Assessing the Barriers and Facilitators to Pulmonary Rehabilitation Referrals Using the Consolidated Framework for Implementation Research (CFIR).

Chronic obstructive pulmonary disease (COPD) is a global health issue causing significant illness and death. Pulmonary Rehabilitation (PR) offers non-pharmacological treatment, including education, exercise, and psychological support which was shown to improve clinical outcomes. In both stable COPD and after an acute exacerbation, PR has been demonstrated to increase exercise capacity, decrease dyspnea, and enhance quality of life. Despite these benefits, referrals for PR for COPD treatment remain low. This study aims to evaluate the perceptions of healthcare providers for referring a COPD patient to PR. Semi-structured qualitative interviews were conducted with pulmonary specialists, hospitalists, and emergency department physicians. Domains and constructs from the Consolidated Framework for Implementation Research (CFIR) were applied to the qualitative data to organize, analyze, and identify the barriers and facilitators to referring COPD patients. The findings from this study will help guide strategies to improve the referral process for PR.

Machine Learning Approaches for Exercise Exertion Level Classification Using Data from Wearable Physiologic Monitors.

This research aimed to develop a model for real-time prediction of aerobic exercise exertion levels. ECG signals were registered during 16-minute cycling exercises. Perceived ratings of exertion (RPE) were collected each minute from the study participants. Based on the reported RPE, each consecutive minute of the exercise was assigned to the "high exertion" or "low exertion" class. The characteristics of heart rate variability (HRV) in time and frequency domains were used as predictive features. The top ten ranked predictive features were selected using the minimum redundancy maximum relevance (mRMR) algorithm. The support vector machine demonstrated the highest accuracy with an F1 score of 82%.

Assessing Patient Perspectives on Pulmonary Telerehabilitation Using Thematic Analysis of Semi-Structured Qualitative Interviews.

The study was aimed at exploring patients' experiences after the completion of a 12-month pulmonary telerehabilitation (PR) program. Semi-structured qualitative interviews were conducted with 16 COPD patients. The interviews were analyzed using a thematic approach to identify patterns and themes. The patients exhibited high acceptability and satisfaction with the remote PR program and provided valuable input for its improvement. These insights will be used for the implementation of a patient-centered COPD telerehabilitation system.

Mixed-Methods Assessment of a Virtual Reality-Based System for Pulmonary Rehabilitation.

Barriers to pulmonary rehabilitation (PR) (e.g., finances, mobility, and lack of awareness about the benefits of PR). Reducing these barriers by providing COPD patients with convenient access to PR educational and exercise training may help improve the adoption of PR. Virtual reality (VR) is an emerging technology that may provide an interactive and engaging method of supporting a home-based PR program. The goal of this study was to systematically evaluate the feasibility of a VR app for a home-based PR education and exercise program using a mixed-methods design. 18 COPD patients were asked to complete three brief tasks using a VR-based PR application. Afterward, patients completed a series of quantitative and qualitative assessments to evaluate the usability, acceptance, and overall perspectives and experience of using a VR system to engage with PR education and exercise training. The findings from this study demonstrate the high acceptability and usability of the VR system to promote participation in a PR program. Patients were able to successfully operate the VR system with minimal assistance. This study examines patient perspectives thoroughly while leveraging VR-based technology to facilitate access to PR. The future development and deployment of a patient-centered VR-based system in the future will consider patient insights and ideas to promote PR in COPD patients.

Exercise Exertion Levels Prediction Based on Real-Time Wearable Physiological Signal Monitoring.

The real-time revolutions per minute (RPM) data, ECG signal, pulse rate, and oxygen saturation levels were collected during 16-minute cycling exercises. In parallel, ratings of perceived exertion (RPE) were collected each minute from the study participants. A 2-minute moving window, with one minute shift, was applied to each 16-minute exercise session to divide it into a total of fifteen 2-minute windows. Based on the self-reported RPE, each exercise window was labeled as "high exertion" or "low exertion" classes. The heart rate variability (HRV) characteristics in time and frequency domains were extracted from the collected ECG signals for each window. In addition, collected oxygen saturation levels, pulse rate, and RPMs were averaged for each window. The best predictive features were then selected using the minimum redundancy maximum relevance (mRMR) algorithm. Top selected features were then used to assess the accuracy of five ML classifiers to predict the level of exertion. The Naïve Bayes model demonstrated the best performance with an accuracy of 80% and an F1 score of 79%.

Patient Perceptions of a Virtual Reality-Based System for Pulmonary Rehabilitation: A Qualitative Analysis.

The objective of this study was to evaluate the attitudes, beliefs, and perspectives of patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) while using a virtual reality (VR) system supporting a home-based pulmonary rehabilitation (PR) program. Patients with a history of COPD exacerbations were asked to use a VR app for home-based PR and then undergo semi-structured qualitative interviews to provide their feedback on using the VR app. The mean age of the patients was 72±9 years ranging between 55 and 84 years old. The qualitative data were analyzed using a deductive thematic analysis. Findings from this study indicated the high acceptability and usability of the VR-based system for engaging in a PR program. This study offers a thorough examination of patient perceptions while utilizing a VR-based technology to facilitate access to PR. Future development and deployment of a patient-centered VR-based system will consider patient insights and suggestions to support COPD self-management according to patient requirements, preferences, and expectations.

Assessing Patient Perspectives of a Cancer Telerehabilitation Platform Using Thematic Analysis of Semi-Structured Qualitative Interviews.

Cancer-related physical impairments and functional decline affect most patients receiving chemotherapy. Despite evidence that exercise can improve these symptoms, access to exercise-based rehabilitation for cancer patients is limited. Providing telerehabilitation services has shown promising results in alleviating these barriers to access. An in-depth understanding of patient perspectives on cancer telerehabilitation is imperative for the successful development of patient-centered interfaces and functionality. The goal of this study was to explore patients' views and experiences based on a walkthrough of a mobile cancer telerehabilitation system. After the walkthrough, semi-structured qualitative interviews were conducted in 29 cancer patients undergoing chemotherapy. The interviews were analyzed using a thematic analysis approach to deductively identify patterns and themes. Patients responded with approval for the telerehabilitation system, particularly its convenience and ease of use. Patients with reported low technology literacy adapted to the system with minimal problems. The thematic analysis results provided an in-depth understanding of the patients' needs and preferences of the interface and functionality of the telerehabilitation system. These valuable insights will be considered for future development and implementation of a patient-centered cancer telerehab system.

Patient Perspectives on Long-Term Use of a Pulmonary Telerehabilitation Platform: A Qualitative Analysis.

To effectively develop patient-centered interfaces and functionality, it is essential to investigate different viewpoints on pulmonary telerehabilitation. The purpose of this study is to explore the views and experiences of COPD patients after the completion of a 12-month home-based pulmonary telerehabilitation program. Semi-structured qualitative interviews were conducted with 15 COPD patients. The interviews were analyzed using a thematic analysis approach to deductively identify patterns and themes. Patients responded with approval for the telerehabilitation system, particularly for its convenience and ease of use. This study offers a thorough investigation of patient viewpoints when utilizing the telerehabilitation technology. These insightful observations will be considered for future development and implementation of a patient-centered COPD telerehabilitation system to provide support tailored to patient needs, preferences, and expectations.

Automated Classification of Exercise Exertion Levels Based on Real-Time Wearable Physiological Signal Monitoring.

This study aimed to build machine learning (ML) algorithms for the automated classification of cycling exercise exertion levels using data from wearable devices. The best predictive features were selected using the minimum redundancy maximum relevance algorithm (mRMR). Top selected features were then used to build and assess the accuracy of five ML classifiers to predict the level of exertion. The Naïve Bayes showed the best F1 score of 79%. The proposed approach may be used for real-time monitoring of exercise exertion.

Exercise Exertion Level Prediction Using Data from Wearable Physiologic Monitors.

This study aims to develop machine learning (ML) algorithms to predict exercise exertion levels using physiological parameters collected from wearable devices. Real-time ECG, oxygen saturation, pulse rate, and revolutions per minute (RPM) data were collected at three intensity levels during a 16-minute cycling exercise. Parallel to this, throughout each exercise session, the study subjects' ratings of perceived exertion (RPE) were gathered once per minute. Each 16-minute exercise session was divided into a total of eight 2-minute windows. Each exercise window was labeled as "high exertion," or "low exertion" classes based on the self-reported RPEs. For each window, the gathered ECG data were used to derive the heart rate variability (HRV) features in the temporal and frequency domains. Additionally, each window's averaged RPMs, heart rate, and oxygen saturation levels were calculated to form all the predictive features. The minimum redundancy maximum relevance algorithm was used to choose the best predictive features. Top selected features were then used to assess the accuracy of ten ML classifiers to predict the next window's exertion level. The k-nearest neighbors (KNN) model showed the highest accuracy of 85.7% and the highest F1 score of 83%. An ensemble model showed the highest area under the curve (AUC) of 0.92. The suggested method can be used to automatically track perceived exercise exertion in real-time.

Respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) modulates brain response to stress in major depression.

BACKGROUND: Negative stress significantly impacts major depressive disorder (MDD), given the shared brain circuitry between the stress response and mood. Thus, interventions that target this circuitry will have an important impact on MDD. The aim of this study was to evaluate the acute effects of a novel respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) technique in the modulation of brain activity and connectivity in women with MDD in response to negative stressful stimuli. METHODS: Twenty premenopausal women with recurrent MDD in an active episode were included in a cross-over experimental study that included two functional MRI visits within one week, randomized to receive exhalatory- (e-RAVANS) or inhalatory-gated (i-RAVANS) at each visit. Subjects were exposed to a visual stress challenge that preceded and followed RAVANS. A Factorial analysis was used to evaluate the effects of RAVANS on brain activity and connectivity and changes in depressive and anxiety symptomatology post-stress. RESULTS: Compared with i-RAVANS, e-RAVANS was significantly associated with increased activation of subgenual anterior cingulate, orbitofrontal and ventromedial prefrontal cortices and increased connectivity between hypothalamus and dorsolateral prefrontal cortex, and from nucleus tractus solitarii to locus coeruleus and ventromedial prefrontal cortex. Changes in brain activity and connectivity after e-RAVANS were significantly associated with a reduction in depressive and anxiety symptoms. CONCLUSIONS: Our study suggests exhalatory-gated RAVANS effectively modulates brain circuitries regulating response to negative stress and is associated with significant acute reduction of depressive and anxiety symptomatology in women with recurrent MDD. Findings suggest a potential non-pharmacologic intervention for acute relief of depressive symptomatology in MDD.

Respiratory-gated Auricular Vagal Afferent Nerve Stimulation (RAVANS) effects on autonomic outflow in hypertension.

Transcutaneous stimulation of the auricular branch of the vagus nerve (ABVN) has been proposed as a non-invasive alternative to vagus nerve stimulation (VNS). However, its cardiovagal effects are inconsistent across studies, likely due to inhomogeneity in the stimulation parameters. Here, we evaluate respiratory-gated ABVN stimulation (Respiratory-gated Auricular Vagal Afferent Nerve Stimulation, RAVANS), where the stimuli are delivered in 1 s bursts during the exhalation phase of respiration, thus mimicking the breathing-induced modulation of cardiac vagal activity. In this study, we present preliminary results from an ongoing single-arm, open label trial investigating the effects of different intensities of RAVANS in hypertensive subjects. We found that a mid-intensity RAVANS stimulation (rated as a 5 on a 0-10 scale) increases the cardiovagal tone and reduces the sympathetic tone during a paced breathing task. The present results could contribute to optimize RAVANS as a non-invasive, low-cost therapeutic intervention for hypertension.