Advisor(s)

James H Rimmer

Committee Member(s)

Abebaw M Yohannes
John D Lowman
Scott Snyder
Surya P Bhatt

Document Type

Dissertation

Date of Award

6-1-2026

Degree Name

Doctor of Philosophy (PhD)

School

School of Health Professions

Department

Physical Therapy

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a heterogeneous, progressive respiratory condition and the third leading cause of death worldwide. It is associated with dyspnea, reduced exercise tolerance, significant psychological burden, and poor quality of life. Telehealth pulmonary rehabilitation (PR) has evolved as an effective approach to improve health outcomes and overcome barriers related to center based pulmonary rehabilitation. However, it is important to determine whether these programs are guided by intervention frameworks that effectively promote overall well-being in individuals with COPD. This dissertation examined current telehealth PR models and evaluated the effectiveness of a generic, comprehensive telewellness program (MENTOR: Mindfulness, Exercise, and Nutrition to Optimize Resilience) in individuals with COPD in a mixed disability cohort along with individuals with any mobility limitations. A qualitative study explored COPD participants’ perceptions of their health and experiences in the program. The overall objective was to identify current trends and gaps in telehealth PR models, evaluate the effectiveness of a generic, comprehensive telewellness program, and use these findings to inform the development of an evidence-based, tailored telewellness intervention for individuals with COPD. Methods This mixed-methods research included three studies. Study 1 involved a scoping review of quantitative and qualitative literature on telehealth pulmonary rehabilitation (PR). Study 2 was a prospective, single-group observational study evaluating the effectiveness of an 8-week (5 hours/week) generic telewellness program, MENTOR (Mindfulness, Exercise, and Nutrition to Optimize Resilience). The program was originally designed for individuals with mobility limitations, and this study is the first to evaluate its feasibility and effectiveness in individuals with COPD. Study 3 employed a qualitative approach to explore barriers and facilitators to program participation, guided by the evidence-based Guidelines, Recommendations, Adaptations Including Disability (GRAIDs) framework across five domains: built environment and community context, service delivery, instruction, technology/equipment, and policy. Results Study 1, the scoping review included 30 telehealth PR studies (26 quantitative, 4 qualitative). Approximately 50% utilized hybrid models combining synchronous and asynchronous intervention delivery, and 46% incorporated remote monitoring technologies. Common interventions included aerobic and resistance training (94%), self-management education (70%), and health coaching (43%). Health coaching was frequently informed by theoretical frameworks to support sustainable behavior change. Hybrid models demonstrated improvements in physical activity, symptom burden, dyspnea, quality of life, self-management abilities, psychological wellbeing, sleep quality, with maintenance of benefits at long term follow-up. Qualitative findings emphasized the need for sustained motivation, individualized program components, and adequate baseline technology training to support long-term engagement. Study 2, (n = 20; mean age: 70 ± 8 years; mean forced expiratory volume in one second (FEV₁): 33% predicted), participation in the MENTOR program resulted in significant pre-post improvements (p<0.05) in symptom burden (COPD Assessment Test [CAT]), physical activity (Godin Leisure-Time Exercise Questionnaire [GLTEQ]), health-related quality of life (St. George’s Respiratory Questionnaire [SGRQ] total and impact scores), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), and overall and mental well-being (National Center on Health, Physical Activity and Disability Wellness Assessment [NWA]). Improvements were also observed in exercise, diet, sleep, and pain domains on the NWA physical subscale (p<0.05). Program attendance averaged 69%, with high participant satisfaction (median 3.0; IQR: 2.0–3.75). Study 3, (n=15) identified twelve themes related to personal beliefs, participants experiences, and barriers and facilitators to program participation, along with recommendations for optimizing engagement in the telewellness program. Participants reported improved motivation, confidence in physical activity, emotional regulation, and nutrition awareness. The group-based mixed-disability format reduced isolation and fostered peer support. However, engagement was influenced by symptom burden, comorbidities, home environment and digital literacy. Participants’ valued supportive instructors, multimodal instructions (verbal, visual, written summaries, live demonstrations, journals), self-explanatory telehealth platform and holistic nature of the program. Participants suggested the need for COPD-specific tailoring related to nutrition guidance, technical training to use telehealth platform and exercise equipment, and long term access to program resources. Conclusion The findings from these three studies demonstrated that a generic, 8-week telewellness program designed for individuals with mobility limitations is feasible and effective in improving health outcomes in individuals with COPD. However, optimizing its impact requires greater inclusion of individuals with COPD, incorporation of COPD-specific exercises, provision of baseline technical training, and sustained access to program components. Additionally, clear referral pathways to interdisciplinary healthcare professionals are essential to support long-term engagement and enhance participant satisfaction. Future randomized controlled trials are needed to evaluate the effectiveness of tailored telewellness interventions. Key words: COPD, Chronic Obstructive Pulmonary Disease, COPD, Telehealth Pulmonary Rehabilitation, Telewellness.

Keywords

Chronic Obstructive Pulmonary Disease;COPD;Telehealth Pulmonary Rehabilitation;Telewellness

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