Dataset Information

Effect of telemonitoring on quality of life for patients with chronic obstructive pulmonary disease-A randomized controlled trial.

ABSTRACT:

Introduction

Patients with chronic obstructive pulmonary disease (COPD) often experience severe physical limitations and psychological distress, which can lead to a deterioration in quality of life (QoL). Telemonitoring (TM) may improve QoL and reduce the number of hospitalizations and readmissions, but results from previous studies have been conflicting. The aim of this study was to assess the effect of TM on QoL in patients with moderate to severe COPD recruited during hospitalization for acute exacerbation (AECOPD).

Methods

We conducted a randomized controlled trial at Silkeborg and Viborg Regional Hospitals in Denmark. Participants were recruited during hospitalization for AECOPD and randomized to a six-month telemonitoring service in addition to standard COPD care or standard COPD care alone. Patients were followed for 24 months. QoL was measured by the Hospital Anxiety and Depression Scale (HADS), and St Georges Respiratory Questionnaire (SGRQ) at 3-, 6-, 12-, and 24-months follow-up. The main outcome was QoL at 6 months.

Results

In total, 101 patients were randomized to the TM intervention and 97 to standard care. The between-group difference in SGRQ at 6 months was -2.0 (-8.5; 4.5), in HADS-Anxiety -0.3 (-2.0; 1.4) and in HADS-depression 0.2 (-1.0; 1.4) corresponding to no significant difference in health-related QoL for patients receiving TM compared to standard care. No difference was seen at 12-24 months follow-up either.

Discussion

TM in addition to standard care did not improve QoL in patients with moderate to severe COPD. Other means of improving management and QoL in severe COPD are urgently needed.

SUBMITTER: Kopfli ML

PROVIDER: S-EPMC9926364 | biostudies-literature | 2023 Jan-Dec

REPOSITORIES: biostudies-literature

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Publications

Effect of telemonitoring on quality of life for patients with chronic obstructive pulmonary disease-A randomized controlled trial.

Køpfli Maria L ML Børgesen Sanne S Jensen Michael Skov MS Hyldgaard Charlotte C Bell Cathrine C Andersen Frank D FD

Chronic respiratory disease 20230101

<h4>Introduction</h4>Patients with chronic obstructive pulmonary disease (COPD) often experience severe physical limitations and psychological distress, which can lead to a deterioration in quality of life (QoL). Telemonitoring (TM) may improve QoL and reduce the number of hospitalizations and readmissions, but results from previous studies have been conflicting. The aim of this study was to assess the effect of TM on QoL in patients with moderate to severe COPD recruited during hospitalization ...[more]

PMID: 36775280

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Project description:BackgroundAlthough a number of studies have suggested that the use of Telemonitoring (TM) in patients with Chronic Obstructive Pulmonary Disease (COPD) can be useful and efficacious, its real utility in detecting Acute Exacerbation (AE) signaling the need for prompt treatment is not entirely clear. The current study aimed to investigate the benefits of a TM system in managing AE in advanced-stage COPD patients to improve their Health-Related Quality of Life (HRQL) and to reduce utilization of healthcare services.MethodsA 12-month Randomised Controlled Trial (RCT) was conducted in the Veneto region (Italy). Adult patients diagnosed with Class III-IV COPD in accordance with the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification were recruited and provided a TM system to alert the clinical staff via a trained operator whenever variations in respiratory parameters fell beyond the individual's normal range. The study's primary endpoint was HRQL, measured by the Italian version of the two Short Form 36-item Health Survey (SF36v2). Its secondary endpoints were: scores on the Hospital Anxiety and Depression Scale (HADS); the number and duration of hospitalizations; the number of readmissions; the number of appointments with a pulmonary specialist; the number of visits to the emergency department; and the number of deaths.ResultsThree hundred thirty-four patients were enrolled and randomized into two groups for a 1 year period. At its conclusion, changes in the SF36 Physical and Mental Component Summary scores did not significantly differ between the TM and control groups [(-2.07 (8.98) vs -1.91 (7.75); p = 0.889 and -1.08 (11.30) vs -1.92 (10.92); p = 0.5754, respectively]. Variations in HADS were not significantly different between the two groups [0.85 (3.68) vs 0.62 (3.6); p = 0.65 and 0.50 (4.3) vs 0.72 (4.5); p = 0.71]. The hospitalization rate for AECOPD and/or for any cause was not significantly different in the two groups [IRR = 0.89 (95% CI 0.79-1,04); p = 0.16 and IRR = 0.91 (95% CI 0,75 - 1.04); p = 0.16, respectively]. The readmission rate for AECOPD and/or any cause was, however, significantly lower in the TM group with respect to the control one [IRR = 0.43 (95% CI 0.19-0.98); p = 0.01 and 0.46 (95% CI 0.24-0.89); p = 0.01, respectively].ConclusionStudy results showed that in areas where medical services are well established, TM does not significantly improve HRQL in patients with COPD who develop AE. Although not effective in reducing hospitalizations, TM can nevertheless facilitate continuity of care during hospital-to-home transition by reducing the need for early readmission.Trial registrationRetrospectively registered on January 2012, ClinicalTrials.gov Identifier: NCT01513980 .

Project description:BackgroundChronic obstructive pulmonary disease (COPD) is one of the most common disorders in the world. COPD is characterized by airflow obstruction, which is not fully reversible. Patients usually experience breathing-related symptoms with periods of acute worsening and a substantial decrease in the health-related quality-of-life. Active and comprehensive disease management can slow down the progressive course of the disease and improve patients' disabilities. Technological progress and digitalization of medicine have the potential to make elaborate interventions easily accessible and applicable to a broad spectrum of patients with COPD without increasing the costs of the intervention.ObjectiveThis study aims to develop a comprehensive telemonitoring and hybrid virtual coaching solution and to investigate its effects on the health-related quality of life of patients with COPD.MethodsA monocentric, assessor-blind, two-arm (intervention/control) randomized controlled trial will be performed. Participants randomized to the control group will receive usual care and a CAir Desk (custom-built home disease-monitoring device to telemonitor disease-relevant parameters) for 12 weeks, without feedback or scores of the telemonitoring efforts and virtual coaching. Participants randomized to the intervention group will receive a CAir Desk and a hybrid digital coaching intervention for 12 weeks. As a primary outcome, we will measure the delta in the health-related quality of life, which we will assess with the St. George Respiratory Questionnaire, from baseline to week 12 (the end of the intervention).ResultsThe development of the CAir Desk and virtual coach has been completed. Recruitment to the trial started in September 2020. We expect to start data collection by December 2020 and expect it to last for approximately 18 months, as we follow a multiwave approach. We expect to complete data collection by mid-2022 and plan the dissemination of the results subsequently.ConclusionsTo our knowledge, this is the first study investigating a combination of telemonitoring and hybrid virtual coaching in patients with COPD. We will investigate the effectiveness, efficacy, and usability of the proposed intervention and provide evidence to further develop app-based and chatbot-based disease monitoring and interventions in COPD.Trial registrationClinicalTrials.gov identifier: NCT04373070; https://clinicaltrials.gov/ct2/show/NCT04373070.International registered report identifier (irrid)DERR1-10.2196/20412.

Project description:ObjectiveTo explore the effect of continuous nursing care based on the Information, Knowledge, Attitude, and Practice (IKAP) theory on the quality of life of patients with chronic obstructive pulmonary disease (COPD).MethodsThis study is a randomized control trial. COPD patients attending the Affiliated Hospital of Inner Mongolia Medical University, China between July 1 and October 31, 2017 were eligible. Following random assignment of participants to either the intervention group or control group, 70 patients (35 in each group) were included in the final sample. The intervention group received nursing care based on the Information, Knowledge, Attitude, and Practice theory, while the control group received standard nursing care. Data were collected before the intervention, 1 month after the intervention, and three months after the intervention. The St. George's Respiratory Questionnaire (SGRQ) was used to measure quality of life.ResultsThree months after the intervention, there were significant differences in the total SGRQ score (20.29 ± 10.03 vs 30.14 ± 12.52) and in the three SGRQ dimensions between the intervention group and the control group (P < .05). A repeated-measures analysis of variance showed that the total SGRQ score and the scores for impact and symptoms had a significant time effect (P < .001), that the total SGRQ score and the score for symptoms had a significant interaction effect (P < .05), and that the impact dimension had a significant group effect (P = .042). Pairwise comparisons of the data for the intervention group showed that there were significant differences between the pre-intervention and 1 month after intervention scores as well as between pre-intervention and three months after intervention, for the total SGRQ scores and the scores for impact and symptoms(P < .001). In terms of the impact dimension, there was a significant difference in the intervention group between 1 month after intervention and 3 months after intervention (P = .016).ConclusionContinuous nursing care based on Information, Knowledge, Attitude, and Practice theory improved quality of scores at 3 months after intervention among COPD patients. Given limitations of the study, future large-scale studies are needed to validate our results.

Project description:Single-limb knee extension exercises have been found to be effective at improving lower extremity exercise capacity in patients with chronic obstructive pulmonary disease (COPD). Since the positive local physiological effects of exercise training only occur in the engaged muscle(s), should upper extremity muscles also be included to determine the effect of single limb exercises in COPD patients.a prospective, assessor-blind, block randomized controlled, parallel-group multicenter trial.stage II-IV COPD patients, > 40?years of age, ex-smokers, with stable medical treatment will be included starting May 2011. Recruitment at three locations in Sweden.1) high-repetitive single limb exercise (HRSLE) training with elastic bands, 60 minutes, three times/week for 8?weeks combined with four sessions of 60 minutes patient education, or 2) the same patient education alone.Primary: determine the effects of HRSLE on local muscle endurance capacity (measured as meters walked during 6-minute walk test and rings moved on 6-minute ring and pegboard test) and quality of life (measured as change on the Swedish version of the Chronic Respiratory Disease Questionnaire). Secondary: effects on maximal strength, muscular endurance, dyspnea, self-efficacy, anxiety and depression. The relationship between changes in health-related variables and changes in exercise capacity, sex-related differences in training effects, feasibility of the program, strategies to determine adequate starting resistance and provide accurate resistance for each involved movement and the relationship between muscle fatigue and dyspnea in the different exercise tests will also be analyzed. Randomization: performed by a person independent of the recruitment process and using a computer random number generator. Stratification by center and gender with a 1:1 allocation to the intervention or control using random block sizes. Blinding: all outcome assessors will be blinded to group assignment.The results of this project will contribute to increase the body of knowledge regarding COPD and HRSLE.

Project description:ObjectivePulmonary rehabilitation improves exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). However, many patients do not have access to pulmonary rehabilitation programs. We hypothesized that an alternative to pulmonary rehabilitation to improve exercise tolerance is the practice of pranayama, or yoga breathing, which could be done independently at home. We also sought to determine whether yoga nonprofessionals could adequately teach pranayama to patients.DesignProof-of-concept, randomized, double-blind, controlled pilot trial.Settings/locationTwo academic pulmonary practices.SubjectsForty-three patients with symptomatic, moderate-to-severe COPD.InterventionsTwelve weeks of pranayama plus education versus education alone. Two yoga professionals trained the research coordinators to conduct all pranayama teaching and monitored the quality of the teaching and the practice of pranayama by study participants.Outcome measuresThe primary outcome was a change in the 6-min walk distance (6MWD). Secondary outcomes included changes in lung function, markers of oxidative stress and systemic inflammation, and measures of dyspnea and quality of life.ResultsThe 6MWD increased in the pranayama group (least square mean [95% confidence interval] = 28 m [-5 to 61]) and decreased in the control group (-15 m [-47 to 16]), with a nearly significant treatment effect (p = 0.06) in favor of pranayama. Pranayama also resulted in small improvements in inspiratory capacity and air trapping. Both groups had significant improvements in various measures of symptoms, but no overall differences in respiratory system impedance or markers of oxidative stress or systemic inflammation.ConclusionThis pilot study successfully demonstrated that pranayama was associated with improved exercise tolerance in patients with COPD. Lay personnel were able to adequately teach patients to practice pranayama. These results suggest that pranayama may have significant clinical benefits for symptomatic patients with COPD, a concept that needs to be confirmed in future, larger clinical trials.

Dataset Information

Effect of telemonitoring on quality of life for patients with chronic obstructive pulmonary disease-A randomized controlled trial.

Introduction

Methods

Results

Discussion

Publications

Effect of telemonitoring on quality of life for patients with chronic obstructive pulmonary disease-A randomized controlled trial.

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