Feasibility of a Health Coaching and Home-Based Rehabilitation Intervention With Remote Monitoring for COPD

Abstract

BACKGROUND: Pulmonary rehabilitation is an effective treatment for patients with COPD, but patient uptake and adherence to the current offering of center-based pulmonary rehabilitation is modest due to transportation, access, poverty, and frailty, and even more so in the context of the COVID pandemic. Home-based options have been proposed and were found noninferior to centerbased rehabilitation; however, there is a lack of home-based programs, and more understanding is needed. We aimed to test the feasibility, uptake, and adherence to a home-based program for COPD rehabilitation with health coaching. METHODS: We conducted a randomized trial with a wait-list controlled design to evaluate the effects of a home-based program with health coaching on breathlessness in subjects with moderate to severe COPD unable to attend the regular pulmonary rehabilitation program. The 8-week intervention consisted of video-guided exercises to be done 6 times a week and captured with a computer tablet. Health coaching was done weekly over the telephone to review subject activity and symptoms and to provide an opportunity for the subject to define their weekly goals. The primary outcomes were uptake, adherence, and Chronic Respiratory Questionnaire (CRQ) Dyspnea Domain. Secondary outcomes were self-management abilities and CRQ Emotions-Mastery-Fatigue. RESULTS: 154 subjects with moderate to severe COPD were randomized. Subject adherence was 86% to the proposed 6-times a week exercise routine. There (P 5 .062) was no significant difference in breathlessness (CRQ dyspnea). There was a significant improvement in self-management abilities (P < .001). The results of the qualitative interviews showed high levels of acceptability of the program. CONCLUSIONS: The tested home-based rehabilitation program with health coaching was feasible, highly acceptable, showed a high degree of adherence, and improved self-management abilities. This study offers seminal information for homebased rehabilitation programs to design alternative options of rehabilitation to individuals with COPD that cannot attend to the well-established center-based pulmonary rehabilitation. (ClinicalTrials.gov registration NCT02557178.

Pulmonary rehabilitation in a postcoronavirus disease 2019 world: feasibility, challenges, and solutions

“…The outcomes from unsupervised home-based models appear to be mixed. For example, Benzo et al [42] implemented a model of telephone health coaching along with unsupervised, video-guided exercise six times per week. This model showed a high degree of acceptability and adherence, as well as improvements in participants' self-management abilities, but no significant improvement in dyspnoea.…”

Effect of telemonitoring and telerehabilitation on physical activity, exercise capacity, health-related quality of life and healthcare use in patients with chronic lung diseases or COVID-19: A scoping review

“…Twenty-seven of the studies involved mobile apps, web pages, or virtual platforms accessed using a laptop, tablet or smartphone. 39 , 41 – 44 , 46 , 47 , 49 , 55 , 59 – 61 , 63 – 69 , 71 , 72 , 74 – 76 , 79 – 81 In two studies the intervention was delivered using a teleconference platform, 66 , 76 and one social platform. 67 Other transmitting devices/systems used in the studies included the health buddy device, 40 , 51 the iRobi robot, 73 a PalmOne, 45 touch screen telemonitoring equipment, 57 a home health system connected to a phone line, 53 a computer-linked interactive phone tele-system, 48 a tele-modem, 50 , 54 , 62 , 82 a satellite platform, 83 computer or push-bottom telephone, 58 handheld monitor connected to a phone line, 52 a digital pen and health dairy paper together with SMS.…”

“…Telerehabilitation 76 – 78 , 81 alone or in combination with telemonitoring was not associated with changes in physical activity compared to control groups among COPD patients. 66 , 71 , 81 …”

“…However, no significant difference in HRQoL change was found between the intervention groups and controls. 66 – 68 , 70 , 71 , 73 , 74 , 78 , 81 …”

Home-Based Physical Activity Program with Health Coaching for participants with Chronic Obstructive Pulmonary Disease in Sweden, A Pilot Study

“…The selected exercises coordinated movements with breaths to bene t the strength and exibility of the thorax thus improving pulmonary function and breathing. The exercise videos are based on previous studies adapted to COPD (39,43). The two Tai chi-based exercise practices involved exibility and balance.…”