A randomised trial of a web-based physical activity self-management intervention in COPD

Abstract

Improving exercise capacity is a primary objective in COPD. Declines in exercise capacity result in reduced physical activity and health-related quality of life (HRQoL). Self-management interventions can teach patients skills and behaviours to manage their disease. Technology-mediated interventions have the potential to provide easily accessible support for disease self-management. We evaluated the effectiveness of a web-based self-management intervention, focused on physical activity promotion, on exercise capacity in COPD. This 6-month randomised controlled trial (NCT02099799) enrolled 153 persons with COPD at two US sites (VABoston, n=108; VABirmingham, n=45). Participants were allocated (1:1) to the web-based self-management intervention (physical activity promotion through personalised, progressive step-count goals, feedback, online COPD-related education and social support via an online community) or usual care. The primary outcome was exercise capacity (6-min walk distance (6 MWD)). Secondary outcomes included physical activity (daily steps per day), HRQoL (St. George's Respiratory Questionnaire Total Score), dyspnoea, COPD-related knowledge and social support. Change in step-count goals reflected intervention engagement. Participants' mean age was 69 (sd=7), and mean forced expiratory volume in 1 s % predicted was 61% (sd=21%). Change in 6MWD did not differ between groups. Intervention participants improved their mean daily step counts by 1312 more than those in the usual care group (p<0.001). Groups did not differ on other secondary outcomes. VABirmingham participants were significantly more engaged with the intervention, although site did not modify the effect of the intervention on 6MWD or secondary outcomes. The intervention did not improve exercise capacity but improved physical activity at 6 months. Additional intervention modifications are needed to optimise its COPD self-management capabilities.

FIGURE 1

Consolidated Standards of Reporting Trials (CONSORT) diagram. BOS: VABoston; BIR: VABirmingham.

FIGURE 2

Screenshot of intervention webpage. The intervention supports physical activity and self-management with four unique components: 1) objective walking assessment and feedback; 2) individualised step-count goals; 3) educational tips and motivational messages; and 4) an online community.

FIGURE 3

Within the intervention group, change in step-count goal from baseline across the 24-week (6-month) study period by site. A higher change in step-count goal reflects higher engagement in the intervention. Values plotted on the y-axis represent the least squares means from a general linear mixed-effects model for repeated measures, employing a first-order auto-regressive covariance matrix, adjusted for age, mean forced expiratory volume in 1 s % predicted and rurality. Both sites demonstrated increased within-group change in weekly step-count goals from baseline to 24 weeks (BOS: p=0.014; BIR: p=0.021), with BIR goals consistently higher than BOS goals. BOS: VABoston; BIR: VABirmingham.