A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial

Abstract

Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days. The primary efficacy outcome was recovery rate of symptoms measured by COPD assessment test (CAT) score. Exacerbations, readmission, inhaler technique quality of life and patient activation (PAM) scores were also captured by a blinded team. The app was acceptable in this care setting and was used by 17 of the 20 patients with sustained use over the study period. The treatment effect on the CAT score was 4.49 (95% CI: −8.41, −0.58) points lower in the myCOPD arm. Patients’ inhaler technique improved in the digital intervention arm (101 improving to 20 critical errors) compared to usual care (100 to 72 critical errors). Exacerbations tended to be less frequent in the digital arm compared to usual care; 34 vs 18 events. Hospital readmissions risk was numerically lower in the digital intervention arm: OR for readmission 0.383 (95% CI: 0.074, 1.987; n = 35). In this feasibility study of the digital self-management platform myCOPD, the app has proven acceptable to patients to use and use has improved exacerbation recovery rates, with strong signals of lower re-exacerbation and readmission rates over 90 days. myCOPD reduced the number of critical errors in inhaler technique compared to usual care with written self-management. This provides a strong basis for further exploration of the use of app interventions in the context of recently hospitalised patients with COPD and informs the potential design of a large multi-centre trial.

Feasibility, acceptability, and efficacy of online supportive care for individuals living with and beyond lung cancer: a systematic review

“…Adding to the growing body of literature exploring the use of online supportive care for people living with and beyond cancer, this review shows emerging evidence that online supportive care platforms are also feasible and The physician would be notified via email when self-evaluated symptoms met a pre-specified criterion 564/691 of all forms were completed, which is 82% of the maximum Mean monthly compliance was 94% Mean weekly compliance was 79% 100% of participants felt reassured they were being followed by their oncologist A weekly follow-up system using the internet deemed feasible to detect relapse or tumor progression with a high rate of compliance acceptable for people LWBLC. This aligns with the larger body of literature among breast [48,49], prostate [16,50], colorectal cancer [51,52], and chronic obstructive pulmonary disease (COPD) [53,54], a progressive chronic lung disease which has similar symptoms and QoL impact to lung cancer [55]. This evidence suggests that online supportive care is feasible and acceptable in these populations.…”

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

“…myCOPD is a web-based app that has been shown to improve inhaler use [ 11 ] and, through an online pulmonary rehabilitation programme, improve exercise capacity in severe COPD [ 11 ]. A feasibility trial of myCOPD suggested potential to reduce readmissions, improve symptoms and reduce inhaler errors following hospitalisation with a COPD exacerbation [ 12 , 13 ]. However, little is known about myCOPD's role in mild, moderate or recently diagnosed COPD.…”

Together for the Future – Development of a Digital Website to Support Chronic Obstructive Pulmonary Disease Self-Management: A Qualitative Study

“… 9 However, web-based support is an important tool to increase access to self-management strategies and a complement to group-based education with support from other participants and professionals. 29 , 30 …”