Web-Based Self-management Program (SPACE for COPD) for Individuals Hospitalized With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Nonrandomized Feasibility Trial of Acceptability

Abstract

Background Hospital admissions due to the acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are costly for individuals and health services. Pulmonary rehabilitation (PR) is known to reduce hospital readmissions when delivered after hospitalization, but the uptake and completion of PR following hospitalization remains poor (<10% of those eligible in the UK audit data). A web-based platform of the SPACE (Self-management Program of Activity Coping and Education) for COPD (chronic obstructive pulmonary disease) has previously shown promising results in patients with stable COPD but has not been tested following an AECOPD. Objective This study aims to assess the feasibility and acceptability of a web-based self-management program. Methods A nonrandomized feasibility study for patients with confirmed AECOPD who were deemed web literate was conducted. All patients consented during their hospitalization and received access to the website following discharge in addition to usual care. The program aims to facilitate patients to better understand and manage their condition through education and home-based exercises. Participants were asked to complete the Bristol COPD Knowledge Questionnaire at baseline and after 6 months. A total of 14 participants were also interviewed (n=8 completers; n=6 noncompleters) regarding their experiences with the web-based program and trial. The interviews were analyzed using thematic analysis. Results In total, 2080 patients were screened for eligibility, of which 100 patients (age: mean 71.2 years, SD 9.3 years; male: 55/100, 55%; forced expiratory volume in 1 second/forced vital capacity ratio: mean 0.46, SD 0.14; pack-years: mean 50.2, SD 31.0; current smokers: 35/100, 35%) were recruited (4.8% of those screened). The main reason for ineligibility was a lack of web literacy (1366/1980, 68.98%). In total, 18% (18/100) of patients had completed the web program by 6 months, with others still registered in the program (27/100, 27%), and more than half did not register (55/100, 55%). There was a mean change in Bristol COPD Knowledge Questionnaire scores at 6 months of 7.8 (SD 10.2) points. Qualitative interviews identified three main themes: preparing for, engagement with, and benefits of the study and program. A total of 57% (57/100) accepted a referral to PR on discharge and 19% (19/100) had completed the program after 6 months. Conclusions On the basis of the challenges of recruiting, retaining, and engaging participants in a web-based self-management program, it is not a feasible approach to roll out widely. This study acknowledges that this is a challenging time for patients with an AECOPD to engage in exercise and self-management education. However, for patients who were able to engage in such an intervention, the completion rate of PR was double the previous audit estimates from the United Kingdom, disease knowledge improved, and the intervention was of value to patients. Trial Registration ISRCTN Registry 13081008; https://www.isrctn.com/ISRCTN13081008

Recruiting patients to a digital self-management study whilst in hospital for a chronic obstructive pulmonary disease exacerbation: A feasibility analysis

“…Predominate reasons for exclusion reported were not being web literate (69%), unwilling (15%) or had comorbidities precluding involvement (12%). 13 Our study findings that recruiting patients with COPD during hospitalisation can be difficult appear to be supported by the literature.…”

Using Telemedicine to Provide Education for the Symptomatic Patient with Chronic Respiratory Disease

“…A significant increase in measuring learning outcomes has occurred in the last decade with 6 of the 13 studies evaluating gain of skills, knowledge, and attitudes. In adults, technology-enabled patient education showed an increased disease specific knowledge [12,21] and inhaler technique improved [13]. The perception of coping with the condition also increased [12].…”

“…For all studies that measured patient satisfaction, technology-enabled patient education was a positive experience by the majority of participants. The majority of participants would recommend the technology-enabled patient education to peers, finding the webbased and application-based education kept them motivated, was easy to use, and was relevant and perceived their knowledge and skills to have improved [5,6,9,12,[14][15][16]21,23]. Participants also found that the technology solution meant the information was always readily available and not able to be misplaced, and this was very helpful [6].…”

“…Passwords and log-in details being required to access the web-platforms were also barriers [6]. Confidence in using computers, smart phones, and tablets influenced uptake for participants was also reported, and this may influence accessibility through avoidance due to stress levels [21]. Indeed nonusers of the technology-enabled patient education were people who felt "scared" to use computers [9].…”

Promoting Exercise Training Remotely

“…For example, Infarinato and colleagues developed a scale based on the Technology Acceptance Model (TAM [41,42]) and were able to demonstrate that patients' intention to use their remote rehabilitation program depended on their perceived usefulness and ease of use of the program [43]. Houchen-Wolloff and colleagues leveraged qualitative methods to understand patient perceptions of their web-based self-management program [44]. Through interviews, they discovered that those who felt more comfortable with a computer were more willing to engage with the intervention and felt a stronger sense of motivation.…”