Findings of the Chronic Obstructive Pulmonary Disease-Sitting and Exacerbations Trial (COPD-SEAT) in Reducing Sedentary Time Using Wearable and Mobile Technologies With Educational Support: Randomized Controlled Feasibility Trial

Abstract

BackgroundTargeting sedentary time post exacerbation may be more relevant than targeting structured exercise for individuals with chronic obstructive pulmonary disease. Focusing interventions on sitting less and moving more after an exacerbation may act as a stepping stone to increase uptake to pulmonary rehabilitation.ObjectiveThe aim of this paper was to conduct a randomized trial examining trial feasibility and the acceptability of an education and self-monitoring intervention using wearable technology to reduce sedentary behavior for individuals with chronic obstructive pulmonary disease admitted to hospital for an acute exacerbation.MethodsParticipants were recruited and randomized in hospital into 3 groups, with the intervention lasting 2 weeks post discharge. The Education group received verbal and written information about reducing their time in sedentary behavior, sitting face-to-face with a study researcher. The Education+Feedback group received the same education component along with real-time feedback on their sitting time, stand-ups, and steps at home through a waist-worn inclinometer linked to an app. Patients were shown how to use the technology by the same study researcher. The inclinometer also provided vibration prompts to encourage movement at patient-defined intervals of time. Patients and health care professionals involved in chronic obstructive pulmonary disease exacerbation care were interviewed to investigate trial feasibility and acceptability of trial design and methods. Main quantitative outcomes of trial feasibility were eligibility, uptake, and retention, and for acceptability, were behavioral responses to the vibration prompts.ResultsIn total, 111 patients were approached with 33 patients recruited (11 Control, 10 Education, and 12 Education+Feedback). Retention at 2-week follow-up was 52% (17/33; n=6 for Control, n=3 for Education, and n=8 for Education+Feedback). No study-related adverse events occurred. Collectively, patients responded to 106 out of 325 vibration prompts from the waist-worn inclinometer (32.62%). Within 5 min of the prompt, 41% of responses occurred, with patients standing for a mean 1.4 (SD 0.8) min and walking for 0.4 (SD 0.3) min (21, SD 11, steps). Interviews indicated that being unwell and overwhelmed after an exacerbation was the main reason for not engaging with the intervention. Health care staff considered reducing sedentary behavior potentially attractive for patients but suggested starting the intervention as an inpatient.ConclusionsAlthough the data support that it was feasible to conduct the trial, modifications are needed to improve participant retention. The intervention was acceptable to most patients and health care professionals.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN) 13790881; http://www.isrctn.com/ISRCTN13790881 (Archived by WebCite at http://www.webcitation.org/6xmnRGjFf)

Are COPD self-management mobile applications effective? A systematic review and meta-analysis

“…All 13 trials [13][14][15][16][17][18][19][20][21][22][23][24] were published after 2008, with most (12 of 13) published since 2011. Trials were conducted in a number of countries and settings; however, most were in the Netherlands [17][18][19][20] or the United Kingdom 13,16,22,23 . Five trials 14,17,18,23,25 included fewer than 50 participants and the largest number of participants was 343 21 .…”

“…Trials were conducted in a number of countries and settings; however, most were in the Netherlands [17][18][19][20] or the United Kingdom 13,16,22,23 . Five trials 14,17,18,23,25 included fewer than 50 participants and the largest number of participants was 343 21 . Across all 13 trials, the total number of participants was 1447.…”

“…A description of the interventions is outlined in Supplementary Table 1. Eight of the interventions 13,15,17,19,21,[23][24][25] were smartphone-based, using custom applications whereby participants entered COPD symptom data and received custom or automated feedback based on their responses. Healthcare professional involvement through active monitoring of entered data, clinical advice, or intervention on deteriorating observations was noted in seven trials 14,16,[18][19][20]22,24 .…”

“…Healthcare professional involvement through active monitoring of entered data, clinical advice, or intervention on deteriorating observations was noted in seven trials 14,16,[18][19][20]22,24 . Eleven trials [13][14][15][17][18][19][20][21][23][24][25] delivered the intervention through a smartphone and two 16,22 utilized a mobile tablet device. Five trials 14,18,[21][22][23] provided participants with a monitoring device such as a pulse oximeter and a pedometer, which linked to the applications to provide additional data.…”

“…Risk of selective reporting was considered low in 12 trials with the remaining trial 18 classified as having a high risk of bias. Regarding blinding of participants to intervention, four trials [19][20][21]23 were considered at high risk of bias, eight trials [14][15][16][17][18]22,24,25 did not provide sufficient information for assessment about the degree of participant blinding, and the remaining trial 13 was considered at low risk. Halpin et al (2011) was judged to be at low risk because both control and intervention participants had access to a smartphone application, with only the intervention group receiving alerts, and participants were not informed of their allocation 13 .…”