Participants’ Experiences with a Telerehabilitation Behavioral Exercise Intervention to Improve Physical Function and Physical Activity After Lung Transplantation: A Multi-Method Study
DOI:
https://doi.org/10.63144/ijt.2025.6705Keywords:
Lung transplantation, TelerehabilitationAbstract
Few studies have examined the factors influencing participant acceptability and engagement of telerehabilitation-based interventions. The study purpose was to describe the experiences of participants who were randomly assigned to the Lung Transplant Go (LTGO) telerehabilitation intervention group of a two-group, randomized, controlled parent trial. Survey measures included usability and familiarity with technology, exercise self-efficacy, and intervention adherence rates. Semi-structured interviews (SSI) were completed at 3- and 6-months post-intervention. Survey scores and adherence rates were high. SSI responses were generally positive with reported benefits including motivation, building strength, and becoming more physically active. Frustrations reported with technology or delivery were few and promptly resolved. Participants were willing to participate in the LTGO intervention again. Those who demonstrate limited familiarity with information technologies may benefit from additional support prior to intervention delivery.
References
Abidi, Y., Kovats, Z., Bohacs, A., Fekete, M., Naas, S., Madurka, I., Torok, K., Bogyo, L., & Varga, J. T. (2023). Lung transplant rehabilitation—a review. Life, 13(2), 506. https://doi.org/10.3390/life13020506 DOI: https://doi.org/10.3390/life13020506
Arkhipova-Jenkins, I., & Helfand, M. (2020). Topic brief: Benefits of pulmonary rehabilitation. In Effective Health Care Program (No. 0921). https://effectivehealthcare.ahrq.gov/system/files/docs/benefits_pulmonary_rehab_topic_brief.pdf
Ayala, G. X., & Elder, J. P. (2011). Qualitative methods to ensure acceptability of behavioral and social interventions to the target population. Journal of Public Health Dentistry, 71(s1). https://doi.org/10.1111/j.1752-7325.2011.00241.x DOI: https://doi.org/10.1111/j.1752-7325.2011.00241.x
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W.H. Freeman. http://www.uky.edu/~eushe2/BanduraPubs/BanduraGuide2006.pdf
Bonnevie, T., Smondack, P., Elkins, M., Gouel, B., Medrinal, C., Combret, Y., Muir, J., Cuvelier, A., Prieur, G., & Gravier, F. (2021). Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: A systematic review. Journal of Physiotherapy, 67(1), 27–40. https://doi.org/10.1016/j.jphys.2020.12.006 DOI: https://doi.org/10.1016/j.jphys.2020.12.006
Chan, C., Yamabayashi, C., Syed, N., Kirkham, A., & Camp, P. G. (2016). Exercise telemonitoring and telerehabilitation compared with traditional cardiac and pulmonary rehabilitation: A systematic review and meta-analysis. Physiotherapy Canada, 68(3), 242–251. https://doi.org/10.3138/ptc.2015-33 DOI: https://doi.org/10.3138/ptc.2015-33
Choi, J., Hergenroeder, A. L., Burke, L., Dabbs, A. D., Morrell, M., Saptono, A., & Parmanto, B. (2016). Delivering an in-home exercise program via telerehabilitation: A pilot study of Lung Transplant GO (LTGO). International Journal of Telerehabilitation, 8(2), 15–26. https://doi.org/10.5195/ijt.2016.6201 DOI: https://doi.org/10.5195/ijt.2016.6201
Crafoord, M., Fjell, M., Sundberg, K., Nilsson, M., & Langius-Eklöf, A. (2020). Engagement in an interactive app for symptom self-management during treatment in patients with breast or prostate cancer: Mixed methods study. Journal of Medical Internet Research, 22(8), e17058. https://doi.org/10.2196/17058 DOI: https://doi.org/10.2196/17058
Dennett, A., Harding, K. E., Reimert, J., Morris, R., Parente, P., & Taylor, N. F. (2021). Telerehabilitation’s safety, feasibility, and exercise uptake in cancer survivors: Process evaluation. JMIR Cancer, 7(4), e33130. https://doi.org/10.2196/33130 DOI: https://doi.org/10.2196/33130
Faett, B. L., Brienza, D. M., Geyer, M. J., & Hoffman, L. A. (2013). Teaching self-management skills in persons with chronic lower limb swelling and limited mobility: Evidence for usability of telerehabilitation. International Journal of Telerehabilitation, 5(1), 17-26. https://doi.org/10.5195/ijt.2013.6114 DOI: https://doi.org/10.5195/ijt.2013.6114
Fekete, M., Fazekas-Pongor, V., Balazs, P., Tarantini, S., Nemeth, A. N., & Varga, J. T. (2021). Role of new digital technologies and telemedicine in pulmonary rehabilitation. Wiener Klinische Wochenschrift, 133(21–22), 1201–1207. https://doi.org/10.1007/s00508-021-01930-y DOI: https://doi.org/10.1007/s00508-021-01930-y
Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving integration in mixed methods designs—principles and practices. Health Services Research, 48(6pt2), 2134–2156. https://doi.org/10.1111/1475-6773.12117 DOI: https://doi.org/10.1111/1475-6773.12117
Fischer MJ, Scharloo M, Abbink JJ, van ’t Hul AJ, van Ranst D, Rudolphus A, Weinman, J., Rabe, K. F., & Kaptein, A. A. (2009). Drop-out and attendance in pulmonary rehabilitation: the role of clinical and psychosocial variables. Respiratory Medicine, 103, 1564–1571. https://doi.org/10.1016/j.rmed.2008.11.020 DOI: https://doi.org/10.1016/j.rmed.2008.11.020
Garcia-Silva, J., Peralta-Ramírez, M. I., Navarrete Navarrete, N., Silva-Silva, D., & Caballo, V. E. (2018). Validez y fiabilidad de la escala de autoeficacia para el ejercicio físico en pacientes con síndrome metabólico [Validity and reliability of the self-efficacy to regulate exercise scale in patients with metabolic syndrome]. Revista espanola de salud publica, 92, e201808046.
Gutierrez-Arias, R., Martinez-Zapata, M. J., Gaete-Mahn, M. C., Osorio, D., Bustos, L., Tanner, J. M., Hidalgo, R., & Seron, P. (2021). Exercise training for adult lung transplant recipients. Cochrane Library, 2021(7). https://doi.org/10.1002/14651858.cd012307.pub2 DOI: https://doi.org/10.1002/14651858.CD012307.pub2
Hanlon, P., Daines, L., Campbell, C., McKinstry, B., Weller, D., & Pinnock, H. (2017). Telehealth interventions to support self-management of long-term conditions: A systematic metareview of diabetes, heart failure, asthma, chronic obstructive pulmonary disease, and cancer. Journal of Medical Internet Research, 19(5), e172. https://doi.org/10.2196/jmir.6688 DOI: https://doi.org/10.2196/jmir.6688
Hansen, H., Bieler, T., Beyer, N., Kallemose, T., Wilcke, J. T., Østergaard, L. M., Andeassen, H. F., Martinez, G., Lavesen, M., Frølich, A., & Godtfredsen, N. S. (2020). Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: A randomised multicentre trial. Thorax, 75(5), 413–421. https://doi.org/10.1136/thoraxjnl-2019-214246. DOI: https://doi.org/10.1136/thoraxjnl-2019-214246
Hergenroeder, A.L., Willey, B., Vendetti, M. & Dabbs A.D. (2023). Exercise progression protocol for Lung Transplant GO: A multicomponent telerehab exercise intervention for patients after lung transplantation. Cardiopulmonary Physical Therapy Journal, 34(1), 2-12. https://doi.org/10.1097/CPT.0000000000000203 DOI: https://doi.org/10.1097/CPT.0000000000000203
Holland, A. E., Cox, N. S., Houchen-Wolloff, L., Rochester, C. L., Garvey, C., ZuWallack, R., Nici, L., Limberg, T., Lareau, S. C., Yawn, B. P., Galwicki, M., Troosters, T., Steiner, M., Casaburi, R., Clini, E., Goldstein, R. S., & Singh, S. J. (2021). Defining modern pulmonary rehabilitation. An official American Thoracic Society Workshop report. Annals of the American Thoracic Society, 18(5), e12–e29. https://doi.org/10.1513/annalsats.202102-146st DOI: https://doi.org/10.1513/AnnalsATS.202102-146ST
Hsieh, H.F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288. https://doi.org/10.1177/1049732305276687 DOI: https://doi.org/10.1177/1049732305276687
Jones, A. W., Taylor, A., Gowler, H., O’Kelly, N., Ghosh, S., & Bridle, C. (2017). Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD. ERJ Open Research, 3(1), 00089–02016. https://doi.org/10.1183/23120541.00089-2016 DOI: https://doi.org/10.1183/23120541.00089-2016
Kobashigawa, J., Dadhania, D., Bhorade, S., Adey, D., Berger, J., Bhat, G., Budev, M., Duarte-Rojo, A., Dunn, M., Hall, S., Harhay, M. N., Johansen, K. L., Joseph, S., Kennedy, C. C., Kransdorf, E., Lentine, K. L., Lynch, R. J., McAdams-DeMarco, M., Nagai, S., . . . Lai, J. C. (2019). Report from the American Society of Transplantation on frailty in solid organ transplantation. American Journal of Transplantation, 19(4), 984–994. https://doi.org/10.1111/ajt.15198 DOI: https://doi.org/10.1111/ajt.15198
Kolaitis, N., & Singer, J. (2018). Defining success in lung transplantation: From survival to quality of life. Seminars in Respiratory and Critical Care Medicine, 39(02), 255–268. https://doi.org/10.1055/s-0037-1615801. DOI: https://doi.org/10.1055/s-0037-1615801
Krippendorff, K. (2004). Content analysis: An introduction to its methodology (2nd ed.). Sage Publications (CA).
Lahham, A., & Holland, A. E. (2021). The need for expanding pulmonary rehabilitation services. Life, 11(11), 1236. https://doi.org/10.3390/life11111236 DOI: https://doi.org/10.3390/life11111236
Levack, W. M., Watson, J., Hay-Smith, E. J. C., Davies, C., Ingham, T., Jones, B., Cargo, M., Houghton, C., & McCarthy, B. (2018). Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: A qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers. Cochrane Library. https://doi.org/10.1002/14651858.cd013195 DOI: https://doi.org/10.1002/14651858.CD013195
Materia, F. T., & Smyth, J. M. (2021). Acceptability of intervention design factors in mHealth intervention research: Experimental factorial study. JMIR Mhealth and Uhealth, 9(7), e23303. https://doi.org/10.2196/23303. DOI: https://doi.org/10.2196/23303
Moon, S.J.E., DeVito Dabbs, A.J., Hergenroeder, A.L., Vendetti, M., Jones, K., Willey, B.M., Morrell, M.R., Imes, C.C. (2021). Considerations for assessing physical function and physical activity in clinical trials during the COVID-19 pandemic. Contemporary Clinical Trials, 105. 10.1016/j.cct.2021.106407 DOI: https://doi.org/10.1016/j.cct.2021.106407
Myers, J., Niebauer, J., & Humphrey, R. (2021). Prehabilitation coming of age. Journal of Cardiopulmonary Rehabilitation and Prevention, 41(3), 141–146. https://doi.org/10.1097/hcr.0000000000000574 DOI: https://doi.org/10.1097/HCR.0000000000000574
Oaten, M., & Cheng, K. (2010). Longitudinal gains in self‐regulation from regular physical exercise. British Journal of Health Psychology, 11(4), 717–733. https://doi.org/10.1348/135910706x96481 DOI: https://doi.org/10.1348/135910706X96481
Parmanto, B., Pulantara, I. W., Schutte, J. L., Saptono, A., & McCue, M. P. (2013). An integrated telehealth system for remote administration of an adult autism assessment. Telemedicine Journal and e-Health, 19(2), 88–94. https://doi.org/10.1089/tmj.2012.0104 DOI: https://doi.org/10.1089/tmj.2012.0104
Perch, M., Hayes, D., Cherikh, W. S., Zuckermann, A., Harhay, M. O., Hsich, E., Potena, L., Sadavarte, A., Lindblad, K., Singh, T. P., & Stehlik, J. (2022). The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Thirty-ninth adult lung transplantation report—2022; focus on lung transplant recipients with chronic obstructive pulmonary disease. The Journal of Heart and Lung Transplantation, 41(10), 1335–1347. https://doi.org/10.1016/ j.healun.2022.08.007. Epub 2022 Aug 20.
Peretti, A., Amenta, F., Tayebati, S. K., Nittari, G., & Mahdi, S. S. (2017). Telerehabilitation: Review of the state-of-the-art and areas of application. JMIR Rehabilitation and Assistive Technologies, 4(2), e7. https://doi.org/10.2196/rehab.7511 DOI: https://doi.org/10.2196/rehab.7511
Rochester, C. L., Vogiatzis, I., Holland, A. E., Lareau, S. C., Marciniuk, D. D., Puhan, M. A., Spruit, M. A., Masefield, S., Casaburi, R., Clini, E. M., Crouch, R., Garcia-Aymerich, J., Garvey, C., Goldstein, R. S., Hill, K., Morgan, M., Nici, L., Pitta, F., Ries, A. L., . . . ZuWallack, R. L. (2015). An official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, use, and Delivery of Pulmonary Rehabilitation. American Journal of Respiratory and Critical Care Medicine, 192(11), 1373–1386. https://doi.org/10.1164/rccm.201510-1966st DOI: https://doi.org/10.1164/rccm.201510-1966ST
Schein, R. M., Schmeler, M. R., Holm, M. B., Saptono, A., & Brienza, D. M. (2010). Telerehabilitation wheeled mobility and seating assessments compared with in person. Archives of Physical Medicine and Rehabilitation, 91(6), 874–878. https://doi.org/10.1016/j.apmr.2010.01.017 DOI: https://doi.org/10.1016/j.apmr.2010.01.017
Schein, R. M., Schmeler, M. R., Saptono, A., & Brienza, D. (2010). Patient satisfaction with telerehabilitation assessments for wheeled mobility and seating. Assistive Technology, 22(4), 215–222. https://doi.org/10.1080/10400435.2010.518579 DOI: https://doi.org/10.1080/10400435.2010.518579
Sekhon, M., Cartwright, M., & Francis, J. J. (2017). Acceptability of healthcare interventions: An overview of reviews and development of a theoretical framework. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2031-8 DOI: https://doi.org/10.1186/s12913-017-2031-8
Selzler, A., Rodgers, W. M., Berry, T. R., & Stickland, M. K. (2016). The importance of exercise self-efficacy for clinical outcomes in pulmonary rehabilitation. Rehabilitation Psychology, 61(4), 380–388. https://doi.org/10.1037/rep0000106 DOI: https://doi.org/10.1037/rep0000106
Singer, J. P., Soong, A., Bruun, A., Bracha, A., Chin, G., Hays, S. R., Kukreja, J., Rigler, J., Golden, J. A., Greenland, J. R., & Garvey, C. (2018). A mobile health technology enabled home‐based intervention to treat frailty in adult lung transplant candidates: A pilot study. Clinical Transplantation, 32(6). https://doi.org/10.1111/ctr.13274 DOI: https://doi.org/10.1111/ctr.13274
Spruit, M. A., Pitta, F., Garvey, C., ZuWallack, R. L., Roberts, C. M., Collins, E. G., Goldstein, R., McNamara, R., Surpas, P., Atsuyoshi, K., López-Campos, J., Vogiatzis, I., Williams, J. E., Lareau, S., Brooks, D., Troosters, T., Singh, S. J., Hartl, S., Clini, E. M., & Wouters, E. F. (2014). Differences in content and organisational aspects of pulmonary rehabilitation programmes. European Respiratory Journal, 43(5), 1326–1337. https://doi.org/10.1183/09031936.00145613 DOI: https://doi.org/10.1183/09031936.00145613
Subedi, N., Rawstorn, J. C., Gao, L., Koorts, H., & Maddison, R. (2020). Implementation of telerehabilitation interventions for the self-management of cardiovascular disease: Systematic review. JMIR Mhealth and Uhealth, 8(11), e17957. https://doi.org/10.2196/17957 DOI: https://doi.org/10.2196/17957
Valapour, M., Lehr, C. J., Schladt, D. P., Smith, J. M., Goff, R., Mupfudze, T. G., Swanner, K., Gauntt, K., & Snyder, J. J. (2023). OPTN/SRTR 2021 Annual Data Report: Lung. American Journal of Transplantation, 23(2), S379–S442. https://doi.org/10.1016/j.ajt.2023.02.009 DOI: https://doi.org/10.1016/j.ajt.2023.02.009
Vendetti, M. L., Esther Moon, S. J., Imes, C. C., Hergenroeder, A., Sciurba, F., Lendermon, E., Pilewski, J., Ren, D., Parmanto, B., Dewhirst, B., Willey, B., Jones, K., Morrell, M. R., Sanchez, P., & DeVito Dabbs, A. (2023). Design of Lung Transplant Go (LTGO): A randomized controlled trial evaluating the efficacy of a telerehabilitation behavioral exercise intervention to improve physical activity, physical function, and blood pressure control after lung transplantation. Contemporary Clinical Trials Communications, 33, 101097. https://doi.org/10.1016/j.conctc.2023.101097 DOI: https://doi.org/10.1016/j.conctc.2023.101097
Wickerson, L., Mathur, S., Singer, L. G., & Brooks, D. (20150). Physical activity levels early after lung transplantation. Physical Therapy, 95(4), 517–525. https://doi.org/10.2522/ptj.20140173 DOI: https://doi.org/10.2522/ptj.20140173
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Copyright (c) 2025 Sweta Jena, Elizabeth Tarazi, Bryan Willey, Andrea Hergenroeder, Christopher Imes, Elizabeth Lenderman, Seol Ju E. Moon, Kristen Jones, Melissa Vendetti, Annette Dabbs

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National Institute of Nursing Research
Grant numbers R01NR017196-01A1
ISSN 1945-2020 (online)