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European Journal of Physical and Rehabilitation Medicine 2013 February;49(1):51-7


lingua: Inglese

Pulmonary rehabilitation at home guided by telemonitoring and access to healthcare facilities for respiratory complications in patients with neuromuscular disease

Garuti G. 1, Bagatti S. 1, Verucchi E. 2, Massobrio M. 1, Spagnolatti L. 1, Vezzani G. 3, Lusuardi M. 1

1 Respiratory Rehabilitation Unit, AUSL Reggio Emilia, Ospedale S. Sebastiano, Correggio, Reggio Emilia, Italy; 2 Unione Italiana per la Lotta contro la Distrofia Muscolare (UILDM), Reggio Emilia, Italy; 3 Pulmonary Rehabilitation and Sleep Medicine Unit, Pulmonology Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy


Background: Pulmonary complications are the main cause of morbidity and mortality in neuromuscular patients. Aim of this study was to evaluate the feasibility of a home follow-up program combining telemonitoring and chest physiotherapy (CPT) in preventing acute respiratory episodes.
Design: Prospective observational study in a period of 24 months, and comparison with preintervention data of the same patients.
Setting: Outpatients and community.
Population: Neuromuscular patients. Enrolment criteria were: reduced efficacy of cough, high family support, long home-to-hospital distance.
Methods: Caregivers and patients had to register daily respiratory signs and symptoms. Each patient was equipped with a pulse oximeter with a modem for transmitting data to a remote control center, in charge of alerting the pulmonologist in case of sign and symptom deterioration. CPT interventions at home were planned after indication by the pulmonologist. The number of emergency room admissions or hospitalization following respiratory exacerbations were registered.
Results: Thirteen patients were enrolled. In the first year of monitoring, 18 alerts were transmitted to the pulmonologist, average 1.38±1.38 alert/patient. In the second year, the number of alerts were 5, average 0.38±0.65 alert/patient (P<0.01). In 24 months, 241 respiratory therapists’ interventions were conducted on 11 patients. In the first 12 months there were four episodes of hospitalisation, none in the following 12 months. In the year prior to the project, there were seven cases of hospitalisation and one case of emergency room admission.
Conclusion: The combination of telemonitoring and CPT at home is feasible in the long-term for patients with neuromuscular disease.
Clinical rehabilitation impact: An apparent reduction of hospitalisation and emergency room admissions for respiratory complications can justify a randomized control trial to confirm efficacy and effectiveness.

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