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An App to Support Rehabilitation for Patients undergoing Lung Surgery

The Institute of Digital healthcare (IDH) is currently working on a project with the health Foundation and Heart of England Foundation Trust. The app and project are now being trialled. This article will discuss the details of this app; the trials it is undergoing, and the next stages to get it rolled out nationally.

by Chris Golby

Currently, patients undergoing lung surgery at Heartlands hospital in Birmingham are required to go through a rehabilitation program, before and after surgery.
These exercise sessions are ran by a physiotherapy team at the hospital. This comprises of 2 x 90 minute sessions / week. They are Functional, targeting cardiovascular, strengthening and upper body mobility, and require minimal equipment as shown in the picture below. Patients’ breathlessness is monitored during the session using a ‘Borg scale of breathlessness’. A record of this is kept to monitor progress.
However, once patients undergo surgery, they are discharged and don’t return to the hospital for 4 weeks. Patients are encouraged to re-start exercises on hospital discharge post-surgery with gentle progression.
It was noted in the past that patients were unclear as to which exercises they could perform at home. In order to address this issue, the team at Heartlands Hospital created a DVD which contained information about lung surgery, and provided the patients with a set of exercises they could carry out whilst at home.
A trial was performed with patients using the DVD, and re-admissions were shown to reduce from 14% to 5% as a result of use of the DVD.
The DVD was therefore demonstrated to be successful, however, patients often stated that there was a lack of feedback as to whether they were performing the exercises correctly, and whether their performance was adequate.

After receiving this feedback, the current team decided to develop an ‘ios app’ which could be used at home, and provide the patient with greater feedback. The equipment used consists of an IOS (Apple) mobile device (Ipad), and a Blue tooth enabled Pulse Oximeter. The pulse oximeter is able to record heart rate, and oxygen saturation. The app allows the patients to perform rehabilitation at home, daily, whilst generating feedback. A picture of the devices is shown below.
The application include the videos that were on the DVD and this can be seen in the image below. Whilst the patient is conducting exercises, their oxygen saturation and heart rate is measured, warning the patient if they are under or over exerting themselves. Patients are also given the option to simplify, or intensify the exercises, often using weights.
At the end of each exercise, a patient is asked a set of questions, including reasons for stopping exercising earlier than the intended time and in-line with the in-hospital exercises, they’re breathlessness based on the ‘Borg scale of breathlessness’, as shown below.

Finally, the user is presented with data about the session they just undertook. This is recorded, and can later be viewed by the research team for data analysis.
The application is now being trialled with a set of patients during 2015-16. The research will involve quantitative and qualitative streams, analysing data whilst testing usability of the app. The intention is then to roll out the app nationally across the NHS, with support from the Health Foundation.