Abstract
BackgroundSocially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization.ObjectiveThis pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group.MethodsAt discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted.ResultsIntention-to-treat and per protocol analyses showed no significant differences in the number of respiratory-related hospitalizations between groups. The intervention group was more adherent to their long-acting inhalers (mean number of prescribed puffs taken per day=48.5%) than the control group (mean 29.5%, P=.03, d=0.68) assessed via electronic recording. Self-reported adherence was also higher in the intervention group after controlling for covariates (P=.04). The intervention group increased their rehabilitation exercise frequency compared with the control group (mean difference −4.53, 95% CI −7.16 to −1.92). There were no significant differences in quality of life. Of the 25 patients who had the robot, 19 had favorable attitudes.ConclusionsThis pilot study suggests that a homecare robot can improve adherence to medication and increase exercise. Further research is needed with a larger sample size to further investigate effects on hospitalizations after improvements are made to the robots. The robots could be especially useful for patients struggling with adherence.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12615000259549; http://www.anzctr.org.au (Archived by WebCite at http://www.webcitation.org/6whIjptLS)
Highlights
BackgroundChronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that primarily involves airflow obstruction
Further research is needed with a larger sample size to further investigate effects on hospitalizations after improvements are made to the robots
This paper presents the primary outcome—that is, hospitalization—along with a cost-effectiveness analysis and the secondary outcomes of medication adherence and quality of life
Summary
Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease that primarily involves airflow obstruction. The frequency and severity of exacerbations increase. Treatment for COPD primarily involves medication and behavioral changes such as smoking cessation and exercise. Pulmonary rehabilitation (consisting of exercise, education, and support) can improve patient outcomes and reduce hospital admissions and health care costs [1]. Severe, and very severe COPD benefit more from rehabilitation than patients with mild forms of the disease, and home-based programs are as effective as hospital-based programs [2]. Assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization
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