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| Id | 569 | |
| Author | Barker R.E., Jones S.E., Banya W., Fleming S., Kon S.S.C., Clarke S.F., Nolan C.M., Patel S., Walsh J.A., Maddocks M., Farquhar M., Bell D., Wedzicha J.A., Man W.D.-C. | |
| Title | The effects of a video intervention on posthospitalization pulmonary rehabilitation uptake | |
| Reference | Barker R.E., Jones S.E., Banya W., Fleming S., Kon S.S.C., Clarke S.F., Nolan C.M., Patel S., Walsh J.A., Maddocks M., Farquhar M., Bell D., Wedzicha J.A., Man W.D.-C.; The effects of a video intervention on posthospitalization pulmonary rehabilitation uptake ;American Journal of Respiratory and Critical Care Medicine vol:201 issue: 12 page:1517.0 |
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| Link to article | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85086525203&doi=10.1164%2frccm.201909-1878OC&partnerID=40&md5=8679e89e9639f1be11501d412e2db108 |
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| Abstract | Rationale: Pulmonary rehabilitation (PR) after hospitalizations for exacerbations of chronic obstructive pulmonary disease (COPD) improves exercise capacity and health-related quality of life and reduces readmissions. However, posthospitalization PR uptake is low. To date, no trials of interventions to increase uptake have been conducted. Objectives: To study the effect of a codesigned education video as an adjunct to usual care on posthospitalization PR uptake. Methods: The present study was an assessor- and statistician-blinded randomized controlled trial with nested, qualitative interviews of participants in the intervention group. Participants hospitalized with COPD exacerbations were assigned 1:1 to receive either usual care (COPD discharge bundle including PR information leaflet) or usual care plus the codesigned education video delivered via a handheld tablet device at discharge. Randomization used minimization to balance age, sex, FEV1 % predicted, frailty, transport availability, and previous PR experience. Measurements and Main Results: The primary outcome was PR uptake within 28 days of hospital discharge. A total of 200 patients were recruited, and 196 were randomized (51% female, median FEV1% predicted, 36 interquartile range, 27–48 ). PR uptake was 41% and 34% in the usual care and intervention groups, respectively (P = 0.37), with no differences in secondary (PR referral and completion) or safety (readmissions and death) endpoints. A total of 6 of the 15 participants interviewed could not recall receiving the video. Conclusions: A codesigned education video delivered at hospital discharge did not improve posthospitalization PR uptake, referral, or completion. Copyright © 2020 by the American Thoracic Society |
Rationale: Pulmonary rehabilitation after hospitalizations for exacerbations of chronic obstructive pulmonary disease improves exercise capacity and health-related quality of life and reduces readmissions. In the latest iteration of the Cochrane Systematic Review Puhan and colleagues included randomized controlled trials and patients and found moderate-to-large effects of postexacerbation PR on health-related quality of life and exercise capacity and moderate-quality evidence that postexacerbation PR reduces hospital readmissions. The intervention group was also provided with the same COPD discharge bundle but was asked to watch a patient-codesigned education video. Qualitative Study Using purposive sampling topic-guided audio-recorded interviews of participants in the intervention group were conducted to capture their perspectives about the education video and the research process. With hindsight a greater focus on behavioral aspects for example with health coaching may have enhanced the benefits of showing the video.
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