Exploratory Study for Using the mobile Hudl App with Telehealth: A Randomized Controlled Trial Shows Positive Impact on Home Exercise Program Adherence in People with Chronic Diseases and in Financial Distress (Preprint)

BACKGROUND Patients with chronic diseases often must adhere to a long-term individualized home exercise program (HEP). Limited adherence (ie, performing the required number of HEP/week) to long-term exercise, given during physical therapy (PT) visits, reduces the capacity of exercise to manage or improve symptoms related to chronic disease. Lower socio-economic status additionally negatively impacts exercise adherence. To mitigate this, apps available to motivate people to exercise could be a viable option. Using an app through telehealth may benefit adults with chronic diseases achieve long-term HEP adherence. However, because using apps for rehabilitation is an emerging field, the app's feasibility needs to be evaluated. OBJECTIVE To address HEP adherence in participants with chronic diseases and in financial distress, defined by being on Medicaid or similar programs, we evaluated feasibility and satisfaction with the Hudl Technique® app and telehealth, satisfaction with PT care, and we monitored HEP adherence and compliance (ie, percentage of participant-recorded videos sent), in participants using the app/telehealth compared to using standard HEP on paper. METHODS We recruited patients scheduled for outpatient PT. We performed a randomized controlled trial where the experimental group received weekly HEP demonstrations through app videos on a tablet with feedback on their self-recorded HEP video performance from the telehealth-physical therapist. The control group received HEP on paper without feedback as is custom in PT practice. The treating therapist and data analyst were blinded to the allocation. Demographic, clinical, and health coverage information was collected for screening and baseline measurements. Adherence and compliance were evaluated. Both groups completed surveys at 8 and 24 weeks on satisfaction with PT care and, for the experimental group, also satisfaction with the app/telehealth use. Descriptive and non-parametric statistics (ie, Chi square, Wilcoxon, and Mann-Whitney tests) were used for within-and between group comparisons, and analyzed with JMP®, Version 13. RESULTS Forty-five adults with chronic diseases and financial distress were randomized into an experimental (n=23) and a control group (n=22), with respectively 17 and 19 participants completing the 24-week HEP. The experimental group maintained a HEP adherence frequency of 4±2 times/week at 8 and 24 weeks (P=.29), whereas HEP adherence decreased in the control group from 4±2 to 3±2 times/week (P=.07), with a significant difference (P=.04) between groups at 24 weeks. Sixty-eight percent of participants sent videos. They sent on average 68% of the requested number of videos. The average score for PT care satisfaction was maintained at 87% in the experimental group (P=1.00) whereas it dropped from 89% at 8 weeks to 74% at 24 weeks (P=.008) in the control group. There were no app-related adverse events. CONCLUSIONS The Hudl app/telehealth is feasible for delivering HEP and maintain HEP adherence in participants with chronic diseases and financial distress. CLINICALTRIAL The full trial protocol is available at ClinicalTrials.gov (NCT02659280).