Ampliar a adesão e manutenção à Reabilitação Respiratória: codesign e implementação de uma intervenção híbrida

The goal of SCALE-UP is to improve uptake of and adherence to pulmonary rehabilitation (PR) and maintain PR benefits over time in patients with chronic respiratory diseases (CRDs). CRDs are highly prevalent worldwide and one of the leading causes of morbidity and mortality. PR is a cornerstone of care for patients with CRD with well-known benefits on exercise capacity, symptoms and health-related quality of life, as well as the reduction of healthcare use/costs. However, uptake of and adherence to ‘traditional’ center-based PR programs is poor and, in those who complete PR, benefits fade away after 6-12 months unless patients continue to exercise. The use of Information and Communication Technologies has been proposed to support PR implementation (e.g., telerehabilitation) and maintenance of its effects in the long-term. However, evidence on its effectiveness is limited and it may be well-received by only a highly selective group of patients. Innovative approaches, such as hybrid PR interventions (i.e., combination of face-to-face and remote delivery) may be a way to address these challenges, as they can retain the benefits of ‘traditional’ center-based PR programs while, at the same time, increase flexibility and accessibility when allowing exercise sessions to be completed remotely at patients’ home. Therefore, this project aims to co-design and implement a person-centered hybrid PR intervention which considers the key stakeholders’ needs and preferences and is supported by the best evidence available. Our key outputs include a prototype of a hybrid PR intervention and guidance to support its use. To achieve them, we will (specific aims): 1) Define the guiding principles for the development of hybrid PR interventions (Task 1); 2) Define software and security requirements of the digital platform (digital component of the hybrid PR) (Task 2); 3) Development of the hybrid PR intervention using a participatory co-design approach (Task 3); 4) Evaluate intervention feasibility and preliminary effects (Task 4); 5) Disseminate findings among key stakeholders (Task 5). The first aim will be achieved by analyzing the best evidence available and conducting a Delphi study to build consensus on key characteristics of hybrid PR interventions. At the same time, a throughout analysis of current national/EU privacy protection laws/regulations will be conducted to determine software/security requirements of the digital platform (2nd aim). These tasks will establish the scientific and technical basis of the intervention. The development of the hybrid PR intervention (Aim 3) will be accomplished by engaging key stakeholders (patients, HCPs) in co-design workshops. Whenever appropriate, other stakeholders (e.g., healthcare service executives, policymakers) will be invited. Then, the intervention will be implemented in a pilot study to achieve the 4th aim, and findings from the project will be disseminated (Aim 5). By the end of SCALE-UP, the following outputs are expected: • Advanced knowledge on guiding principles to develop hybrid PR; • A prototype of a hybrid PR intervention and guidance to support its use; • Preliminary data on intervention feasibility and effects to support its implementation in a more robust design study (RCT). Findings from this project will inform the potential scalability of the person-centered hybrid PR intervention, shaping future strategies for improving CRD management and patient outcomes.