Currently submitted to: Journal of Medical Internet Research
Date Submitted: Mar 12, 2020
Open Peer Review Period: Mar 12, 2020 - May 12, 2020
(currently open for review)
Technology-enabled self-management of Chronic Obstructive Pulmonary Disease (COPD) with or without asynchronous remote monitoring: a randomized controlled trial
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.
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.
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.
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.
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. Clinical Trial: ClinicalTrials.gov NCT03741855; https://clinicaltrials.gov/ct2/show/
Request queued. Please wait while the file is being generated. It may take some time.
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.