The Independence
Chaya Gottesman, a physiotherapist in the Lung Transplant Program in the Soham & Shaila Ajmera Family Transplant Centre at UHN, providing virtual exercise instruction. (Photo: UHN)

Donna Cormier admits using a computer app to monitor her fitness was intimidating at first.

"I was hesitant as I am not tech savvy," Donna, a patient on the waiting list for a double lung transplant at UHN recalls of her initial reaction when approached by physiotherapist Lisa Wickerson earlier this year to participate in an innovative pilot project funded by the Sprott Department of Surgery, Toronto Lung Transplant Program and Soham & Shaila Ajmera Family Transplant Centre.

Patients are required to regularly travel or even relocate to Toronto for rehabilitation to prepare for, and recover from, lung transplant surgery. This project, designed to facilitate integrated care and support people closer to home, uses remote patient monitoring, communication and education available through an app accessed on the patients' phone or tablet.

With Lisa's help, Donna overcame her hesitation – "it seemed simple, even for me," she quips – and was able to do her fitness program Mondays and Fridays in Brampton, closer to home, and Wednesday at Toronto General Hospital (TGH). Using the system through Vivify Health, all data from her offsite workouts was sent to TGH as though she was visiting the hospital's treadmill room, and when she came into Toronto once each week she could discuss with Lisa any questions or concerns that arose.

Then, COVID-19 hit. The pulmonary rehabilitation programs at both hospitals Donna visited each week were closed abruptly. The online fitness management program that was proving convenient, now became a vital link to care.

"It was a smooth transition to exercising from home, where I have a treadmill, oximeter (instrument to monitor oxygen levels in blood) and weights," Donna says. "Lisa and I have video calls every two weeks. Vivify provides me with a resource library, UHN transplant updates, texting and phone calls to my team.

"This program has been instrumental in keeping me on track in my transplant journey."

Donna Cormier
Donna Cormier, a double lung transplant patient at the Soham & Shaila Ajmera Family Transplant Centre at UHN, says she’s had “a smooth transition to exercising from home.” (Photo: Courtesy Donna Cormier)

Across UHN, COVID-19 has led to the closing of outpatient rehabilitation programs. That's prompted care teams to come up with virtual alternatives for patients. Quickly. By mid-March, the vast majority of patients awaiting lung transplant, or within three months of having had one, were using the app through Vivify Health.

Physiotherapists now follow about 75 lung transplant patients virtually for exercise training, physical activity counselling and oxygen titration. The program will be evaluated to see how the exercise pathway in the app can be optimized and a hybrid rehabilitation model can be delivered post-pandemic to enhance convenience for patients. The Lung Transplant team is also exploring future downloading of biometric data into the app using Bluetooth-enabled devices such oxygen oximeters, activity trackers and spirometers.

"The ability to deliver rehabilitation remotely will change our practice going forward as we look to effective and safe ways to combine individualized care with reduced treatment burden for patients and their caregivers," Lisa says.

At the Brain Program at Toronto Rehab, delayed access to rehabilitation can have serious consequences for neurorehabilitation patients, particularly as they transition home after inpatient rehabilitation.

In response to a complete disruption in outpatient therapy caused by COVID-19, the program has transitioned to providing therapy entirely virtually, primarily through videoconferencing. This allows patients living stroke, brain injury, multiple sclerosis, chronic pain and congenital childhood disability to receive care while sheltering in place.

For physiotherapist Nina Hovanec, who also treats patients who have had a stroke, the videoconferencing offers a unique perspective.

Nina Hovanec
Physiotherapist Nina Hovanec of the Brain Program at Toronto Rehab and Interim Lead of the Rocket Upper Extremity Clinic, says the shift to virtual care has been challenging but rewarding. (Photo: UHN)

"Virtual rehab is like being invited into someone's home as guest, to see how they really engage with their environment," Nina says. "It is reassuring, motivating and vulnerable.

"Our rapid shift has challenged us to the full scope of our skills, but also emphasized that as much as physiotherapy is about physical touch, it is also so much more."

For patient such as Rita Vassallo, there are tradeoffs to working virtually with a therapist.

Rita appreciates that she doesn't have to travel for a session and can do a full hour "because I'm not so exhausted." But she admits "I do miss the closeness" as the response can be delayed in a virtual setting and she has to listen and focus much more closely as her and the therapist are not in the same room.

"It's a partnership and I am very grateful for it!" Rita says.

While other health professions at Toronto Rehab had offered virtual therapy prior to COVID-19, it's a new approach for physiotherapists. And, the response is very positive.

"As a community, we have really come together strongly to support each other, learn, share," Nina says. "Overall, we can see that we are making a change.

"Patients and families feel connected, feel valued, that their recovery matters, for those who would otherwise have no therapy after they leave inpatient rehab – and that is a real privilege."

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