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

呼吸困难或呼吸急促是慢性阻塞性肺疾病（COPD）患者最常见的致残症状。作为健康沟通渠道的新兴技术的可获得性和接受度不断提高，为更多个体提供了方便和无缝的呼吸困难及相关症状自我管理支持的机会。本提案的总体目标是比较一种新的互联网呼吸困难自我管理计划（i-DSMP）与面对面计划（f-DSMP）的影响，后者已被证明对COPD患者有效。假设i-DSMP和f-DSMP在ADL呼吸困难的主要结局、肺恶化、运动表现和依从性方面没有显著差异，次要结局是社会支持感知、管理呼吸困难运动的自我效能、健康资源利用和对方案的满意度在3、6和12个月。次要目的是将受试者的使用模式和满意度与结果的变化联系起来，并描述急性加重之前、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）将被随机分为i-DSMP、f-DSMP或注意力控制组。在生理概念、社会认知理论和跨理论模型的指导下，项目包括：1)初次面对面的呼吸困难访谈和运动咨询；2)呼吸困难教育；3)个体化的运动方案；4)运动和症状的自我监测；5)运动提醒和强化。i-DSMP将使用在线互动学习模块、文字聊天和公告板进行交流和教育，并使用无线设备（PDA）监测症状和运动，并接受强化运动。f-DSMP将面对面会面，使用书面日志，并接受电话增援。如果这个i-DSMP和f-DSMP一样有效，它将代表着建立一个证据基础的第一步，为使用互联网和移动环境的慢性疾病症状患者广泛实施自我管理计划。

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.