Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
DOCUMENT
The primary aims of this study were (1) to evaluate whole-body mechanical efficiency (ME) in a large group of chronic obstructive pulmonary disease (COPD) patients with a wide range of degrees of illness and (2) to examine how ME in COPD is related to absolute work rate and indices of disease severity during exercise testing. A total of 569 patients (301 male patients; GOLD stage I: 28, GOLD stage II: 166, GOLD stage III: 265, and GOLD stage IV: 110) with chronic obstructive pulmonary disease (COPD) were included in the data analysis. Individual maximal workload (watt), peak minute ventilation ((Equation is included in full-text article.)E, L/min body temperature and pressure, saturated), and peak oxygen uptake ((Equation is included in full-text article.)O2, mL/min standard temperature and pressure, dry) were determined from a maximal incremental cycle ergometer test. Ventilatory and metabolic response parameters were collected during a constant work rate test at 75% of the individual maximal workload. From the exercise responses of the constant work rate test, the gross ME was calculated. The mean whole-body gross ME was 11.0 ± 3.5% at 75% peak power. The ME declined significantly (P < .001) with increasing severity of the disease when measured at the same relative power. Log-transformed absolute work rate (r = .87, P < .001) was the strongest independent predictor of gross ME. Body mass was the single other variable that contributed significantly to the linear regression model. Gross ME in COPD was largely predicted by the absolute work rate (r = .87; P < .001) while indices of the severity of the disease did not predict ME in COPD.
DOCUMENT
If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use. The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users. In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months’ use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH).
DOCUMENT
AANLEIDING Mensen met Chronic Obstructive Pulmonary Disease (COPD) hebben vaak langdurig fysiotherapie nodig. Symptomen zoals kortademigheid en vermoeidheid, veelal in combinatie met beperkte gezondheidsvaardigheden (46%), beïnvloeden hun leven sterk. Persoonsgerichte zorg is afgestemd op iemands persoonlijke behoeften, wensen en voorkeuren. Dit vereist dat fysiotherapeuten zinvol gebruik maken van meetresultaten. Zinvol betekent meetresultaten integreren in het zorgproces, deze communiceren op een begrijpelijke manier voor de patiënt, om samen te beslissen en zodoende tot persoonsgerichte zorg te komen. Echter, fysiotherapeuten vinden het lastig om meetresultaten zinvol te gebruiken in het zorgproces en de ervaren meerwaarde van gebruik van meetresultaten is beperkt. In de dagelijkse praktijk ontbreekt het fysiotherapeuten aan praktische handvatten om meetresultaten zinvoller te gebruiken ten behoeve van verdere personalisatie van fysiotherapeutische zorg. DOEL Het bevorderen van inzicht, kennis, vaardigheden en attitude van fysiotherapeuten in het zinvol gebruiken van meetresultaten voor patiënten met COPD. Dit willen we bereiken door: • Praktische handvatten voor zinvol gebruik van meetresultaten, wat leidt tot een transparanter, efficiënter en effectiever zorgproces. • Een verschuiving naar meer persoonsgerichte zorg, waarbij patiënten actief betrokken worden bij hun zorgproces en ongelijkheid in zorg wordt verminderd. CONSORTIUM Zuyd Hogeschool, Hogeschool Utrecht, Amsterdam UMC, LUMC, Nivel, Chronisch ZorgNet, KNGF, Longfonds, Mens Achter de Patiënt, 7 eerstelijns fysiotherapiepraktijken. ONDERZOEKSPLAN De doelstellingen worden gerealiseerd met een mixed methods design met vier, onderling samenhangende, werkpakketten (WP) met elk een specifieke focus. WP1: Verdiepend inzicht (maand 1-12) WP2: Handvatten selecteren en (door)ontwikkelen met de praktijk (maand 1-13) WP3: Handvatten testen met de praktijk (maand 13-20) WP4: Disseminatie (maand 13-24) RELEVANTIE Dit project is relevant omdat eerstelijns fysiotherapeuten beter toegerust worden om meetresultaten zinvol te kunnen gebruiken voor persoonsgerichte zorg bij patiënten met COPD. In het verlengde daarvan dragen ze bij aan het verminderen van ongelijkheid in zorg, betere gezondheidsuitkomsten en meer patiënttevredenheid.
