Patient Activation Measure Research Articles

A systematic review of the effect of personal health records on patient activation.

Personal health records (PHRs) or patient portals have been on the healthcare policy agenda for many countries as a promising mechanism to support patient-centred healthcare by making medical records accessible to patients and those assisting patients in health self-management. Studies on clinical outcome have been inconsistent. To help us to understand why, we propose to look at measures that precede clinical outcome, specifically patient engagement and activation. Patient activation describes the knowledge, skills and confidence a person has in managing their own health and healthcare. To systematically review the current evidence on the impact of PHRs on patient activation. A literature search was conducted for randomised controlled trials and quasi-experimental studies published up to January 2024 across EMBASE, PsycINFO, CINAHL and PubMed. Publications were included in the study if they examined any association between PHR use and activation. The search initially produced 3062 papers for review, of which 88 full-text articles were screened for eligibility. Two reviewers assessed 22 of these articles, and 8 papers were identified as meeting the selection criteria. Among these, seven studies found no statistically significant differences in activation. However, one study reported a significantly greater effect than the others. Data from seven randomised controlled trials and quasi-experimental studies examining the effects of PHRs on patient activation and similar measures were extracted for meta-analysis. Overall, the use of PHRs was associated with a 0.41 standardised mean difference increase in activation (95% confidence interval 0.31-0.51). There was a high degree of heterogeneity (I² = 98%), with one study showing a much larger effect size compared to the rest. Most studies showed little impact on activation, but one study found a large effect. This study notably offered PHRs combined with health coaching and training in the use of the system to their intervention group, which may indicate an important requirement for how to get the best out of a PHR system.

Validity and Reliability of Patient Activation Measure (PAM13-I) Italian Version Among Patient Undergoing Elective Surgery.

The patient activation measure (PAM), a recognized measure of how active patients are in their care, is one of the most extensively used, widely translated, and tested instruments worldwide in measuring patient activation. This study aimed to assess the psychometric properties and construct validity of the Italian version of the 13-item Patient Activation Measure (PAM13-I) among patients undergoing elective laparoscopic cholecystectomy. A multicenter study was conducted across 111 surgical units in Italy. This study involved the preoperative administration of the PAM questionnaire to 4532 patients. The psychometric properties of the PAM were evaluated using Rasch analysis. The PAM13-I demonstrated good internal consistency (Cronbach's α = 0.95) and reliability indices. While fit statistics were acceptable, ceiling effects were observed. No significant differential item functioning was found. However, issues with targeting and local response dependency were identified. The Italian PAM-13 showed promising psychometric properties among surgical patients, indicating its potential utility in assessing patient activation. However, concerns regarding ceiling effects and targeting suggest the need for further refinement and validation in surgical populations.

App Assisted Depression Self-Management in Integrated Primary Care: A Pilot Study Exploring Patient and Provider Experiences

Abstract The integrated primary care (IPC) setting is currently the de facto institution for accessing mental healthcare among underserved populations. However, many barriers exist for these populations when seeking regular and adequate mental healthcare, including provider availability and transportation challenges. This study piloted the incorporation of mindLAMP, a mHealth app, into IPC treatment to offer a low-resource intervention designed to improve and expand access to mental healthcare for underserved patients between face-to-face visits. This study gathered data from a sample of both behavioral health providers and patients (N = 6) in IPC settings to pilot the use of the mindLAMP app among traditionally underserved patients with depression. The Patient Activation Measure and Patient Health Questionnaire were used to assess patient outcomes in addition to conducting a directed content analysis on qualitative data obtained with interviews of both patients and providers. Results from the mixed methods study design indicate that implementing this digital intervention in the IPC setting is feasible and positively experienced by both patients and providers. Perceived positive outcomes were reported by both patients and providers after incorporating the mHealth app into their mental healthcare. However, both patients and providers discussed barriers to mHealth app use that need to be addressed in order to accommodate more widespread use. Further, constraints and barriers at the provider, patient, and healthcare system levels were discussed and need to be examined further to increase the implementation of this multilevel digital intervention.

Real-World-Evidence of Digital Health Applications (DiGAs) in Rheumatology: Insights from the DiGAReal Registry.

Prescribable digital health applications (DiGAs) present scalable solutions to improve patient self-management in rheumatology, however real-world evidence is scarce. Therefore, we aimed to assess the effectiveness, usage, and usability of DiGAs prescribed by rheumatologists, as well as patient satisfaction. The DiGAReal registry includes adult patients with rheumatic conditions who received a DiGA prescription. Data at baseline (T0) and the 3-month follow-up (T1) were collected through electronic questionnaires. Study outcomes included DiGA-specific outcome assessments as well as generic outcome assessments, including the Patient Global Impression of Change (PGIC), Patient Activation Measure (PAM®), and the German Telehealth Usability and Utility Short Questionnaire (TUUSQ). Changes between T0 and T1 were analyzed using descriptive statistics and paired tests. A total of 191 patients were included between June 2022 and April 2023. Of these, 127 completed the 3-month follow-up, and 114 reported using the prescribed DiGA, with 66% reporting weekly use and 15% completing the full DiGA program. The most commonly prescribed DiGAs targeted pain management (53%). Symptom improvement was reported by 51% of patients using a DiGA, with significant reductions in exhaustion levels (p = 0.03). Significant DiGA-specific improvements were observed for DiGAs addressing back pain (p = 0.05) and insomnia (p = 0.006). However, no overall significant changes were detected in patient activation, health literacy, pain, overall health, or disease activity. Back pain and weight management DiGAs were the most effective, frequently used, and best-rated DiGAs, with symptom improvements reported by 50% to 82% of patients. The findings suggest that DiGAs can improve symptom management in rheumatic patients, especially for conditions like back pain and weight control. Further real-world evidence is needed and may support value-based digital health efforts and reimbursement frameworks.

Feelings of guilt among cancer patients and the usage of complementary or alternative medicine - A cross-sectional survey.

This study aimed to investigate the influence of feelings of guilt among cancer patients on their health behavior, with a specific focus on the use of complementary and alternative medicine (CAM). A multicentric cross-sectional study was conducted, involving 162 oncological patients, assessing sociodemographic variables, feelings of guilt, patient activation, self-efficacy, and CAM usage. The Shame-Guilt-Scale was employed to measure guilt, with subscales including punitive guilt, self-criticism (actions), moral perfectionism, and empathy-reparation. To assess patient activation and self-efficacy, we used the German Version of the Patient Activation Measure 13 and the Short Scale for Measuring General Safe-efficacy Beliefs, respectively. To evaluate CAM-usage, we used a standardized instrument from the working group Prevention and Integrative Oncology of the German Cancer Society. Statistical analyses, including regression models, were employed to examine potential associations. Female gender was associated with more frequent CAM usage. Regarding holistic and mind-body-methods, younger patients more often used these methods. No significant association was found between feelings of guilt and CAM usage. Patients experienced guilt most strongly related to empathy and reparation for their own actions. Our results do not support the hypothesis of a direct link between guilt and CAM usage. Guilt may be an important aspect in psychological support for cancer patients, yet, with respect to counselling on CAM, it does not play an important part to understand patients' motivations.

Accurate evaluation of factor VIII activity of efanesoctocog alfa in the presence of emicizumab.

Efanesoctocog is a B-domain-deleted, Fc-fusion FVIII linked to the D'D3 domain of VWF and two XTEN polypeptides, designed for an ultra-extended half-life for prophylaxis in hemophilia A, but also aiding in managing acute bleeding or surgery in patients on long-term emicizumab. However, no current laboratory method accurately measures FVIII levels in the presence of emicizumab. We hypothesized that the chromogenic (CSA) FVIII assay, specifically calibrated for efanesoctocog using bovine coagulation factors, could provide an accurate assessment of efanesoctocog activity. Seven centers across five countries received 12 plasma samples to measure in triplicate using two calibration methods across three independent days. Samples (n=6) contained either only efanesoctocog (FVIII :C=150 to 5 IU/dL), or efanesoctocog (FVIII:C=150 to 5 IU/dL) in combination with emicizumab (50 μg/mL)(n=5). One sample contained efanesoctocog (FVIII :C=50 IU/dL) and a high dose of emicizumab (80 μg/mL), another sample contained efanesoctocog (FVIII :C=50 IU/dL) with a low dose of emicizumab (20 μg/mL). Each center used its own analyzers, along with their usual reagents. CSA calibrated with standard calibrators highly overestimate FVIII activity. However, specific calibration with efanesoctocog enabled accurate measurement of FVIII activity, with low inter- and intra-laboratory variability, and no interference from emicizumab. All CSA reagents used in the study demonstrated low variability across different laboratories (Inter-laboratory coefficient of variation ranges between 9% and 20%). Specific calibration of the CSA FVIII assay using efanesoctocog and bovine reagents allows for accurate measurement of FVIII activity in patients receiving efanesoctocog, even in the presence of emicizumab.

Continuous Glucose Monitors and Programmed Shared Medical Appointments in Managing Type 2 Diabetes Mellitus Among First Nation Women in Australia: A Co-Designed Feasibility Study.

First Nations women in Australia diagnosed with type 2 diabetes, co-designed and attended a programmed shared medical appointment that included continuous glucose monitors and culturally responsive food appreciation activities over 8 weekly sessions to improve glycaemic control. The project was a single site, longitudinal change from baseline, mixed methods, feasibility study using HbA1c as the primary outcome measure. Secondary outcome measures included, weight, metabolic health-related blood panels, CGM, Blood Glucose Levels (BGL) time-in-range percentage, Patient Activation Measure (PAM) and Problem Areas In Diabetes (PAID) tools and client satisfaction survey and semi focussed interviews. Forty participants commenced and twenty-five participants completed the program (62,5%). Of the completing participants the mean HbA1c had an absolute reduction of 0.7 percentage points ( from baseline to program completion, P = .013). Eighteen (75%) reduced HbA1c and maintained some reduction for 12 months. Seven (28%) achieved remission, HbA1c <6.4% (46mmol/l) maintained for 12 months. There were statistically significant improvements in weight, systolic blood pressure, liver enzymes, BGL time-in-range, PAM and PAID scores. It is feasible to use programmed shared medical appointments incorporating CGM aiming to improve glycaemic control and other metabolic measures of health among First Nations women in Australia. Trial Registration: The project was registered with the Australian and New Zealand Clinical Trial Registry ACTRN12622000650796. The trial web page = https://www.anzctr.org.au/ACTRN12622000650796.aspx.

Patient activation and support needs in patients after ICU discharge: A UK survey of critical illness survivors.

Understanding the degree to which patients are actively involved, confident and capable of engaging with self-management and rehabilitation could be an initial step in guiding individualised supportive strategies for people after critical illness. To assess the levels of active involvement with self management among ICU survivors using the Patient Activation Measure (PAM), explore associations between patient characteristics and PAM results, and investigate its relationship with patients' support needs at key transition points during the recovery process. Eligible participants received both the PAM and Support Needs After Critical care (SNAC) questionnaires by post. The return of the completed questionnaires was considered as consent to participate. Ethical approval was obtained (17/NI/0236). Descriptive statistics were used to summarise the data and Pearson's coefficient for correlations between variables. There were 200 completed PAM and SNAC questionnaires. PAM scores showed that levels of active involvement with self management fell into level 1 (n = 64; disengaged and overwhelmed, low confidence to self manage) and 2 (n = 70; still struggling), with considerably less participants achieving scores in level 3 (n = 51; taking action) and 4 (n = 15; pushing further). Lower patient activation levels were associated with higher support needs (r = -0.16, p = 0.02). We found that patient activation levels are low implying low knowledge, skills and confidence to self-manage after critical illness, and also that patients have support needs at various timepoints during recovery. Future research should focus on a longitudinal study to track changes in activation and support needs in the same patients over time and identify effective strategies to optimise recovery after critical illness.

Exploring Patient Activation and Compliance in Patients with Different Rheumatological Disorders.

Purpose: This study aimed to assess patient activation using patient activation measure 13 (PAM-13) in systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), and axial spondyloarthritis (axSPA). Patients and methods: A cross-sectional study was conducted involving patients with three rheumatological conditions (SLE, PsA, and axSPA). Patients were contacted either at the clinic or through social media platforms. Data, including demographics, PAM 13, Arabic compliance questionnaire for rheumatology (ACQR), and disease-related activity scores, were collected electronically. The analyses included Chi-squared tests, linear regression, and binary logistic regression. Results: Overall, 418 patients were recruited (SLE = 323, PsA = 65, and axSPA = 30), with a mean (±SD) age of 42 ± 11 years and a female predominance (88%). PAM-13 scores did not significantly differ between the rheumatological disorders. Patients with axSPA showed significantly higher compliance than those with SLE or PsA (p = 0.012). In regression models, patients with PsA were more likely to be in activation level 1, with an OR of 2.890 (95% CI: 1.044-8.000, p = 0.0041), whereas patients with axSPA were more likely to be in activation level 4, with an OR of 2.460 (95% CI: 1.122-5.393, p = 0.025). The SLEDAI score was inversely related to the PAM-13 score (Pearson's correlation coefficient = -0.221, p < 0.001). Conclusions: This study explored the levels of activation and medication compliance in different rheumatological conditions. Larger studies are needed to confirm these findings and explore the challenges and opportunities for improving compliance and activation.

Higher patient activation is associated with lower odds of functional limitation in older adults with chronic diseases

ObjectivesTo investigate the association between patient activation and functional limitation among older adults living with multiple chronic conditions. MethodsWe performed a secondary analysis of a parent study, which examined the relationship between self-efficacy and both inflammatory biomarkers and frailty. We conducted multivariate logistic regression while controlling for the patients’ sociodemographic variables and comorbidities to examine the association between self-reported functional limitation and patient activation as measured by the Patient Activation Measure (PAM-10). ResultsWe included 159 participants with a mean age of 82.00 ± 6.27 years. While controlling for the patients’ demographic, socioeconomic status, and comorbidities, we found that functional limitation decreases by 16 % (OR 0.84, 95 % CI: 0.75, 0.94, p = 0.002) for every one unit increase in patient activation score. ConclusionHigher patient activation scores were associated with decreased odds of functional limitation. Providers may consider the potential value of using behavioral activation strategies to address functional decline.

A Tailored Electronic Survivorship Care Plan for Prostate Cancer Survivors: A Multicenter Randomized Controlled Trial.

Although the provision of a survivorship care plan (SCP) has been recommended after prostate cancer (PCa) treatment, there have been no randomized controlled trials to examine their impact. The objective of this study was to evaluate the effect of a tailored PCa-SCP intervention provided to early-stage PCa survivors. A prospective, parallel 1:1 randomized controlled trial was conducted at 3 sites across Canada. Early-stage PCa survivors were randomized (n = 189; 64% response rate) to receive PCa-SCP intervention or usual care. Assessments were performed at baseline, 6 months, and 12 months. The primary outcome was change in patient activation (Patient Activation Measure-13); secondary outcomes included satisfaction with information, self-management support, prostate-specific quality of life, cancer worry, health care utilization, and health behaviors. For the primary patient activation analyses, no significant group-by-time differences were detected. There were significant between-group differences in (1) satisfaction with information from baseline to 6 months (mean [95% CI]: 7.13 [5.53-8.71]; effect size [ES], 0.34; P < .001) and baseline to 12 months (4.91 [3.06, 7.06], ES, 0.19, P < .001); (2) social integration and support from baseline to 6 months (mean [95% CI]: 0.16 [0.06-0.26]; ES, 0.25; P = .002); and (3) skill and technique acquisition from baseline to 6 months (mean [95% CI]: 0.12 [-0.02 to 0.24]; ES, 0.33; P = .05). No other group-by-time differences were detected. The PCa-SCP intervention did not have a significant effect on patient activation but did increase satisfaction with information and some aspects of self-management support. Although the benefits of the provision of a SCP alone remain unclear, the PCa-SCP intervention is likely a valuable tool that can be built upon as part of a comprehensive approach to enhance the quality of care for PCa survivors. NCT03017456.

PAM-13 in clinical cancer care: A systematic review.

The Patient Activation Measure-13 (PAM-13) assesses patients' ability to manage their healthcare. This systematic review aimed to summarize the relationship between the PAM-13 and patient characteristics, as well as program effectiveness. A systematic literature search was conducted using the PubMed database and following the PRISMA guidelines. After screening and selection processes, a total of 21 articles were included for analysis. Half of single cancer type studies have been conducted on breast cancer. In terms of impact on the PAM-13 score, non-digital programs (75%) demonstrated higher efficacy in cancer care compared to digital ones (14.29%). Patient characteristics, including education, fear of recurrence, and time spent with healthcare providers, influenced activation levels. This systematic review provides insights into the association of PAM-13 with patient characteristics and program effectiveness in clinical cancer care. Future research should validate interventions using PAM-13 and improve digital initiatives to optimize cancer care outcomes.

Tailoring nursing interventions to empower patients: personal coping strategies and self-management in type 2 diabetes care

BackgroundDiabetes is one of the most common chronic diseases that severely reduce a patient’s quality of life. Effective self-care and management are critical for maintaining blood glucose levels and preventing complications.AimThis study evaluates the effectiveness of a structured diabetes self-management education program on patients’ self-management behaviors, empowerment, and activation levels.MethodsThis study employed a quasi-experimental design involving 100 participants aged 30–65 to improve diabetes self-management and empowerment. Over 16 weeks, the program included three phases: a two-week pre-test phase for recruitment and baseline assessments using the Diabetes Self-Management Questionnaire (DSMQ), Diabetes Empowerment Scale (DES), and Patient Activation Measure (PAM); a 12-week intervention phase featuring weekly 90-minute educational sessions on topics such as diet, exercise, medication adherence, stress management, and self-empowerment; and a two-week post-test phase for follow-up assessments using the same tools. Data were analyzed using descriptive statistics, chi-square tests for PAM levels, and paired t-tests for DSMQ and DES scores, with statistical significance set at p < 0.05.ResultsThe study demonstrated significant improvements in participants’ self-management, empowerment, and activation levels after the intervention. DSMQ scores increased from 64.5 to 68.6 (p < 0.001), DES scores rose from 65.4 to 70.0 (p = 0.001), and the number of participants at the highest PAM activation level (Level 4) grew from 30 to 50 (p = 0.016). Positive correlations among DSMQ, DES, and PAM scores suggest these improvements are interrelated.ConclusionThe structured diabetes self-management education programme significantly impacted participants’ self-management behaviors, empowerment, and activation levels. The findings underscore healthcare professionals’ need to implement targeted interventions that facilitate patient engagement in diabetes care.RecommendationFuture interventions should be designed to address the specific needs of diverse populations, paying attention to those facing socio-economic challenges. It is vital to facilitate greater access to diabetes self-management education to enhance health outcomes for these demographic groups.

A virtual community of practice to empower patients with recent ischemic heart disease: A randomized controlled trial.

To evaluate the effectiveness of a virtual community of practice (vCoP) in improving the activation of individuals with ischemic heart disease (IHD). We conducted a randomized controlled trial. A total of 282 patients with IHD from Madrid, Catalonia, and the Canary Islands were randomly allocated to an intervention or a control group. Patients were anonymized and the statistician was blinded to group allocation. The intervention was a multicomponent-tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was the Patient Activation Measure score. Secondary outcomes were self-efficacy to manage the disease, adherence to the Mediterranean diet, level of physical activity, depression, anxiety, medication adherence, and health-related quality of life. A linear regression model of mixed effects was carried out to estimate the effect of participating in the vCoP. Significant differences in adherence to the Mediterranean diet were found favoring the intervention at 6, 12, and 18 months, B = 0.86, 95% confidence interval (CI) [0.36, 1.35]. No significant changes among data collection points were found for the other variables. Our results suggest that vCoPs can be helpful for improving adherence to the Mediterranean diet in individuals with IHD, but not for improving their activation or quality of life. However, considerable uncertainty remains due to participants' high dropout rate. Further research is needed to identify the behavioral change mechanisms of such an intervention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Validation of the Patient Activation Measure in kidney stone disease patients.

We aimed to validate the Patient Activation Measure (PAM) within a kidney stone disease (KSD) population, determine the variability of patient activation within this population, and characterize relationships between activation and variables such as health literacy, quality of life, and demographics. This cross-sectional study includes individuals 18 years or older followed for KSD at University of Montreal Hospital Center. Demographic data and responses for the PAM, Wisconsin Stone Quality of Life scale, and health literacy questionnaire (HLQ) were acquired. Females and those with poor medication adherence were found to have significantly lower activation. The HLQ dimensions "Actively managing my health," "Navigating the healthcare system," and "Understand health information well enough to know what to do" were associated with significantly higher activation. Rasch analysis revealed an item reliability of 0.81, a person reliability of 0.98, and a Cronbach's alpha of 0.88. Regarding item fit, only item 1 (When all is said and done, I am the person who is responsible for taking care of my health) fit poorly with the model. Principle component analysis revealed evidence of a second dimension, accounting for 9.0% of the variation in observed responses. Female sex and poor medication adherence were associated with significantly lower activation. Aspects of health literacy concurring with the precise definition of "activation" were associated with significantly higher PAM scores. The PAM was found to have good person and item reliability, and good internal consistency; however, principal component analysis revealed that construct validity is possibly threatened by multidimensionality.

Novel photopeak-independent correction method for internal activity calculation of 99mTc: a simulation study.

This paper presents a new method for correcting the contribution of scattered radiation to the measurement of 99mTc internal activity in nuclear medicine patients using gamma cameras. So, this study aims to derive scattering correction factors by Monte Carlo simulation for anterior and posterior count rates (${I}_{\mathrm{A}}$ and ${I}_{\mathrm{P}}$) in the conjugate view method, enabling more precise estimation of activity A(t) compared to traditional trapezoidal and triangular approximations. The new approach eliminates the need to use photopeak for determining the fraction of scattered photons. Our results showed differences of <3% with respect to the real activity and 11% for the trapezoidal and triangular approaches.

The relationship between self-care preparedness and quality of life in a 3-year-follow-up: a study in primary health care.

Measuring self-care preparedness may enable better support for patients in general practice. This study assessed the relationship between the self-care preparedness index (SCPI) and health-related quality of life (HRQoL) in a longitudinal analysis over 36 months. This was a secondary analysis of an intervention group of a randomized controlled trial. Participants were adults (n = 256) with hypertension, diabetes, or coronary artery disease in primary health care. The intervention group was included in the present study since they had answered SCPI as a part of the intervention. The relationship between SCPI and HRQoL (15D) and other outcomes were studied at baseline. The mean changes in SCPI and 15D were calculated from baseline up to 36 months. Regression-based analysis was used to study to what extent the baseline SCPI was associated with the change in SCPI and 15D and to what extent the change in SCPI was associated with the change in 15D. At baseline, 15D, physical activity, self-rated health, life satisfaction, and patient activation measures had a positive linear relationship with SCPI. Body mass index and depressive symptoms had a negative linear relationship with SCPI. The longitudinal association between changes in SCPI and 15D was statistically significant and positive. The adjusted β was + 0.19 (95% confidence interval: 0.07 to 0.30, P = .002). Those patients who managed to increase their SCPI over the study period experienced an improvement in HRQoL.

Comfort and patient activation in patients with myocardial infarction: A cross-sectional study

AimsTo examine comfort and patient activation, affecting factors, and the relationship between comfort and patient activation in patients with myocardial infarction. BackgroundComfort is an important requirement for managing the treatment and patients' well-being and patient activation improves patient engagement. Assessment of comfort, patient activation and associated factors are important to reduce complications and ensure adherence. MethodThis cross-sectional study was conducted between May and August 2023 on 138 patients in the cardiology clinic who met the inclusion criteria. The research data were collected using a Personal Information Form, a General Comfort Scale, and the Patient Activation Measure. ResultsIt was determined that 67.4 % of the patients were male, and the mean age of patients was 55.47 ± 13.59 years. Comfort was found to be moderate and patient activation level was in the first stage in 50.7 % of the patients. A relationship was found between comfort and gender, education status, health perception, hospitalization experience and number, complications, having chronic disease and medication use, source of information and symptoms, while education and employment status, regular exercise, having chronic disease and symptoms affected patient activation. There was a significant, positive correlation between comfort and the patient activation. ConclusionsComfort and patient activation levels of patients with myocardial infarction are related to sociocultural and disease-related factors. Individualized nursing interventions should be planned in line with the affecting factors to increase comfort and patient activation. Also, controlled studies should be conducted in individuals identified as risk groups are important for clinical applications.

Analysing physical activity measures and clustering in patients with type 2 diabetes in secondary care: insights from the DIAbetes and LifEstyle Cohort Twente (DIALECT)—an observational cohort study

ObjectivesTo analyse variance in accelerometer-based physical activity (PA) measures in patients with type 2 diabetes, identify the most distinctive PA measures and classify patients into different PA clusters based on...

Healthy at Home for COPD: An Integrated Digital Monitoring, Treatment, and Pulmonary Rehabilitation Intervention.

Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality in the United States. Frequent exacerbations result in higher use of emergency services and hospitalizations, leading to poor patient outcomes and high costs. Demonstrate the feasibility of a multimodal, digitally enhanced remote monitoring, treatment, and tele-pulmonary rehabilitation intervention among patients with COPD. In this pilot clinical trial, community-dwelling adults with moderate-severe COPD were enrolled in a multimodal digital monitoring and treatment program including a Fitbit wearable device, study app that tracked COPD-related symptoms, on-demand mobile integrated health (MIH) services for acute home-based treatment, and tele-pulmonary-rehabilitation. Participants were enrolled in the program for six months. COPD severity and health-related quality of life assessments were performed at baseline, 3 months, and 6 months. Primary feasibility outcomes include recruitment and retention rate, and participant protocol fidelity, which were reported descriptively. Exploratory clinical outcomes included patient-reported quality of life, activation, and intervention satisfaction. Over 18 months, 1,333 patients were approached and 100 (7.5%) were enrolled (mean age 66, 52% female). Ninety-six participants (96%) remained in the study for the full enrollment period. Fifty-five (55%) participated in tele-pulmonary-rehabilitation. Participants wore the Fitbit for a median of 114 days (IQR 183.6) and 16.85 hours/day (4.05), resulting in a median of 1133 minutes (243) per day. Completion rates for scheduled instruments ranged from 78-93%. Nearly all participants (85%) performed COPD ecological momentary assessment at least once with a median of 4.85 recordings. On average, a 2.48-point improvement (p=0.03) in COPD Assessment Test Score was observed from baseline to study completion. The adherence and symptom improvement metrics were not associated with baseline patient activation measures. A multimodal intervention combining preventative care, symptom and biometric monitoring, and home treatment was feasible in adults living with COPD. Participants demonstrated high protocol fidelity and engagement and reported improved quality of life.