Huong Q Nguyen1, Adrienne Bailey2, Karen J Coleman3, Smita Desai4, Vincent S Fan5, Michael K Gould3, Leah Maddock3, Kimberly Miller3, William Towner3, Anny H Xiang3, Marilyn L Moy6. 1. Department of Research & Evaluation, Kaiser Permanente Southern California, United States. Electronic address: huong.q2.nguyen@kp.org. 2. Patient Advisory Board Member, United States. 3. Department of Research & Evaluation, Kaiser Permanente Southern California, United States. 4. Kaiser Permanente Southern California, San Diego, United States. 5. University of Washington, Seattle, United States. 6. Harvard Medical School, VA Boston Healthcare System, Pulmonary and Critical Care Section, United States.
Abstract
BACKGROUND:Physical inactivity is significantly associated with more frequent hospitalizations and increased mortality in COPD even after adjusting for disease severity. While practice guidelines recommend regular physical activity for all patients with COPD, health systems are challenged in operationalizing an effective and sustainable approach to assist patients in being physically active. METHODS: A pragmatic randomized controlled trial design was used to determine the effectiveness of a 12-month home and community-based physical activity coaching intervention (Walk On!) compared to standard care for 1650 patients at high risk for COPD exacerbations from a large integrated health care system. Eligible patients with a COPD-related hospitalization, emergency department visit, or observational stay in the previous 12months were automatically identified from the electronic medical records (EMR) system and randomized to treatment arms. The Walk On! intervention included collaborative monitoring of step counts, semi-automated step goal recommendations, individualized reinforcement from a physical activity coach, and peer/family support. RESULTS: The primary composite outcome included all-cause hospitalizations, emergency department visits, observational stays, and death in the 12months following randomization. Secondary outcomes included COPD-related utilization, cardio-metabolic markers, physical activity, symptoms, and health-related quality of life. With the exception of patient reported outcomes, all utilization and clinical variables were automatically captured from the EMR. CONCLUSIONS: If successful, findings from this multi-stakeholder driven trial of a generalizable and scalable physical activity intervention, carefully designed with sufficient flexibility, intensity, and support for a large ethnically diverse sample could re-define the standard of care to effectively address physical inactivity in COPD.
RCT Entities:
BACKGROUND: Physical inactivity is significantly associated with more frequent hospitalizations and increased mortality in COPD even after adjusting for disease severity. While practice guidelines recommend regular physical activity for all patients with COPD, health systems are challenged in operationalizing an effective and sustainable approach to assist patients in being physically active. METHODS: A pragmatic randomized controlled trial design was used to determine the effectiveness of a 12-month home and community-based physical activity coaching intervention (Walk On!) compared to standard care for 1650 patients at high risk for COPD exacerbations from a large integrated health care system. Eligible patients with a COPD-related hospitalization, emergency department visit, or observational stay in the previous 12months were automatically identified from the electronic medical records (EMR) system and randomized to treatment arms. The Walk On! intervention included collaborative monitoring of step counts, semi-automated step goal recommendations, individualized reinforcement from a physical activity coach, and peer/family support. RESULTS: The primary composite outcome included all-cause hospitalizations, emergency department visits, observational stays, and death in the 12months following randomization. Secondary outcomes included COPD-related utilization, cardio-metabolic markers, physical activity, symptoms, and health-related quality of life. With the exception of patient reported outcomes, all utilization and clinical variables were automatically captured from the EMR. CONCLUSIONS: If successful, findings from this multi-stakeholder driven trial of a generalizable and scalable physical activity intervention, carefully designed with sufficient flexibility, intensity, and support for a large ethnically diverse sample could re-define the standard of care to effectively address physical inactivity in COPD.
Authors: Jade Schrijver; Anke Lenferink; Marjolein Brusse-Keizer; Marlies Zwerink; Paul Dlpm van der Valk; Job van der Palen; Tanja W Effing Journal: Cochrane Database Syst Rev Date: 2022-01-10
Authors: David B Coultas; Bradford E Jackson; Rennie Russo; Jennifer Peoples; Karan P Singh; John Sloan; Minyong Uhm; Jamile A Ashmore; Steven N Blair; Sejong Bae Journal: Ann Am Thorac Soc Date: 2018-04
Authors: Huong Q Nguyen; Marilyn L Moy; In-Lu Amy Liu; Vincent S Fan; Michael K Gould; Smita A Desai; William J Towner; George Yuen; Janet S Lee; Stacy J Park; Anny H Xiang Journal: JAMA Netw Open Date: 2019-08-02