Leveraging Technology to Address Access and Adherence to Conventional Hospital-Based Pulmonary Rehabilitation in Veterans with COPD

利用技术解决慢性阻塞性肺病退伍军人接受和坚持传统医院肺康复的问题

• 批准号: 10377366
• 负责人: Marilyn L. Moy
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10377366
• 关键词: Accelerometer; Acute; Address; Adherence; Aerobic Exercise; Affect; American; Anxiety; Area; Behavioral; Cause of Death; Cessation of life; Characteristics; Chronic Obstructive Pulmonary Disease; Clinical; Couples; Disabled Persons; Disease; Dyspnea; Education; Exercise; Face; Feedback; Geography; Goals; Guidelines; High Prevalence; Home; Hospitalization; Hospitals; Individual; Informal Social Control; Instruction; Internet; Intervention; Maintenance; Measures; Mediating; Medical; Medical center; Mental Depression; Monitor; Morbidity - disease rate; Motivation; Outcome; Outpatients; Participant; Patients; Persons; Physical Exercise; Physical activity; Questionnaires; Randomized; Randomized Controlled Trials; Recovery of Function; Rehabilitation therapy; Research; Resources; Risk; Self Efficacy; Self Management; Services; Social support; Supervision; Technology; Time; Travel; United States; Veterans; Veterans Health Administration; Walkers; base; burden of illness; cost; deconditioning; efficacy study; efficacy testing; exercise adherence; exercise capacity; exercise intensity; exercise intervention; experience; functional disability; health related quality of life; improved; mortality; online community; pedometer; physical inactivity; programs; pulmonary function; pulmonary rehabilitation; research and development; safety and feasibility; sedentary lifestyle; standard of care; theories; treatment as usual; walking program; web site; web-based intervention

Conventional pulmonary rehabilitation (PR) programs are highly effective and the standard of care in patients with chronic obstructive pulmonary disease (COPD). PR faces two significant problems: (1) most patients with COPD who would benefit from PR cannot access it, and 2) there is no effective long-term strategy to maintain physical activity (PA) and benefits after completing PR. We propose a randomized controlled trial (RCT) to test the efficacy of a technology-mediated intervention to increase PA in persons with COPD who cannot access conventional, hospital-based PR. We also propose a non-randomized study to explore the ability of the PA intervention to maintain PA and exercise adherence, extending the benefits of PR, in persons with COPD who complete a conventional PR program. COPD is the third leading cause of death in the United States; an estimated 16 million Americans have COPD. Despite maximal medical therapy, patients with COPD characteristically experience breathlessness, which leads to a downward spiral of sedentary behavior, physical inactivity, deconditioning, and functional disability. Low physical activity is associated with poor outcomes in COPD--increased risk of acute exacerbations, hospitalizations, and death, independent of lung function. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend regular PA for all patients with COPD. Conventional, supervised PR programs clearly reduce breathlessness, and improve health-related quality of life (HRQL) and exercise capacity. However, PR programs face significant challenges of access and adherence. We developed Every Step Counts (ESC), a technology-mediated intervention based on the Behavioral Theory of Self-Regulation, to target sedentary behavior, promote PA, and alleviate deconditioning. ESC couples a website with a pedometer to directly monitor step counts. The website provides individualized step-count goals, iterative feedback, education on disease self-management, motivation, and an online community of social support. In two randomized studies in Veterans with COPD, we demonstrated ESC's safety, feasibility, and efficacy to increase PA. Accessible via the internet and available at any time from home, ESC could be an ideal low-cost platform to address the limitations of conventional PR. We hypothesize that ESC may be an efficacious strategy to promote PA in the many patients who cannot attend a PR program, and may be an option to maintain engagement in PA after patients complete a conventional PR program. Primary Aim 1: Determine the efficacy of a web-based intervention, ESC, to increase PA (measured directly with an accelerometer and a questionnaire that assesses intensity), compared to usual care, in persons with COPD who are referred to conventional PR but who cannot access it. Secondary Aim 2: Estimate the effect of the ESC intervention on (a) exercise adherence, (b) exercise self- efficacy, (c) HRQL, (d) dyspnea, (e) anxiety and depression, (f) exercise capacity, and (g) risk of acute exacerbations and COPD-related hospitalizations, compared to usual care. Exploratory Aim 3: Assess the ability of ESC to maintain PA and exercise adherence, and extend the benefits of PR, in participants with COPD who have completed conventional PR.

传统的肺康复(PR)方案是非常有效的，而且在 慢性阻塞性肺疾病(COPD)患者。公关面临两个重大问题：(1)最 将从PR中受益的COPD患者无法获得它，以及2)没有有效的长期策略 保持体力活动(PA)和完成公关后的益处。我们建议进行一项随机对照试验 (RCT)测试技术中介干预提高COPD患者PA的有效性 无法访问传统的、基于医院的公关。我们还提出了一项非随机研究来探索这种能力 PA的干预，以维持PA和锻炼的依从性，扩大PR的好处，在患有 完成常规公关计划的慢性阻塞性肺病患者。慢性阻塞性肺病是美国第三大死因。 据估计，美国有1600万人患有慢性阻塞性肺病。尽管进行了最大限度的药物治疗，但COPD患者 特点是呼吸急促，这会导致久坐不动的行为、身体 不活动、去条件反射和功能障碍。低体力活动与不良预后有关。 COPD--急性加重、住院和死亡的风险增加，与肺功能无关。这个 全球慢性阻塞性肺疾病倡议(GOLD)指南建议所有人定期进行PA 慢性阻塞性肺疾病患者。传统的、有监督的公关计划明显减少了呼吸困难，并改善了 健康相关生活质量(HRQL)和运动能力。然而，公关计划面临着巨大的挑战 可获得性和坚持性。我们开发了每一步都很重要(ESC)，这是一种技术中介的干预 基于自我调节的行为理论，针对久坐行为，促进PA，缓解 解除条件。ESC将网站与计步器结合在一起，直接监测步数。该网站 提供个性化的步数目标、迭代反馈、疾病自我管理教育、 动力，以及一个社会支持的在线社区。在两项针对患有COPD的退伍军人的随机研究中，我们 证明了ESC增加PA的安全性、可行性和有效性。可通过互联网访问并可用 在家里的任何时候，ESC都可能是一个理想的低成本平台，以解决传统公关的局限性。 我们推测，ESC可能是一种有效的策略，可以在许多无法推广PA的患者中推广PA 参加公关计划，并可能是一个选项，以保持对PA的参与后，患者完成了 传统的公关计划。主要目标1：确定基于网络的干预措施(ESC)的有效性 增加PA(使用加速度计和评估强度的问卷直接测量)，进行比较 对于那些被转介到传统公关但无法获得公关的慢性阻塞性肺病患者，可以进行常规护理。 次要目标2：评估ESC干预对(A)锻炼坚持，(B)锻炼自我的影响 疗效，(C)HRQL，(D)呼吸困难，(E)焦虑和抑郁，(F)运动能力，和(G)急性 与常规护理相比，病情恶化和COPD相关的住院治疗。探索性目标3：评估 ESC的能力，以维持PA和锻炼的坚持，并扩大公关的好处，在参与者 完成常规公关的慢性阻塞性肺疾病患者。