The pandemic has created many problems but it has also driven innovation and invention as clinical innovators find new ways to help their patients.
Doctors and Physiotherapists at Tallaght University Hospital (TUH) in Dublin wanted to develop a simple app to enable patients with chronic obstructive pulmonary disease (COPD) to exercise at home. One of the treatment strategies that has clearly demonstrated efficacy in reducing exacerbations and therefore hospitalisations, enhancing patients’ quality of life and enabling self-management is Pulmonary Rehabilitation (PR). These classes incorporating exercise and education run for eight weeks and are given to small groups of patients by a Physiotherapist at the Hospital.
The onset of the COVID-19 pandemic forced suspension of face-to-face PR classes and TUH physiotherapists had to find alternative ways to enrol patients in Pulmonary Rehabilitation at home.
The TUH clinical team proposed the development of an app/technology to deliver short video clips of these exercise classes that patients could participate in at home and to motivate patients to have a brisk daily walk.
The challenge was how to make these suitable for patients with different levels of physical fitness and how to increase the exercise goals automatically for patients but adapted to each patient’s individual abilities.
Dr. John Cullen, consultant in general internal & respiratory medicine in the acute medical unit at TUH, as well as clinical senior lecturer in respiratory medicine in Trinity College Dublin, was part of the TUH clinical team that posed this challenge to small companies via a process called Small Business Innovation research (SBIR), a collaboration between TUH, HSE and Enterprise Ireland.
He said: "None of the currently available apps and technologies addressed our specific needs, i.e. how to incrementally and automatically increase activity levels based on patient progress; tailor the exercise programme according to the patient’s ability to exercise; and incentivise this activity to ensure ongoing and long-term patient engagement with the exercise programme. Most of the currently available apps are so-called 'flat apps' with no in-built mechanism for automation or progressing.”
Working with the Health Services Executive, the Hospital used a pre-procurement initiative to fund the development of a prototype from two companies, one of which was UK-based Aseptika, a medical device company specialising in remote patient monitoring and a keen interest in motivating physical activity.
Kevin Auton, Managing Director of Aseptika commented: “What attracted us to this opportunity was the very detailed description of the problem the clinical team needed to solve. What they wanted was very close to our existing product, but their vision would push this to an entirely new level of automation for health service delivery. This new product was prototyped at record speed in just four months."
He explained that the solution works by asking each patient how breathless their prescribed exercise class or walking is making them. As patients get fitter over time, knowing how much exercise they are doing and how they are coping with their activity goals, it automatically adjusts the exercise programme up or down for each patient.
How they are doing is fed back to the clinical team, along with information about how well they are feeling, whether they have had another flare-up of their lung condition, what medication they are taking and whether they feel well enough to continue to exercise.
In the next stage of the development programme, the new app called Active me REMOTE Recovery, will be developed further and will be tested by patients at TUH along the way to ensure they are involved directly in its design before it is tested formally at the Hospital. The Hospital team aim to be able to roll-out this new product as a medically-approved app in the EU and UK during 2022.
If these trials are successful, the clinical team hope to see the app made available to all patients in Ireland that have COPD to help them self-manage at home. It will also help hospitals recover from the high demands placed on them by the pandemic.
