Dyspnea Self-Management: Internet or Face-to-Face

呼吸困难或呼吸短促是慢性阻塞性肺疾病（COPD）患者最常见的致残症状。新兴技术作为健康传播渠道的可用性和接受度不断提高，为更多的人提供了方便和无缝的呼吸困难和相关症状自我管理支持的机会。本提案的总体目标是比较新的互联网呼吸困难自我管理计划（i-DSMP）与已被证明对COPD患者有效的面对面计划（f-DSMP）的影响。假设i-DSMP和f-DSMP在第3、6和12个月时的主要结局（ADL呼吸困难、肺部急性加重、运动表现和依从性）、次要结局（社会支持感知、呼吸困难运动管理自我效能、卫生资源利用和对计划的满意度）方面没有显著差异。次要目的是将受试者使用模式和满意度与结局变化联系起来，并描述急性加重前、期间和之后症状群和运动模式的变化。目前正在使用互联网的COPD受试者（N= 200）将被随机分配至i-DSMP、f-DSMP或注意力控制组。以生理学概念、社会认知理论和跨理论模型为指导，这些方案包括：1）初始面对面呼吸困难访谈和运动咨询，2）呼吸困难教育，3）个体化运动方案，4）运动和症状的自我监测，5）运动的提醒和强化。i-DSMP将使用在线互动学习模块、文本聊天和公告板进行沟通和教育，并使用无线设备（PDA）监测症状、锻炼和接受锻炼强化。f-DSMP将进行面对面的会谈，使用书面记录，并接受电话增援。如果这个i-DSMP和f-DSMP一样有效，它将代表着为使用互联网和移动的环境的慢性病症状患者广泛实施自我管理计划建立证据基础的第一步。

Dyspnea or shortness of breath is the most common disabling symptom in patients with chronic obstructive pulmonary disease (COPD). The increased availability and growing acceptance of emerging technologies as a channel for health communication has opened up opportunities to provide convenient and seamless support for self-management of dyspnea and related symptoms to greater numbers of individuals. The overall goal of this proposal is to compare the impact of a new Internet dyspnea self-management program (i-DSMP) with a face-to-face program (f-DSMP) that has been shown to be effective in patients with COPD. It is hypothesized that there will be no significant differences between the i-DSMP and the f-DSMP in the primary outcomes of dyspnea with ADL, pulmonary exacerbations, exercise performance and adherence secondary outcomes of perception of social support, self-efficacy for managing dyspnea exercise, health resource utilization, and satisfaction with program at 3,6, and 12 months. Secondary aims are to relate subject usage patterns and satisfaction to changes in outcomes and to describe changes in symptom clusters and exercise patterns before, during and after acute exacerbations. Subjects with COPD who are currently using the Internet (N= 200) will be randomized to i-DSMP, f-DSMP, or Attention Control. Guided by physiological concepts, Social Cognitive Theory, and the Transtheoretical Model, the programs include: 1) initial face-to-face dyspnea interview and exercise consultation, 2) dyspnea education, 3) individualized exercise program, 4) self monitoring of exercise and symptoms, and 5) reminders and reinforcement of exercise. The i-DSMP will use online interactive learning modules, text chats, and bulletin board for communication and education and a wireless device (PDA) for monitoring symptoms, exercise, and to receive reinforcement for exercise. The f-DSMP will meet face-to-face, use written logs, and receive telephone reinforcement. If this i-DSMP is as effective as the f-DSMP, it will represent a first step in establishing an evidence-base for widespread implementation of self-management programs for people with symptoms of chronic illness using the Internet and mobile environments.