Evidence generation for the clinical impact of myCOPD in patients with mild, moderate and newly diagnosed COPD: a randomised controlled trial

Crooks, Michael G.; Elkes, Jack; Storrar, Will; Roy, Kay; North, Mal; Blythin, Alison; Watson, Alastair; Cornelius, Victoria

doi:10.1183/23120541.00460-2020

Cited by 28 publications

(77 citation statements)

References 22 publications

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“…Another pilot study investigated the same intervention as Crooks et al in inpatients with COPD following an exacerbation and found clinically relevant effects on HRQoL and the incidence of exacerbations 14. This study also reported an effect of a digital health intervention on PA, HRQoL and functional exercise capacity.…”

Section: Discussionsupporting

confidence: 55%

“…The app usage for the IG is reported in line with adherence to definitions previously reported and listed in table 4 14. A prespecified optimal usage rate of four different types of content, on four different days per week, was achieved by 36% of the participants.…”

Section: Resultsmentioning

confidence: 74%

“…Further pilot studies have suggested the potential of digital applications (app) to also improve HRQoL and to reduce hospital readmissions in patients with severe symptoms when compared with standard care 13. Another pilot study suggested a moderate improvement in HRQoL in newly diagnosed COPD, regardless of disease severity 14. The effect of mobile health (mHealth) app use on PA was also investigated in an early feasibility mixed-methods study, but the effect of app usage on PA was not detected 15…”

Section: Introductionmentioning

confidence: 99%

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Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial

Spielmanns

Gloeckl

Jarosch

et al. 2022

Thorax

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BackgroundEvidence suggests that patients with COPD struggle to maintain improved physical activity (PA) after completing pulmonary rehabilitation (PR). Smartphone applications (apps) providing a comprehensive training programme have conferred healthy benefits. This study was conducted to determine whether regular usage of an app maintains PA following PR.MethodsPatients with stage II–IV COPD were enrolled in a 6-month trial following PR. After the screening period, participants were randomised into the Kaia COPD app group (intervention group (IG)) or the control group (CG). The primary outcome was PA (daily steps), measured using an activity tracker. Secondary outcomes included the COPD Assessment Test (CAT), the Chronic Respiratory Disease Questionnaire (CRQ) and the 1 min Sit-to-Stand Test (STST).ResultsSixty participants completed the study. The median steps from baseline to 6 months were significantly different between the groups, in favour of the IG (−105.3, IQR −1970.1 to 2105.8, vs CG −1173.0, IQR −3813.1 to –93.8; p=0.007). CAT was significantly decreased in the IG (15.1±8.6 vs 19.7±6.4, p=0.02), whereas the CRQ subdomains for dyspnoea (4.5±1.7 vs 3.7±1.3, p=0.033) and fatigue (4.5±1.4 vs 3.5±1.3, p=0.028) improved significantly in the IG. The STST at 6 months was not significant. Sleep duration and sleep efficiency showed no significant differences between the two groups at any time.ConclusionsA comprehensive program by using the Kaia app following PR maintained PA and improved symptoms in patients with COPD at 6 months. The app might be an important accessory tool for enhanced COPD care.Trial registration numberDRKS00017275.

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Section: Discussionsupporting

confidence: 55%

Section: Resultsmentioning

confidence: 74%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial

Spielmanns

Gloeckl

Jarosch

et al. 2022

Thorax

View full text Add to dashboard Cite

show abstract

“…Pulmonary rehabilitation is an essential part of COPD standard of care (Steiner and Roberts, 2016;Bourne et al, 2017;Crooks et al, 2020). However, current guidance does not specify the recommended duration and intensity, and the mechanisms which led to clinical improvements are not well understood.…”

Section: Discussionmentioning

confidence: 99%

Evidence Around the Impact of Pulmonary Rehabilitation and Exercise on Redox Status in COPD: A Systematic Review

Watson

Freeman

2021

Front. Sports Act. Living

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Introduction: Oxidative stress is increasingly recognized as a significant factor in the pathogenesis of chronic obstructive pulmonary disease (COPD). Pulmonary rehabilitation, a major component of which is prescribed exercise, is essential in COPD care. Regular exercise has been proposed to increase antioxidant defenses and overall enhance the ability of the body to counteract oxidative stress. However, the mechanisms through which it improves COPD outcomes remain unclear.Objectives: We aimed to appraise the current evidence around the impact of pulmonary rehabilitation on redox status, compared with other exercise interventions, to gain an understanding of optimal exercise interventions to modify this pathophysiological mechanism.Methods: We performed a systematic review through searching CENTRAL, MEDLINE, PubMed, Scopus, and Web of Science. Results were independently reviewed and relevant studies were selected by two independent assessors. Studies were assessed by two independent people using the modified RoB 2 tool and discrepancies were resolved through discussion.Results: We identified 1,710 records and 1,117 records after duplicate removal. Six studies were included in the final analysis. The evidence available was low quality and four studies had high risk of bias and two studies had unclear risk of bias. Studies were small (15–56 participants); only two included details of randomization and patient cohorts were of varying ages and poorly described. Differences in smoking status and previous exercise levels, which are known to impact redox status, were not well documented. Studies were not standardized and used different exercise doses and measured different outcomes. One study reported lower malondialdehyde levels, a marker of lipid peroxidation, after pulmonary rehabilitation, compared with control. However, one study saw no difference following whole-body vibration training and another study showed higher malondialdehyde levels following supervised modified arm swing exercise compared with control.Conclusion: Understanding the impact of exercise on oxidative stress in COPD could lead to tailored exercise programs and modification of pathological mechanisms. However, we identify a lack of high-quality evidence to determine this. Larger, standardized, and high quality randomized controlled trials (RCTs) are essential, which use carefully clinically characterized and controlled cohorts to determine the relative impact of different exercise interventions on redox status to guide COPD management. We propose an idealized RCT design, which could be used to try and meet this need.

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“…Treatment approaches for multimorbidity in COPD Management of patients with multimorbidity is now the most important task facing the medical community and presents a fundamental challenge to the single-disease focus that pervades medicine [176]. Self-management approaches to improve knowledge, confidence and skills of patients may prove an important approach in these patients [177,178]. Recent guidelines suggest that management of multimorbidity should involve personalised assessment and tailored treatment plans.…”

Section: Evs Systemic Inflammation and Comorbiditiesmentioning

confidence: 99%

Unravelling the mechanisms driving multimorbidity in COPD to develop holistic approaches to patient-centred care

Burke

Wilkinson

2021

Eur Respir Rev

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COPD is a major cause of morbidity and mortality worldwide. Multimorbidity is common in COPD patients and a key modifiable factor, which requires timely identification and targeted holistic management strategies to improve outcomes and reduce the burden of disease.We discuss the use of integrative approaches, such as cluster analysis and network-based theory, to understand the common and novel pathobiological mechanisms underlying COPD and comorbid disease, which are likely to be key to informing new management strategies.Furthermore, we discuss the current understanding of mechanistic drivers to multimorbidity in COPD, including hypotheses such as multimorbidity as a result of shared common exposure to noxious stimuli (e.g. tobacco smoke), or as a consequence of loss of function following the development of pulmonary disease. In addition, we explore the links to pulmonary disease processes such as systemic overspill of pulmonary inflammation, immune cell priming within the inflamed COPD lung and targeted messengers such as extracellular vesicles as a result of local damage as a cause for multimorbidity in COPD.Finally, we focus on current and new management strategies which may target these underlying mechanisms, with the aim of holistic, patient-centred treatment rather than single disease management.

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Evidence generation for the clinical impact of myCOPD in patients with mild, moderate and newly diagnosed COPD: a randomised controlled trial

Cited by 28 publications

References 22 publications

Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial

Using a smartphone application maintains physical activity following pulmonary rehabilitation in patients with COPD: a randomised controlled trial

Evidence Around the Impact of Pulmonary Rehabilitation and Exercise on Redox Status in COPD: A Systematic Review

Unravelling the mechanisms driving multimorbidity in COPD to develop holistic approaches to patient-centred care

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