Abstract
Objective: Evaluate the feasibility of the COPD Web and its study design and study procedures and to increase the understanding of the potential effect of the tool in order to provide guidance for a future large scale trial.Design: Parallel-group controlled pragmatic pilot trial.Subjects: There was a total of 83 patients with COPD (mean age 70 ± 8 years with a forced expiratory volume in first second percent predicted of 60 ± 17%). The intervention group (n = 43) was introduced to and had access to the COPD Web in addition to usual care, while the control group (n = 40) received usual care alone.Main outcome measures: The feasibility of the COPD Web (i.e., if and how the COPD Web was used) was automatically collected through the website, while outcomes on health, conceptual knowledge, and physical activity (PA) were collected through questionnaires at baseline, 3 months and 12 months.Results: At 3 months, 77% of the intervention group was considered users, and the majority of time spent on the site was related to PA and exercises and was spent during the first month (>80%). In addition, the intervention group reported increased PA (odds ratio [OR] = 4.4, P < .001), increased conceptual knowledge in five domains (OR = 2.6–4.2, all P < .05), and altered disease management strategies (e.g., increased PA) (OR ≥ 2.7 P < .05) in comparison to the control group. The latter was also different between groups at 12 months (OR = 3.7, P = .044). Knowledge of PA was correlated with level of PA (ρ = .425–.512, P < .05) as well as to the use of PA as a strategy to manage their disease (χ2 = 11.2–32.9, P < .05).Conclusion: Giving patients with COPD access to the COPD Web in addition to their ordinary primary care might be an effective shorter term (3 month) strategy to promote self-management. However, these results needs to be confirmed in a definitive large-scale trial.Key pointsEven though self-management strategies are an important part of chronic obstructive pulmonary disease (COPD) management, access to support for such strategies are limited for a large part of the COPD-population.Promoting self-management through the COPD Web might increase short-term levels of physical activity, promote conceptual knowledge and alter disease management strategies.The primary care COPD population in this study experienced limited impact of the disease in daily life, limited exertional dyspnea, and high generic quality-of-life, but vastly reduced levels of physical activity.A future large scale study should include strategies to encourage greater exposures to the COPD Web, including an extended analysis of factors associated with using or not using the tool over time and its impact on outcome measures, objective measures of conceptual knowledge, and physical activity, and it should include a large enough sample size to enable sub-group analyses and strategies to enhance recruitment.
Highlights
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and with a steadily increase in prevalence, the disease is the fourth leading cause of death worldwide [1]
Of the total amount of time spent on the site across these sub-pages, 54% was spent on pages related to selfmanagement and treatment with pages targeting physical activity (PA) and exercise accounting for the vast majority of this time (44% of the total time spent on the COPD Web)
The vast majority of time spent on the COPD Web was spent during the first month, and this decreased over time (Month 1: 82% of total time spent on the site, Month 2: 10% of total time spent on the site, Month 3: 8% of total time spent on the site)
Summary
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, and with a steadily increase in prevalence, the disease is the fourth leading cause of death worldwide [1]. In Sweden only a limited proportion of patients with COPD get access to such services [5], which is related to both structural and individual barriers [6,7] With regard to the former, limited access to pulmonary rehabilitation and to relevant health professionals have recently been reported in Swedish primary care settings [8,9]. To provide guidance for a future definitive large-scale RCT, the objectives of this pilot trial were to evaluate the feasibility of the COPD Web, and its study design and study procedures as well as to increase the understanding of the potential effect of the tool with regard to aspects of health, knowledge, and PA [14]
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