38,39,41,43,44,46,59] Cost 7 (8) …”

“…Only one article did not report a result as compared to the control group because it was a posttrial analysis and it did not address the control group. [28,32,35,38,40,41,43,46,[48][49][50][53][54][55][58][59][60]64] Telemedicine improved results compared to control 9 ( 14) [27,30,33,34,39,45,51,56,62] No statistically significant difference 7 (11) [24,25,43,47,49,50,63] Improved patient satisfaction 6 (9) [36,49,60,62,64,67] Improved health behaviors 6 (9) [22,38,40,41,49,67] Improved compliance/adherence 5 (8) [28,…”

“…Health care administrators can focus on the findings demonstrating that implementation of telemedicine will increase self-management [27,30,35,37,38,40,41,45,46,49,57,58], adherence [32,34,35,37,38,40,43,46,58,67], access [24,27-30, 41,52,53,60], and social support [49,50,54,55,[62][63][64]66]. Telemedicine is shown to be an effective modality of treatment [28,32,35,38,40,41,43,46,[48][49][50][53][54][55][58][59][60]64] at a decreased cost…”

“…A key similarity between the 2020 systematic review [14] and this review is the rapid expansion of telemedicine. Eleven articles analyzed in this review used a phrase similar to "the pandemic created an acceptance of telemedicine technology" [23,25,31,33,41,43,47,51,52,61,62]. A systematic review published in 2018 cited cost as the chief barrier to adoption, whereas this review only found cost as a barrier in 8% of all observations [5].…”