title: Real-time telehealth for COPD self-management using Skype™.
abstract: The utility of real-time interactive voice and video telehealth for teaching pursed-lips breathing (PLB) in chronic obstructive pulmonary disease (COPD) is unknown. This was a pilot study to determine its feasibility and efficacy on the key variables of social support and dyspnea. A randomized control study design with repeated measures (baseline, 4 and 12 weeks) was used. All participants in the control and intervention groups received PLB instruction at baseline, but only the intervention group received one weekly PLB reinforcement session for 4 weeks via home computer and Skype™ software. Outcome measures were Medical Outcomes Study Social Support Survey and dyspnea assessment (visual analogue scales for intensity and distress, modified Borg after six-minute walk distance, and Shortness of Breath Questionnaire for activity-associated dyspnea). A total of 22 participants with COPD (mean FEV(1)% predicted = 56) were randomized; 16 (9 telehealth, 7 control) completed the protocol. Intent-to-treat analysis at week 4, but not week 12, demonstrated significantly improved total social support (P = 0.02) and emotional/informational subscale (P = 0.03) scores. Dyspnea intensity decreased (P = 0.08) for the intervention group with a minimal clinical important difference of 10.4 units. Analysis of only participants who completed the protocol demonstrated a significant decrease in dyspnea intensity (P = < 0.01) for the intervention group at both week 4 and 12. Real-time telehealth is a feasible, innovative approach for PLB instruction in the home with outcomes of improved social support and decreased dyspnea.
authors.affiliation: West Los Angeles VA Healthcare Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. pegnield@gmail.com
authors.forename: Margaret
authors.initials: M
authors.lastname: Nield
authors.forename: Guy W Soo
authors.initials: GW
authors.lastname: Hoo
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001945:Breathing Exercises; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057194:Intention to Treat Analysis; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000523:psychology / Q000628:therapy*; D012648:Self Care; D012944:Social Support; D011795:Surveys and Questionnaires; D017216:Telemedicine / Q000379:methods*; D016896:Treatment Outcome; D049269:Videoconferencing