Maintenance
TelePR
For our program, maintenance covers two distinct areas: 1) among the patients who completed the program, the adoption of long-term behavior changes learned though PR participation including regular exercise, and breathing techniques; and 2) among providers, the extent to which PR clinics have incorporated TelePR into their standard services for their chronic pulmonary patients in the post-study period.Only 5 of the 57 people in TelePR continued some form of exercise at 6 months after study enrollment. Several participants stated that they felt the program had been taken away from them, almost as if a ‘rug had been pulled out from beneath them’ despite efforts by the study team to inform them of local gyms for continued exercise and the delivery of the stationary peddler for continued exercise. In fact, at the end of the program and compared to the start of PR for both TelePR and SPR participants, the social isolation score worsened likely reflecting this feeling of being abandoned after such frequent contact with the PR group. Several participants stated they were continuing to engage in some form of exercise (e.g., walking). Unfortunately, for many patients who had benefitted from PR, continued access to a PR program once their time in the study had ended was not possible due to transportation and financial difficulties and long waitlists for PR.Among providers, during the COVID-9 pandemic, rapid changes in telehealth permissible platforms and insurance reimbursement structures occurred. The Pulmonary division at the largest hospital adopted the same tools that the trial used for vital sign monitoring, and the protocol for TelePR sessions, using a different web-based platform. Unfortunately, nation-wide staffing shortages of respiratory therapists prevented this program from being implemented. Very low rates of insurance reimbursement for PR and for telehealth visits are further barriers. This demonstrates that TelePR is not anymore of a barrier compared to SPR.