title: A RCT of telehealth for COPD patient's quality of life: the whole system demonstrator evaluation.
abstract: OBJECTIVE
  Despite some concerns that the introduction of telehealth (TH) may lead to reductions in quality of life (QoL), lower mood and increased anxiety in response to using assistive technologies to reduce health care utilisation and manage long term conditions, this research focuses on the extent to which providing people with tools to monitor their condition can improve QoL.
  
  
  METHODS
  The Chronic Obstructive Pulmonary Disease (COPD) cohort of the Whole Systems Demonstrator Trial is a pragmatic General Practitioner (GP) clustered randomised controlled trial (RCT) evaluating TH in the UK from three regions in England. All patients at a participating GP practice were deemed eligible for inclusion in the study if they were diagnosed with COPD.
  
  
  RESULTS
  447 participants completed baseline and either a short (4 months) or long term (12 months) follow-up. There was a trend of improved QoL and mood in the TH group at longer-term follow-up, but not short term follow-up. Emotional functioning (g = 0.280 95%CI, 0.051-0.510) and mastery reached (g = 2.979 95%CI, 0-0.46) significance at P < 0.05 (all Hedges g <0.3).
  
  
  CONCLUSIONS
  TH showed minimal benefit to QoL in COPD patients who were not preselected to be at increased risk of acute exacerbations. Benefits were more likely in disease specific measures at longer term follow-up. TH is a complex intervention and should be embedded in a service that is evidenced based. Outcome measures must be sensitive enough to detect changes in the target population for the specific intervention.
authors.affiliation: Health Services Research, School of Health Sciences, City University, London.
authors.forename: Lorna
authors.initials: L
authors.lastname: Rixon
authors.affiliation: Health Services Research, School of Health Sciences, City University, London.
authors.forename: Shashivadan P
authors.initials: SP
authors.lastname: Hirani
authors.affiliation: Health Services Research, School of Health Sciences, City University, London.
authors.forename: Martin
authors.initials: M
authors.lastname: Cartwright
authors.affiliation: Health Services Research, School of Health Sciences, City University, London.
authors.forename: Michelle
authors.initials: M
authors.lastname: Beynon
authors.affiliation: ICON Patient Reported Outcomes, Seacourt Tower, Westway, Oxford, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Doll
authors.affiliation: Data Analytics, The Health Foundation, 90 Long Acre, London.
authors.forename: Adam
authors.initials: A
authors.lastname: Steventon
authors.affiliation: Personal Social Services Research Unit, London School of Economics and Political Science, Houghton St, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Henderson
authors.affiliation: Health Services Research, School of Health Sciences, City University, London.
authors.forename: Stanton P
authors.initials: SP
authors.lastname: Newman
mesh_terms: D000368:Aged; D001007:Anxiety / Q000150:complications / Q000453:epidemiology; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D019468:Disease Management; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D011788:Quality of Life / Q000523:psychology*; D000073278:Self-Management / Q000379:methods; D017216:Telemedicine / Q000592:standards / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology
keywords: COPD - patient reported outcomes - quality of life - self-management - telehealth - self-monitoring