Using Robots at Home to Support Patients With Chronic Obstructive Pulmonary Disease: Pilot Randomized Controlled Trial

Elizabeth Broadbent, Jeff Garrett, Nicola Jepsen, Vickie Li Ogilvie, Ho Seok Ahn, Hayley Robinson, Kathryn Peri, Ngaire Kerse, Paul Rouse, Avinesh Pillai, Bruce MacDonald, Elizabeth Broadbent, Jeff Garrett, Nicola Jepsen, Vickie Li Ogilvie, Ho Seok Ahn, Hayley Robinson, Kathryn Peri, Ngaire Kerse, Paul Rouse, Avinesh Pillai, Bruce MacDonald

Abstract

Background: Socially assistive robots are being developed for patients to help manage chronic health conditions such as chronic obstructive pulmonary disease (COPD). Adherence to medication and availability of rehabilitation are suboptimal in this patient group, which increases the risk of hospitalization.

Objective: This pilot study aimed to investigate the effectiveness of a robot delivering telehealth care to increase adherence to medication and home rehabilitation, improve quality of life, and reduce hospital readmission compared with a standard care control group.

Methods: At discharge from hospital for a COPD admission, 60 patients were randomized to receive a robot at home for 4 months or to a control group. Number of hospitalization days for respiratory admissions over the 4-month study period was the primary outcome. Medication adherence, frequency of rehabilitation exercise, and quality of life were also assessed. Implementation interviews as well as benefit-cost analysis were conducted.

Results: Intention-to-treat and per protocol analyses showed no significant differences in the number of respiratory-related hospitalizations between groups. The intervention group was more adherent to their long-acting inhalers (mean number of prescribed puffs taken per day=48.5%) than the control group (mean 29.5%, P=.03, d=0.68) assessed via electronic recording. Self-reported adherence was also higher in the intervention group after controlling for covariates (P=.04). The intervention group increased their rehabilitation exercise frequency compared with the control group (mean difference -4.53, 95% CI -7.16 to -1.92). There were no significant differences in quality of life. Of the 25 patients who had the robot, 19 had favorable attitudes.

Conclusions: This pilot study suggests that a homecare robot can improve adherence to medication and increase exercise. Further research is needed with a larger sample size to further investigate effects on hospitalizations after improvements are made to the robots. The robots could be especially useful for patients struggling with adherence.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12615000259549; http://www.anzctr.org.au (Archived by WebCite at http://www.webcitation.org/6whIjptLS).

Trial registration: ClinicalTrials.gov NCT02672176.

Keywords: chronic obstructive pulmonary disease; hospitalization; medication adherence; rehabilitation exercise; robotics; telehealth.

Conflict of interest statement

Conflicts of Interest: EB, BM, HSA, NK, and KP received funding from Yujin Robot Ltd for unrelated projects on transportation and aged care robots. The remaining authors declare that they have no competing interests.

©Elizabeth Broadbent, Jeff Garrett, Nicola Jepsen, Vickie Li Ogilvie, Ho Seok Ahn, Hayley Robinson, Kathryn Peri, Ngaire Kerse, Paul Rouse, Avinesh Pillai, Bruce MacDonald. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 13.02.2018.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram.
Figure 2
Figure 2
iRobi robot being used by a patient with a physiotherapist showing the functions.

References

    1. Seemungal TA, Hurst JR, Wedzicha JA. Exacerbation rate, health status and mortality in COPD--a review of potential interventions. Int J Chron Obstruct Pulmon Dis. 2009;4:203–23.
    1. Marciniuk DD, Brooks D, Butcher S, Debigare R, Dechman G, Ford G, Pepin V, Reid D, Sheel AW, Stickland MK, Todd DC, Walker SL, Aaron SD, Balter M, Bourbeau J, Hernandez P, Maltais F, O'Donnell DE, Bleakney D, Carlin B, Goldstein R, Muthuri SK, Canadian Thoracic Society COPD Committee Expert Working Group Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease--practical issues: a Canadian Thoracic Society Clinical Practice Guideline. Can Respir J. 2010;17(4):159–68.
    1. Levack WM, Weatherall M, Reeve JC, Mans C, Mauro A. Uptake of pulmonary rehabilitation in New Zealand by people with chronic obstructive pulmonary disease in 2009. N Z Med J. 2012 Jan 20;125(1348):23–33.
    1. Yohannes AM, Connolly MJ. Pulmonary rehabilitation programmes in the UK: a national representative survey. Clin Rehabil. 2004 Jun;18(4):444–9. doi: 10.1191/0269215504cr736oa.
    1. Vestbo J, Anderson JA, Calverley PM, Celli B, Ferguson GT, Jenkins C, Knobil K, Willits LR, Yates JC, Jones PW. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009 Nov;64(11):939–43. doi: 10.1136/thx.2009.113662.
    1. Bender BG. Nonadherence to COPD treatment: what have we learned and what do we do next? COPD. 2012 Jun;9(3):209–10. doi: 10.3109/15412555.2012.679880.
    1. Milne RJ, Beasley R. Hospital admissions for chronic obstructive pulmonary disease in New Zealand. N Z Med J. 2015 Jan 30;128(1408):23–35.
    1. Polisena J, Tran K, Cimon K, Hutton B, McGill S, Palmer K, Scott RE. Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Telemed Telecare. 2010;16(3):120–7. doi: 10.1258/jtt.2009.090812.
    1. McLean S, Sheikh A, Cresswell K, Nurmatov U, Mukherjee M, Hemmi A, Pagliari C. The impact of telehealthcare on the quality and safety of care: a systematic overview. PLoS One. 2013;8(8):e71238. doi: 10.1371/journal.pone.0071238.
    1. Darkins A, Ryan P, Kobb R, Foster L, Edmonson E, Wakefield B, Lancaster AE. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions. Telemed J E Health. 2008 Dec;14(10):1118–26. doi: 10.1089/tmj.2008.0021.
    1. Lilholt PH, Witt Udsen F, Ehlers L, Hejlesen OK. Telehealthcare for patients suffering from chronic obstructive pulmonary disease: effects on health-related quality of life: results from the Danish 'TeleCare North' cluster-randomised trial. Br Med J Open. 2017 May 09;7(5):e014587. doi: 10.1136/bmjopen-2016-014587.
    1. Pinnock H, Hanley J, McCloughan L, Todd A, Krishan A, Lewis S, Stoddart A, van der Pol M, MacNee W, Sheikh A, Pagliari C, McKinstry B. Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial. Br Med J. 2013;347:f6070.
    1. Shibata T, Wada K. Robot therapy: a new approach for mental healthcare of the elderly - a mini-review. Gerontology. 2011;57(4):378–86. doi: 10.1159/000319015.
    1. Banks MR, Willoughby LM, Banks WA. Animal-assisted therapy and loneliness in nursing homes: use of robotic versus living dogs. J Am Med Dir Assoc. 2008 Mar;9(3):173–7. doi: 10.1016/j.jamda.2007.11.007.
    1. Bemelmans R, Gelderblom GJ, Jonker P, de Witte L. Socially assistive robots in elderly care: a systematic review into effects and effectiveness. J Am Med Dir Assoc. 2012 Feb;13(2):114–120.e1. doi: 10.1016/j.jamda.2010.10.002.
    1. Robinson H, Macdonald B, Kerse N, Broadbent E. The psychosocial effects of a companion robot: a randomized controlled trial. J Am Med Dir Assoc. 2013 Sep;14(9):661–7. doi: 10.1016/j.jamda.2013.02.007.
    1. Broadbent E, Orejana JR, Ahn HS, Xie J, Rouse P, MacDonald BA. The cost-effectiveness of a robot measuring vital signs in a rural medical practice. 24th IEEE International Symposium on Robot and Human Interactive Communication (RO-MAN); August 31-September 4; Kobe, Japan. IEEE; 2015. pp. 577–581.
    1. Orejana JR, MacDonald BA, Ahn HS, Peri K, Broadbent E. Healthcare robots in homes of rural older adults. In: Tapus A, André E, Martin JC, Ferland F, Ammi M, editors. Social Robotics. Lecture Notes in Computer Science vol 9388. Cham: Springer; 2015. pp. 512–521.
    1. Mann JA, MacDonald BA, Kuo I, Li X, Broadbent E. People respond better to robots than computer tablets delivering healthcare instructions. Comput Hum Behav. 2015 Feb;43:112–117. doi: 10.1016/j.chb.2014.10.029.
    1. Kidd CD, Breazeal C. Robots at home: understanding long-term human-robot interaction. International Conference on Intelligent Robots and Systems, IROS; September 22-26; Nice, France. IEEE; 2008. pp. 3230–3235.
    1. Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377–82.
    1. Broadbent E, Peri K, Kerse N, Jayawardena C, Kuo I, Datta C, MacDonald B. Robots in older peoples homes to improve medication adherence and quality of life: a randomised cross-over trial. In: Williams MA, Beetz M, Johnston B, editors. Social Robotics. Lecture Notes in Computer Science, vol 8755. Cham: Springer; 2014. pp. 64–73.
    1. van der Molen T, Willemse BW, Schokker S, ten Hacken NH, Postma DS, Juniper EF. Development, validity and responsiveness of the Clinical COPD Questionnaire. Health Qual Life Outcomes. 2003 Apr 28;1:13.
    1. Poole PJ, Chase B, Frankel A, Black PN. Case management may reduce length of hospital stay in patients with recurrent admissions for chronic obstructive pulmonary disease. Respirology. 2001 Mar;6(1):37–42.
    1. Horne R, Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002 Jan;17(1):17–32. doi: 10.1080/08870440290001502.

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