Feasibility of a Health Coaching and Home-Based Rehabilitation Intervention With Remote Monitoring for COPD

Abstract

Background: Pulmonary rehabilitation is an effective treatment for patients with COPD, but patient uptake and adherence to the current offering of center-based pulmonary rehabilitation is modest due to transportation, access, poverty, and frailty, and even more so in the context of the COVID pandemic. Home-based options have been proposed and were found noninferior to center-based rehabilitation; however, there is a lack of home-based programs, and more understanding is needed. We aimed to test the feasibility, uptake, and adherence to a home-based program for COPD rehabilitation with health coaching.

Methods: We conducted a randomized trial with a wait-list controlled design to evaluate the effects of a home-based program with health coaching on breathlessness in subjects with moderate to severe COPD unable to attend the regular pulmonary rehabilitation program. The 8-week intervention consisted of video-guided exercises to be done 6 times a week and captured with a computer tablet. Health coaching was done weekly over the telephone to review subject activity and symptoms and to provide an opportunity for the subject to define their weekly goals. The primary outcomes were uptake, adherence, and Chronic Respiratory Questionnaire (CRQ) Dyspnea Domain. Secondary outcomes were self-management abilities and CRQ Emotions-Mastery-Fatigue.

Results: 154 subjects with moderate to severe COPD were randomized. Subject adherence was 86% to the proposed 6-times a week exercise routine. There (P = .062) was no significant difference in breathlessness (CRQ dyspnea). There was a significant improvement in self-management abilities (P < .001). The results of the qualitative interviews showed high levels of acceptability of the program.

Conclusions: The tested home-based rehabilitation program with health coaching was feasible, highly acceptable, showed a high degree of adherence, and improved self-management abilities. This study offers seminal information for home-based rehabilitation programs to design alternative options of rehabilitation to individuals with COPD that cannot attend to the well-established center-based pulmonary rehabilitation. (ClinicalTrials.gov registration NCT02557178.).

Keywords: COPD; health coaching; home-based; pulmonary rehabilitation.

Conflict of interest statement

Dr RP Benzo is supported in part by grants R61 HL142933, K24 HL138150, HL140486 from the National Heart Blood and Lung Institute, National Institutes of Health; and Dr RP Benzo and Ms Seifert are supported in part by grant SBIR HL114162-02A1. The authors have no conflicts to disclose.

Copyright © 2021 by Daedalus Enterprises.

Figures

Fig. 1.

Program overview.

Fig. 2.

Tablet views. A: Main screen; (B) exercise screen; (C) daily check-in screen; and (D) tablet weekly report (patient view).

Fig. 3.

Flow chart. CRQ = Chronic Respiratory Questionnaire.