Promoting Chronic Obstructive Pulmonary Disease Wellness through Remote Monitoring and Health Coaching: A Clinical Trial

Abstract

Rationale: Quality of life (QoL) matters the most to patients with chronic obstructive pulmonary disease (COPD) and is associated with healthcare usage and survival. Pulmonary rehabilitation is the most effective intervention in improving QoL but has low uptake and adherence. Home-based programs are a proposed solution. However, there is a knowledge gap on effective and sustainable home-based programs impacting QoL in patients with COPD. Objectives: To determine whether remote patient monitoring with health coaching improves the physical and emotional disease-specific QoL measured by the Chronic Respiratory Questionnaire (CRQ). Methods: This multicenter clinical trial enrolled 375 adult patients with COPD, randomized to a 12-week remote patient monitoring with health coaching (n = 188) or wait-list usual care (n = 187). Primary outcomes include physical and emotional QoL measured by the CRQ summary scores. Prespecified secondary outcomes included the CRQ domains: dyspnea, CRQ-fatigue, CRQ-emotions, CRQ-mastery, daily physical activity, self-management abilities, symptoms of depression/anxiety, emergency room/hospital admissions, and sleep. Results: Participant age: 69 ± 9 years; 59% women; forced expiratory volume in 1 second percent predicted: 45 ± 19. At 12 weeks, there was a significant and clinically meaningful difference between the intervention versus the control group in the physical and emotional CRQ summary scores: change difference (95% confidence interval): 0.54 points (0.36-0.73), P < 0.001; 0.51 (0.39-0.69), P < 0.001, respectively. In addition, all CRQ domains, self-management, daily physical activity, sleep, and depression scores improved (P < 0.01). CRQ changes were maintained at 24 weeks. Conclusions: Remote monitoring with health coaching promotes COPD wellness and behavior change, given its effect on all aspects of QoL, self-management, daily physical activity, sleep, and depression scores. It represents an effective option for home-based rehabilitation. Clinical trial registered with clinicaltrials.gov (NCT03480386).

Keywords: COPD; disease management; quality of life; rehabilitation; self-management.

Figure 1.

Remote monitoring with health coaching system. Adapted from Ref. .

Figure 2.

(A) Home screen depicting “To Do List” and “Message Panel” from the health coach. (B) The “Flexibility and Balance Exercise” tab depicting the video library. Participants can choose the flexibility practice seated or standing. (C) The “Check-In” tab. Participants are asked to answer four daily questions rating their overall well-being, breathing, degree of energy, and yesterday's progress to the step goal. (D) The “My Journey” tab documents the cumulative progress the participant has made in daily steps, minutes of daily practice, and daily tracking of health-related questions (18).

Figure 3.

(A) The “Overview” screen shows an overview of all active participants, including data from the activity monitor, compliance with practice, check-in questions, and any messages. Under the “Activity Monitor” column, a red circle will display if the participant has walked fewer than 1,000 steps. The circle will be black if the participant walked more than 1,000 steps. In the “Flexibility and Balance” column, the circle will be shaded in by the number of minutes of exercises completed. The bottom half of the circle depicts the balance practice, and the top half the flexibility practice. The “Check-In” column depicts red circles if the participant answered “Poor” in any category. (B) The “Trend Report” displays participant progress over the 12-week intervention. (C) The “Weekly Report” gives a daily recap of participant progress over the previous week. (D) The “Daily Report” shows steps by the hour, how the participant answered the check-in questions, the time and length of the exercise, and the oxygen saturation at rest and during the exercise practice.

Figure 4.

CONSORT diagram.

Figure 5.

The trajectory of quality of life in the intervention and control groups. CRQ = Chronic Respiratory Questionnaire.