Qualitative Evaluation of an RT-Led VA Telehealth Spirometry Program for ALS

Abstract

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by progressive skeletal muscle weakness that can impact pulmonary function. Recognizing pulmonary decline can lead to initiation of therapies that can slow disease progression, prevent complications, or provide comfort for the patient. Spirometry is used to monitor lung function quarterly to determine prognosis and therapy needs.

Methods: Semi-structured interviews were conducted with staff and providers to assess implementation between October 2022 and February 2023. Interviews were audio recorded, transcribed verbatim, checked for accuracy, and analyzed in ATLAS.ti v23. We used thematic inquiry analysis and directed content analysis methods.

Results: Staff (n = 6) found implementation of telehealth spirometry to be effective in monitoring respiratory decline in ALS patients. Respiratory therapists (RTs) facilitated appropriate spirometry use by extensively training patients and caregivers in-person and through telehealth. Most patients with ALS were able to use the device independently or with assistance from their home caregiver however some required additional instruction and time to get used to the technology and process. VAMCs worked through challenges with patients to send results in time for their in-person appointments. Providers perceived telehealth spirometry testing as accurate and reliable and could reduce the burden of the in-person clinic time. If patient spirometry measurements were notably lower than previous levels, RTs initiated appropriate follow-up testing and treatment as well as education for patients.

Conclusions: Ongoing RT support is essential for successful implementation of a telehealth spirometry program. Staff reported that having telehealth spirometry measures were helpful for monitoring pulmonary function. Additionally, staff reported that overall patients responded positively and could use the device independently or with caregiver support with continued training and support. These results could inform the development of other telehealth spirometry programs (eg, lung cancer screening).