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Nyberg A1, Tistad M1,2, Lundell S1, Wadell K1
1Umeå University, Umeå, Sweden, 2Dalarna University, Falun, Sweden
Background: Level of physical activity (PA) is the strongest predictor of premature death among people with chronic obstructive pulmonary disease (COPD). As >85% of the COPD population is physically inactive, improving PA is one of the most important goals of COPD management. However, lack in knowledge and insight in their diagnosis, strenuous transportation and changing health are all barriers limiting access to effective treatments. Consequently there is an urgent need to find new methods to facilitate the provision of strategies targeting the decreased PA in people with COPD.
Purpose: Our primary purpose was to investigate whether an eHealth tool, the COPD-web, could be used to improve PA among people with COPD in primary care. Secondary outcomes were conceptual knowledge and disease management strategies used by the patients.
Methods: We conducted a parallel-group controlled pragmatic pilot trial including 83 people with COPD (mean age 70±8, forced expiratory volume in first second percent predicted 60±17%). All patients received a pedometer and information of the benefit of PA. The intervention group, IG, (n=43) was introduced and had access to the COPD-web at home, while the control group, CG, (n=40) received usual care. The COPD-web aims to increase the patients' knowledge and self-management skills and includes texts, pictures, films as well as interactive components, such as a tool for registration of PA including automatized feedback. The COPD-web was introduced to patients by the health professionals as a part of their ordinary work. At baseline, 3 and 12 months, data on PA, conceptual knowledge and strategies used for disease management were collected. Data analyses were intention-to-treat, performed using generalized estimating equations. Spearman rank correlations (ρ) and Pearson Chi2 (χ2) tests were used to explore the mechanisms associated with observed effects.
Results: At 3 months, the IG reported increased PA (Odds Ratio [OR] = 4.4, P 0.001), increased conceptual knowledge in five domains (including knowledge of PA) (OR = 2.6 to 4.2, all P 0.05) and increased use of PA as a strategy to manage their disease (OR = 6.3, P 0.05) in comparison to the CG. The latter was still higher in the IG at 12 months (OR = 3.7, P 0.05). Positive correlations were found across all time-points between knowledge of PA and level of PA (ρ = 0.425 to 0.512, P 0.05) and between knowledge of PA and use of PA as a strategy for disease management (χ2 = 11.2 to 32.9, P 0.05).
Conclusion(s): Use of the COPD-web, might be an effective short-term strategy to improve PA in people with COPD. An increased knowledge of PA is likely an important explanatory mechanism for this observed effect. Further research is warranted, preferably including strategies to enhance long-term effects.
Implications: These results provides health professionals with a clinically relevant and seemingly effective eHealth tool that could be used to enable short-term increases in PA among people with COPD. The pragmatic design of the study, with the COPD-web introduced as part of health professionals' ordinary work also indicate that the delivery of the intervention is clinically feasible and facilitates implementation.
Keywords: COPD, Physical Activity, eHealth
Funding acknowledgements: Swedish Research Council, Strategic Research Area in Care Sciences, Swedish Heart and Lung Foundation, Swedish Heart and Lung Association.
Purpose: Our primary purpose was to investigate whether an eHealth tool, the COPD-web, could be used to improve PA among people with COPD in primary care. Secondary outcomes were conceptual knowledge and disease management strategies used by the patients.
Methods: We conducted a parallel-group controlled pragmatic pilot trial including 83 people with COPD (mean age 70±8, forced expiratory volume in first second percent predicted 60±17%). All patients received a pedometer and information of the benefit of PA. The intervention group, IG, (n=43) was introduced and had access to the COPD-web at home, while the control group, CG, (n=40) received usual care. The COPD-web aims to increase the patients' knowledge and self-management skills and includes texts, pictures, films as well as interactive components, such as a tool for registration of PA including automatized feedback. The COPD-web was introduced to patients by the health professionals as a part of their ordinary work. At baseline, 3 and 12 months, data on PA, conceptual knowledge and strategies used for disease management were collected. Data analyses were intention-to-treat, performed using generalized estimating equations. Spearman rank correlations (ρ) and Pearson Chi2 (χ2) tests were used to explore the mechanisms associated with observed effects.
Results: At 3 months, the IG reported increased PA (Odds Ratio [OR] = 4.4, P 0.001), increased conceptual knowledge in five domains (including knowledge of PA) (OR = 2.6 to 4.2, all P 0.05) and increased use of PA as a strategy to manage their disease (OR = 6.3, P 0.05) in comparison to the CG. The latter was still higher in the IG at 12 months (OR = 3.7, P 0.05). Positive correlations were found across all time-points between knowledge of PA and level of PA (ρ = 0.425 to 0.512, P 0.05) and between knowledge of PA and use of PA as a strategy for disease management (χ2 = 11.2 to 32.9, P 0.05).
Conclusion(s): Use of the COPD-web, might be an effective short-term strategy to improve PA in people with COPD. An increased knowledge of PA is likely an important explanatory mechanism for this observed effect. Further research is warranted, preferably including strategies to enhance long-term effects.
Implications: These results provides health professionals with a clinically relevant and seemingly effective eHealth tool that could be used to enable short-term increases in PA among people with COPD. The pragmatic design of the study, with the COPD-web introduced as part of health professionals' ordinary work also indicate that the delivery of the intervention is clinically feasible and facilitates implementation.
Keywords: COPD, Physical Activity, eHealth
Funding acknowledgements: Swedish Research Council, Strategic Research Area in Care Sciences, Swedish Heart and Lung Foundation, Swedish Heart and Lung Association.
Topic: Cardiorespiratory
Ethics approval required: Yes
Institution: Umeå university
Ethics committee: Etikprövningsnämnden vid umeå universitet
Ethics number: Dnr: 2014-319-31, 2015-457-32
All authors, affiliations and abstracts have been published as submitted.
