Interactive Telehealth Program Effective at COPD Self-management

Study results published in the International Journal of COPD show that a multifaceted pilot telehealth program designed to improve self-management among patients diagnosed with chronic obstructive pulmonary disease (COPD) was well received by patients.

For their study, researchers in the Netherlands included 101 COPD patients who fulfilled COPE II study criteria. Specifically, participants were used in the study if they experienced no COPD symptoms within a month prior to the study’s commencement, or had no more than 3 exacerbation incidents and 1 respiratory-related hospitalization 2 years before the study began. Furthermore, potential subjects must have both a computer and access to the internet.

Based on an inability or unwillingness to participate, only 29 of the 101 eligible patients entered the study. Nevertheless, those 29 subjects were split into a group receiving the telehealth counselling , or control groups that received basic care that is common to COPD treatment.

The telehealth counselling called the Condition Coach, used a four-pronged approach including:

• A Web-based exercise program that advised COPD patients on “breathing exercises, relaxation, mobilization, resistance and endurance training, and mucus clearance”. For each exercise, a physiotherapist assisted with guidelines through the client’s Web portal.
• An activity coach that uses an accelerometer-based activity sensor and a smartphone that displays actual vs. optimal physical activity.
• A self-management module available on the Web portal that allows patients to treat exacerbations on their own, but with access to health care professionals (HCPs) if needed. However, subjects were required to attend two 90-minute information sessions before being given treatment medication. The self-management aspect also requires users to make daily diary entries, which HCPs could oversee.
• A tele-consultation module that allowed COPD patients to ask general and personalized questions to their primary care physiotherapist.

Through page visits, the researchers documented a high usage of the telehealth program (86% of treatment days), especially in the diary. Furthermore, the patients reported a high satisfaction in the program, with the mean score being 26.4 out of a maximum score of 32.

While some patients quit the physiotherapy aspect (exercising and activity coach) of the COPD counseling due to personal circumstances (n=2, T4) or weak (n=1, T1) or unstable condition (n=1, T2), they continued to used the web portal and diary throughout the study.

Despite their success with the web portal and diary, the investigators claimed there was low patient adherence to exercise criteria (21%).

“The use of the web portal differed greatly between patients; some used the diary almost every day, other only half of the days,” the researchers wrote. “Some performed regular additional exercises, while others did not use the exercise module at all.”

In regard to the low exercise adherence, the authors suggested this trend was present because “physiotherapists did not regularly prescribe exercise schemes to the patients or incorporate the activity coach in the treatment program.” As a result, “their attitude toward telehealth treatment can greatly influence the perception and adherence of the patients.”

“Health care providers seem to play an important role in patients' adherence to telehealth in usual care. Future research should focus on full-scale implementation in daily care and investigating technological advances, like gaming, to increase adherence,” the researchers concluded.