Leveraging Technology to Address Access and Adherence to Conventional Hospital-Based Pulmonary Rehabilitation in Veterans with COPD
利用技术解决慢性阻塞性肺病退伍军人接受和坚持传统医院肺康复的问题
基本信息
- 批准号:10377366
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2019
- 资助国家:美国
- 起止时间:2019-04-01 至 2024-03-31
- 项目状态:已结题
- 来源:
- 关键词:AccelerometerAcuteAddressAdherenceAerobic ExerciseAffectAmericanAnxietyAreaBehavioralCause of DeathCessation of lifeCharacteristicsChronic Obstructive Pulmonary DiseaseClinicalCouplesDisabled PersonsDiseaseDyspneaEducationExerciseFaceFeedbackGeographyGoalsGuidelinesHigh PrevalenceHomeHospitalizationHospitalsIndividualInformal Social ControlInstructionInternetInterventionMaintenanceMeasuresMediatingMedicalMedical centerMental DepressionMonitorMorbidity - disease rateMotivationOutcomeOutpatientsParticipantPatientsPersonsPhysical ExercisePhysical activityQuestionnairesRandomizedRandomized Controlled TrialsRecovery of FunctionRehabilitation therapyResearchResourcesRiskSelf EfficacySelf ManagementServicesSocial supportSupervisionTechnologyTimeTravelUnited StatesVeteransVeterans Health AdministrationWalkersbaseburden of illnesscostdeconditioningefficacy studyefficacy testingexercise adherenceexercise capacityexercise intensityexercise interventionexperiencefunctional disabilityhealth related quality of lifeimprovedmortalityonline communitypedometerphysical inactivityprogramspulmonary functionpulmonary rehabilitationresearch and developmentsafety and feasibilitysedentary lifestylestandard of caretheoriestreatment as usualwalking programweb siteweb-based intervention
项目摘要
Conventional pulmonary rehabilitation (PR) programs are highly effective and the standard of care in
patients with chronic obstructive pulmonary disease (COPD). PR faces two significant problems: (1) most
patients with COPD who would benefit from PR cannot access it, and 2) there is no effective long-term strategy
to maintain physical activity (PA) and benefits after completing PR. We propose a randomized controlled trial
(RCT) to test the efficacy of a technology-mediated intervention to increase PA in persons with COPD who
cannot access conventional, hospital-based PR. We also propose a non-randomized study to explore the ability
of the PA intervention to maintain PA and exercise adherence, extending the benefits of PR, in persons with
COPD who complete a conventional PR program. COPD is the third leading cause of death in the United
States; an estimated 16 million Americans have COPD. Despite maximal medical therapy, patients with COPD
characteristically experience breathlessness, which leads to a downward spiral of sedentary behavior, physical
inactivity, deconditioning, and functional disability. Low physical activity is associated with poor outcomes in
COPD--increased risk of acute exacerbations, hospitalizations, and death, independent of lung function. The
Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines recommend regular PA for all
patients with COPD. Conventional, supervised PR programs clearly reduce breathlessness, and improve
health-related quality of life (HRQL) and exercise capacity. However, PR programs face significant challenges
of access and adherence. We developed Every Step Counts (ESC), a technology-mediated intervention
based on the Behavioral Theory of Self-Regulation, to target sedentary behavior, promote PA, and alleviate
deconditioning. ESC couples a website with a pedometer to directly monitor step counts. The website
provides individualized step-count goals, iterative feedback, education on disease self-management,
motivation, and an online community of social support. In two randomized studies in Veterans with COPD, we
demonstrated ESC's safety, feasibility, and efficacy to increase PA. Accessible via the internet and available
at any time from home, ESC could be an ideal low-cost platform to address the limitations of conventional PR.
We hypothesize that ESC may be an efficacious strategy to promote PA in the many patients who cannot
attend a PR program, and may be an option to maintain engagement in PA after patients complete a
conventional PR program. Primary Aim 1: Determine the efficacy of a web-based intervention, ESC, to
increase PA (measured directly with an accelerometer and a questionnaire that assesses intensity), compared
to usual care, in persons with COPD who are referred to conventional PR but who cannot access it.
Secondary Aim 2: Estimate the effect of the ESC intervention on (a) exercise adherence, (b) exercise self-
efficacy, (c) HRQL, (d) dyspnea, (e) anxiety and depression, (f) exercise capacity, and (g) risk of acute
exacerbations and COPD-related hospitalizations, compared to usual care. Exploratory Aim 3: Assess the
ability of ESC to maintain PA and exercise adherence, and extend the benefits of PR, in participants with
COPD who have completed conventional PR.
传统的肺康复 (PR) 计划非常有效,并且护理标准
患有慢性阻塞性肺疾病(COPD)的患者。公关面临两个重大问题:(1)大多数
本来可以从 PR 中受益的 COPD 患者却无法获得 PR,并且 2) 没有有效的长期策略
完成 PR 后保持体力活动 (PA) 和福利。我们提出一项随机对照试验
(随机对照试验)测试技术介导的干预措施对增加慢性阻塞性肺病患者 PA 的有效性,这些患者
无法获得传统的、以医院为基础的公共关系。我们还提出了一项非随机研究来探索能力
PA 干预的目的是维持 PA 和运动依从性,从而扩大 PR 的益处,
完成传统公关计划的慢性阻塞性肺病患者。慢性阻塞性肺病是美国第三大死因
州;据估计,有 1600 万美国人患有慢性阻塞性肺病 (COPD)。尽管进行了最大程度的药物治疗,慢性阻塞性肺病患者
典型地会经历呼吸困难,这会导致久坐行为、身体状况螺旋式下降
缺乏活动、功能失调和功能障碍。身体活动量低与不良结果相关
COPD——急性加重、住院和死亡的风险增加,与肺功能无关。这
全球慢性阻塞性肺疾病倡议 (GOLD) 指南建议所有人定期进行 PA
慢性阻塞性肺病患者。传统的、受监督的公关计划明显减少了呼吸困难,并改善了
健康相关的生活质量(HRQL)和运动能力。然而,公关项目面临重大挑战
的访问和遵守。我们开发了“Every Step Counts”(ESC),一种以技术为媒介的干预措施
基于自我调节行为理论,针对久坐行为,促进 PA,缓解
去调理。 ESC 将网站与计步器结合起来,直接监控步数。网站
提供个性化的步数目标、迭代反馈、疾病自我管理教育,
动机和社会支持的在线社区。在两项针对患有慢性阻塞性肺病 (COPD) 的退伍军人的随机研究中,我们
证明了 ESC 增加 PA 的安全性、可行性和有效性。可通过互联网访问并可用
ESC 可以成为解决传统公关局限性的理想低成本平台。
我们假设 ESC 可能是促进许多无法进行 PA 的患者的有效策略。
参加 PR 计划,并且可能是患者完成 PR 后继续参与 PA 的一种选择
传统的公关计划。主要目标 1:确定基于网络的干预措施 ESC 的有效性
增加 PA(直接用加速度计和评估强度的问卷测量),比较
对于被转诊至常规 PR 但无法获得常规护理的慢性阻塞性肺病患者,可以接受常规护理。
次要目标 2:估计 ESC 干预对 (a) 运动坚持性、(b) 运动自我锻炼的影响
疗效,(c) HRQL,(d) 呼吸困难,(e) 焦虑和抑郁,(f) 运动能力,以及 (g) 急性发作风险
与常规护理相比,病情加重和慢性阻塞性肺病相关的住院治疗。探索性目标 3:评估
ESC 维持 PA 和锻炼依从性的能力,并扩大 PR 的益处,对于患有
已完成常规 PR 的慢性阻塞性肺病患者。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Marilyn L. Moy其他文献
Cardiorespiratory Effects of Tai Chi Versus Walking: Exploratory Data from the LEAP Trial
太极拳与步行对心肺的影响:LEAP 试验的探索性数据
- DOI:
- 发表时间:
2024 - 期刊:
- 影响因子:0
- 作者:
Stephen A. Maris;Yan Ma;D. Litrownik;Marilyn L. Moy;Roger B. Davis;Peter M. Wayne;Gloria Y. Yeh - 通讯作者:
Gloria Y. Yeh
Marilyn L. Moy的其他文献
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{{ truncateString('Marilyn L. Moy', 18)}}的其他基金
Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD
慢性疼痛、呼吸困难和体力活动促进对慢性阻塞性肺病患者大脑功能连接的影响
- 批准号:
10007049 - 财政年份:2020
- 资助金额:
-- - 项目类别:
Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD
慢性疼痛、呼吸困难和体力活动促进对慢性阻塞性肺病患者大脑功能连接的影响
- 批准号:
10448237 - 财政年份:2020
- 资助金额:
-- - 项目类别:
Effects of Chronic Pain, Dyspnea, and Physical Activity Promotion on Functional Connectivity of the Brain in COPD
慢性疼痛、呼吸困难和体力活动促进对慢性阻塞性肺病患者大脑功能连接的影响
- 批准号:
10839756 - 财政年份:2020
- 资助金额:
-- - 项目类别:
Leveraging Technology to Address Access and Adherence to Conventional Hospital-Based Pulmonary Rehabilitation in Veterans with COPD
利用技术解决慢性阻塞性肺病退伍军人接受和坚持传统医院肺康复的问题
- 批准号:
10574496 - 财政年份:2019
- 资助金额:
-- - 项目类别:
The Effect of Physical Activity Promotion on Short and Long-term Outcomes in COPD
体力活动促进对慢性阻塞性肺病短期和长期结果的影响
- 批准号:
8674914 - 财政年份:2014
- 资助金额:
-- - 项目类别:
The Effect of Physical Activity Promotion on Short and Long-term Outcomes in COPD
体力活动促进对慢性阻塞性肺病短期和长期结果的影响
- 批准号:
9016452 - 财政年份:2014
- 资助金额:
-- - 项目类别:
The Effect of Physical Activity Promotion on Short and Long-term Outcomes in COPD
体力活动促进对慢性阻塞性肺病短期和长期结果的影响
- 批准号:
9313646 - 财政年份:2014
- 资助金额:
-- - 项目类别:
Tai Chi after Pulmonary Rehabilitation in Patients with COPD: A Randomized Trial
慢性阻塞性肺病患者肺康复后的太极拳:一项随机试验
- 批准号:
8540342 - 财政年份:2012
- 资助金额:
-- - 项目类别:
Tai Chi after Pulmonary Rehabilitation in Patients with COPD: A Randomized Trial
慢性阻塞性肺病患者肺康复后的太极拳:一项随机试验
- 批准号:
8704396 - 财政年份:2012
- 资助金额:
-- - 项目类别:
Tai Chi after Pulmonary Rehabilitation in Patients with COPD: A Randomized Trial
慢性阻塞性肺病患者肺康复后的太极拳:一项随机试验
- 批准号:
8599514 - 财政年份:2012
- 资助金额:
-- - 项目类别:
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