Technology-Enabled Self-Management of Chronic Obstructive Pulmonary Disease With or Without Asynchronous Remote Monitoring: Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality and leads to frequent hospital admissions and emergency department (ED) visits. COPD exacerbations are an important patient outcome and reducing their frequency would result in significant cost savings. Remote monitoring and self-monitoring could both help patients manage their symptoms and reduce the frequency of exacerbations but they have different resource implications and have not been directly compared. OBJECTIVE The objective of our study was to compare the effectiveness of implementing a technology-enabled self-monitoring program (SM) versus a technology-enabled remote monitoring program (RM) in people with COPD compared to a standard care (SC) group. METHODS We conducted a 3-arm randomized controlled trial evaluating the effectiveness of a RM and a SM program relative to standard care. COPD patients were recruited from outpatient clinics and a pulmonary rehabilitation program. Patients in either intervention used a Bluetooth enabled device kit to monitor oxygen saturation, blood pressure, temperature, weight, and symptoms, but only patients in the RM group were monitored by a respiratory therapist. All patients were assessed at baseline, 3 and 6 months after program initiation. Outcomes included self-management skills, as measured by the Partners in Health (PIH) scale, patient symptoms measured with the St. George's Respiratory Questionnaire (SGRQ), and the Bristol COPD Knowledge Questionnaire (BCKQ). Patients were also asked to self-report on health system usage and data on health utilization was collected from the hospital. RESULTS A total of 122 patients participated in the study, 40 in the SC, 41 in the SM, and 41 in the RM groups. While all three groups improved in PIH, BCKQ scores and SGRQ Impact scores, there were no significant differences between any of the groups. No effects were observed on SGRQ Activity or Symptoms scores, or on hospitalizations, ED visits or clinic visits. CONCLUSIONS Despite regular use of the technology, patients with COPD assigned to remote monitoring or self-monitoring did not have any improvement in patient outcomes like self-management skills, knowledge or symptoms or healthcare utilization compared to each other or to a standard care group. This may be due to low health utilization at baseline, the lack of structured educational components in the intervention groups, and the lack of integration of the action plan with the technology. CLINICALTRIAL ClinicalTrials.gov NCT03741855; https://clinicaltrials.gov/ct2/show/ NCT03741855.

Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis

“…After screening the titles and abstracts, additional 2531 records were excluded for other reasons (Figure 1). The full texts of the remaining 126 studies were assessed, and 22 RCTs [22][23][24][25][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] were included in this review. Of the 22 RCTs, 2 were pilot RCT studies [45,51] and 1 was a feasibility RCT [48].…”

“…These studies were included because they followed the CONSORT (Consolidated Standards of Reporting Trials) checklist [45,51], and they were small sample size RCTs [48,51]. A total of 15 RCTs focused on patients with COPD [22,24,[45][46][47][48][49][50][51][52][53][54][55][56][57]. Of these studies, 11 were included in the meta-analysis [22,24,45,47,48,50,51,[54][55][56][57].…”

“…Of these studies, 11 were included in the meta-analysis [22,24,45,47,48,50,51,[54][55][56][57]. The remaining 4 studies [46,49,52,53] were excluded because no available means and SDs were reported or obtained after contacting the authors. A total of 7 studies focused on patients with asthma [23,25,[58][59][60][61][62].…”

“…A total of 15 COPD studies [22,24,[45][46][47][48][49][50][51][52][53][54][55][56][57] were published between 2006 and 2020 and were conducted in China (n=5) [48,[54][55][56][57], United States (n=2) [24,51], Denmark (n=2) [49,52], Canada (n=1) [53], England (n=1) [45], Spain (n=1) [22], Germany (n=1) [50], Australia (n=1) [46], and 1 in both Spain and Belgium [47]. The sample size ranged from 39 to 242 (with a total sample size of 1477).…”

“…The average age of patients with COPD ranged from 64.10 to 73.50 years. Of the 15 COPD studies, 8 had UC as a CG [22,24,46,47,49,54,56,57], 5 had a visit as CG (meaning that the health care provider visited the patients' home or patients visited the PC or SC) [45,48,51,52,54], and 2 studies had both UC and visits in the CG [50,53]. The settings were home and SC (n=9) [22,24,46,47,[53][54][55][56][57], home care (n=2) [45,48], and home care and PC (n=4) [49][50][51][52].…”