Internet-based dyspnea self-management support for patients with chronic obstructive pulmonary disease.
BACKGROUND
People with chronic obstructive pulmonary disease experience dyspnea with activities despite optimal medical management.


OBJECTIVE
The purpose of this study was to test the efficacy of two 12-month dyspnea self-management programs (DSMPs), Internet-based (eDSMP) and face-to-face (fDSMP), compared with a general health education (GHE) control on the primary outcome of dyspnea with activities.


METHODS
Participants with chronic obstructive pulmonary disease were randomized to eDSMP (n=43), fDSMP (n=41), or GHE (n=41). The content of the DSMPs were similar and focused on education, skills training, and coaching on dyspnea self-management strategies, including exercise, and only differed in the delivery mode. Dyspnea with activities was measured with the Chronic Respiratory Questionnaire at three, six, and 12 months. Secondary outcomes included exercise behavior and performance, health-related quality of life, self-efficacy for dyspnea management, and perception of support for exercise. The study was registered at Clinicaltrials.gov (NCT00461162).


RESULTS
There were no differences in dyspnea with activities across groups over 12 months (P=0.48). With the exception of arm endurance (P=0.04), exercise behavior, performance, and health-related quality of life did not differ across groups (P>0.05). Self-efficacy for managing dyspnea improved for the DSMPs compared with GHE (P=0.06). DSMP participants perceived high levels of support for initiating and maintaining an exercise program.


CONCLUSIONS
The DSMPs did not significantly reduce dyspnea with activities compared with attention control. However, the high participant satisfaction with the DSMPs combined with positive changes in other outcomes, including self-efficacy for managing dyspnea and exercise behavior, highlight the need for additional testing of individually tailored technology-enabled interventions to optimize patient engagement and improve clinically relevant outcomes.
University of Washington, Seattle, Washington, USA. hqn@u.washington.edu
Huong Q
HQ
Nguyen
DorAnne
D
Donesky
Lynn F
LF
Reinke
Seth
S
Wolpin
Lawrence
L
Chyall
Joshua O
JO
Benditt
Steven M
SM
Paul
Virginia
V
Carrieri-Kohlman
D000368:Aged; D000369:Aged, 80 and over; D004417:Dyspnea / Q000503:physiopathology / Q000628:therapy*; D005081:Exercise Therapy; D005260:Female; D006266:Health Education; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010807:Physical Endurance / Q000502:physiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology / Q000628:therapy*; D011788:Quality of Life; D012129:Respiratory Function Tests; D012648:Self Care; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014797:Vital Capacity / Q000502:physiology