A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

Abstract

PurposeWith the limited reach of pulmonary rehabilitation (PR) and low levels of daily physical activity in chronic obstructive pulmonary disease (COPD), a need exists to increase daily exercise. This study evaluated telephone health-mentoring targeting home-based walking (tele-rehab) compared to usual waiting time (usual care) followed by group PR.Patients and methodsPeople with COPD were randomized to tele-rehab (intervention) or usual care (controls). Tele-rehab delivered by trained nurse health-mentors supported participants’ home-based walking over 8–12 weeks. PR, delivered to both groups simultaneously, included 8 weeks of once-weekly education and self-management skills, with separate supervised exercise. Data were collected at three time-points: baseline (TP1), before (TP2), and after (TP3) PR. The primary outcome was change in physical capacity measured by 6-minute walk distance (6MWD) with two tests performed at each time-point. Secondary outcomes included changes in self-reported home-based walking, health-related quality of life, and health behaviors.ResultsOf 65 recruits, 25 withdrew before completing PR. Forty attended a median of 6 (4) education sessions. Seventeen attended supervised exercise (5±2 sessions). Between TP1 and TP2, there was a statistically significant increase in the median 6MWD of 12 (39.1) m in controls, but no change in the tele-rehab group. There were no significant changes in 6MWD between other time-points or groups, or significant change in any secondary outcomes. Participants attending supervised exercise showed a nonsignificant improvement in 6MWD, 12.3 (71) m, while others showed no change, 0 (33) m. The mean 6MWD was significantly greater, but not clinically meaningful, for the second test compared to the first at all time-points.ConclusionTelephone-mentoring for home-based walking demonstrated no benefit to exercise capacity. Two 6-minute walking tests at each time-point may not be necessary. Supervised exercise seems essential in PR. The challenge of incorporating exercise into daily life in COPD is substantial.

Does health coaching improve health‐related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta‐analysis

“…Three studies reported a significant group difference in favour of the intervention condition: at 6 weeks follow‐up (Greening et al ., ; Mitchell et al ., ) and at 6 months follow‐up (Jolly et al ., 2018; Mitchell et al ., ). However, one study reported a significant group difference in favour of the comparison group at 2–3 months follow‐up (Cameron‐Tucker et al ., ). The remaining four studies reported no significant between‐group differences in physical activity at any follow‐up point.…”

“…() reported that the direction of effect for total HRQoL score at 12 months favoured the usual care condition. Another study reported no within‐ or between‐group changes (Cameron‐Tucker et al ., ), and the final study did not state the direction of effect in the COPD subsample analyses (Greening et al ., ). Of note, Greening et al .…”

“…The updated searches in August 2018 retrieved 276 new articles, of which 31 full texts were read in full and one new eligible study was identified. In total, 10 studies met the inclusion criteria (Benzo et al, 2016;Bischoff et al, 2012;Cameron-Tucker et al, 2016;Greening et al, 2014;Johnson-Warrington, Rees, Gelder, Morgan, & Singh, 2016;Jolly et al, 2018;Khdour, Kidney, Smyth, & McElnay, 2009;Mitchell et al, 2014;Song, Yong, & Hur, 2014;Walters et al, 2013). The flow of included studies can be seen in Figure 1.…”

“…The studies were published between 2009 and 2018. Five studies were conducted in the United Kingdom (Greening et al, 2014;Johnson-Warrington et al, 2016;Jolly et al, 2018;Khdour et al, 2009;Mitchell et al, 2014), two studies in Australia (Cameron-Tucker et al, 2016;Walters et al, 2013), one study in Korea (Song et al, 2014), one study in the Netherlands (Bischoff et al, 2012), and one study in the United States (Benzo et al, 2016). Participants were recruited in either a hospital or primary care setting.…”

The effect of health coaching on treatment adherence, self‐efficacy, and quality of life in patients with chronic obstructive pulmonary disease

“…Although there have been coaching studies (Krok‐Schoen et al, ; Leveille et al, ) including patients with different chronic conditions in the literature, studies using education programs, pulmonary rehabilitation, and phone surveillance are available for COPD patients (Cameron‐Tucker et al, ; Da Silva et al, ). The educational coaching that enhanced the adherence with the test technique to improve the PFT results was performed in individuals with COPD (Gannon, Qaseem, Snow, & Snooks, ; O'Donnell, Bankier, O'Donnell, Loring, & Boiselle, ).…”