Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses

Home Telehealth Uptake and Continued Use Among Heart Failure and Chronic Obstructive Pulmonary Disease Patients: a Systematic Review

Background Home telehealth has the potential to benefit heart failure (HF) and chronic obstructive pulmonary disease (COPD) patients, however large-scale deployment is yet to be achieved. Purpose The aim of this review was to assess levels of uptake of home telehealth by patients with HF and COPD and the factors that determine whether patients do or do not accept and continue to use telehealth. Methods This research performs a narrative synthesis of the results from included studies. Results Thirty-seven studies met the inclusion criteria. Studies that reported rates of refusal and/or withdrawal found that almost one third of patients who were offered telehealth refused and one fifth of participants who did accept later abandoned telehealth. Seven barriers to, and nine facilitators of, home telehealth use were identified. Conclusions Research reports need to provide more details regarding telehealth refusal and abandonment, in order to understand the reasons why patients decide not to use telehealth

Allied health video consultation services

Many Australians have limited access to health care services due to a range of barriers including living a considerable distance from health services. Furthermore, there are significant shortages of healthcare workers in many rural and remote areas. Traditionally, many people have had to either travel long distances to access healthcare, or go without. Telehealth is an alternative approach, using telecommunications and information technology to supplement face-to-face delivery of healthcare services

How does it work? Factors involved in telemedicine home-interventions effectiveness: A review of reviews

INTRODUCTION: Definitive evidence of the effectiveness and cost-effectiveness of telemedicine home-interventions for the management of chronic diseases is still lacking. This study examines whether and how published reviews consider and discuss the influence on outcomes of different factors, including: setting, target, and intensity of intervention; patient engagement; the perspective of patients, caregivers and health professionals; the organizational model; patient education and support. Included reviews were also assessed in terms of economic and ethical issues. METHODS: Two search algorithms were developed to scan PubMed for reviews published between 2000 and 2015, about ICT-based interventions for the management of hypertension, diabetes, heart failure, asthma, chronic obstructive pulmonary disease, or for the care of elderly patients. Based on our inclusion criteria, 25 reviews were selected for analysis. RESULTS: None of the included reviews covered all the above-mentioned factors. They mostly considered target (44%) and intervention intensity (24%). Setting, ethical issues, patient engagement, and caregiver perspective were the most neglected factors (considered in 0-4% of the reviews). Only 4 reviews (16%) considered at least 4 of the 11 factors, the maximum number of factors considered in a review is 5. CONCLUSIONS: Factors that may be involved in ICT-based interventions, affecting their effectiveness or cost-effectiveness, are not enough studied in the literature. This research suggests to consider mostly the role of each one, comparing not only disease-related outcomes, but also patients and healthcare organizations outcomes, and patient engagement, in order to understand how interventions work

Home telemonitoring in COPD: a systematic review of methodologies and patients’ adherence

This systematic review aimed to provide a comprehensive description of the methodologies used in home telemonitoring interventions for Chronic Obstructive Pulmonary Disease (COPD) and to explore patients’ adherence and satisfaction with the use of telemonitoring systems. Methods A literature search was performed from June to August and updated until December of 2012 on Medline, Embase, Web of Science and B-on databases using the following keywords: [tele(-)monitoring, tele(-)health, tele(-)homecare, tele(-)care, tele-home health or home monitoring] and [Chronic Obstructive Pulmonary Disease or COPD]. References of all articles were also reviewed. Results Seventeen articles were included, 12 of them published from 2010 to the present. The methodologies were similar in the training provided to patients and in the data collection and transmission processes. However, differences in the type of technology used, telemonitoring duration and provision of prompts/feedback, were found. Patients were generally satisfied and found the systems useful to help them manage their disease and improve healthcare provision. Nevertheless, they reported some difficulties in their use, which in some studies were related to lower compliance rates. Conclusions Telemonitoring interventions are a relatively new field in COPD research. Findings suggest that these interventions, although promising, present some usability problems that need to be considered in future research. These adjustments are essential before the widespreading of telemonitoring

Interactive remote patient monitoring devices for managing chronic health conditions: systematic review and meta-analysis

Background: Telemedicine is an expanding and feasible approach to improve medical care for patients with long-term conditions. However, there is a poor understanding of patients’ acceptability of this intervention and their rate of uptake. Objective: To systematically review the current evidence on telemonitoring in the management of patients with long-term conditions, and to evaluate the patients’ uptake and acceptability of this technology. Methods: MEDLINE, SCOPUS, and CENTRAL were searched from date of inception to 5 February 2021, with no language restrictions. Studies were eligible for inclusion if they reported any of the following outcomes: (i) intervention uptake and adherence; (ii) study retention; (iii) patient acceptability, satisfaction and experience using intervention: (iv) changes in physiological values; (v) all-cause and cardiovascular related hospitalization; (vi) all-cause and disease specific mortality; (vii) patient-reported outcome measures; (viii) quality of life. Two reviewers independently assessed articles for eligibility. Results: Ninety-six studies studies were included and fifty-eight were pooled for meta-analyses. Meta-analyses showed reduction in mortality (RR= 0.71, 95% CI 0.56 to 0.89, P=0.003, I2=0%); and improvements in BP (MD -3.85 mmHg, 95% CI -7.03 to -0.68, P<.02, I2= 100%) and HbA1c (MD -0.33, 95% CI -0.57 to -0.09, P=.008, I2= 99%); but no significant improvements in quality of life (MD 1.45, 95% CI -0.10 to 3, P=.07, I2=80%); and increased risk of hospitalization (RR 1.02, 95% CI 0.85 to 1.23, P=.81, I2=79%) with telemonitoring compared to usual care. Twelve studies reported adherence outcomes and nine on satisfaction/acceptance, however heterogeneity in the assessment methods meant meta-analysis could not be performed. Conclusion: Telemonitoring is a valid alternative to usual care, reducing mortality and improving self-management of the disease, with patients reporting good satisfaction and adherence. Further studies are required to address some potential concerns regarding higher hospitalisation rates and a lack of a positive impact on patients’ quality of life. This systematic review was registered on PROSPERO (CRD42021236291)

Understanding intention to use telerehabilitation : applicability of the Technology Acceptance Model (TAM)

Indiana University-Purdue University Indianapolis (IUPUI)Background: Pulmonary rehabilitation (PR) has the potential to reduce the symptoms and complications of respiratory diseases through an interdisciplinary approach. Providing PR services to the increasing number of patients with chronic respiratory diseases challenges the current health care systems because of the shortages in health care practitioners and PR programs. Using telerehabilitation may improve patients’ participation and compliance with PR programs. The purpose of this study was to examine the applicability of the technology acceptance model (TAM) to explain telerehabilitation acceptance and to determine the demographic variables that can influence acceptance. Methods: A cross-sectional survey-based design was utilized in the data collection. The survey scales were based on the TAM. The first group of participants consisted of health care practitioners working in PR programs. The second group of participants included patients attending traditional PR programs. The data collection process started in January 2017 and lasted until May 2017. Results: A total of 222 health care practitioners and 134 patients completed the survey. The results showed that 79% of the health care practitioners and 61.2% of the patients reported positive intention to use telerehabilitation. Regression analyses showed that the TAM was good at predicting telerehabilitation acceptance. Perceived usefulness was a significant predictor of the positive intentions to use telerehabilitation for health care providers (OR: 17.81, p < .01) and for the patients (OR: 6.46, p = .04). The logistic regression outcomes showed that age, experience in rehabilitation, and type of PR increased the power of the TAM to predict the intention to use telerehabilitation among health care practitioners. Age, duration of the disease, and distance from the PR center increased the power of the TAM to predict the intention to use telerehabilitation among patients. Conclusion: This is the first study to develop and validate a psychometric instrument to measure telerehabilitation acceptance among health care practitioners and patients in PR programs. The outcomes of this study will help in understanding the telerehabilitation acceptance. It will help not only to predict future adoption but also to develop appropriate solutions to address the barriers of using telerehabilitation

Domiciliary monitoring to predict exacerbations of COPD

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a common, longterm condition that is usually caused by cigarette smoking. In addition to daily symptoms and limitation in activities, patients are prone to chest infections ('exacerbations'). These are a significant problem: unpleasant for patients, and sometimes severe enough to cause hospital admission and death. Reducing the impact of exacerbations is very important. Previous studies have shown that earlier treatment of exacerbations results in faster recovery, and reduced risk of hospital admission. Helping patients to better detect exacerbations early is therefore important. This PhD focuses on measuring overnight heart rate and oxygen saturation, which we hypothesised would provide the best chance of detecting COPD exacerbations earlier than changes in symptoms. // Aim: To evaluate the potential of monitoring physiological variables to provide earlier detection of exacerbations of COPD. // Methods: Firstly, a systematic review was conducted to assess the existing literature on predicting exacerbations of COPD by monitoring physiological variables. Next, two clinical tele-health datasets were accessed, from two different NHS services in London, to report the impact of false alarms on tele-health service, and to examine the feasibility of using downloadable data from home non-invasive ventilation to detect exacerbations resulting in hospitalisation. National and international surveys were conducted to explore the techniques that have been used by healthcare providers on how to customise tele-health alarm limits for each individual, and to explore healthcare providers’ perceptions of tele-health for COPD. These preliminary projects enabled me to formulate my research question and main PhD hypothesis, tested using a prospective randomised controlled trial. Patients were randomised into two groups (one measured physiology only in the morning versus overnight continuous measurement) and patients were monitored for up to six months or the first exacerbation, whichever was sooner. Patients’ acceptance of continuous overnight monitoring was assessed at the end of the study. // Results: Existing studies that used physiological variables were small and heterogeneous using different variables and different protocols. The majority of medical alarms received by tele-health teams are false. Most patients reported a positive acceptance of being monitored overnight. Continuous overnight monitoring identified changes at exacerbation earlier than once-daily monitoring, and earlier than symptoms. Changes in physiological variables were correlated with changes in symptoms during non-stable phases. There is widespread UK national and international use of tele-health monitoring physiological variables in COPD without sufficient evidence base. // Conclusion: Monitoring physiological parameters may be useful in assisting earlier detection of COPD exacerbations but further, robust studies are required to confirm this. A particular challenge is how to set alarm limits for individual patients given the heterogeneity inherent in COPD and COPD exacerbations

Autogestão na reabilitação de pacientes com doença pulmonar obstrutiva crónica: o papel da telemonitorização e atividade física

Doutoramento em Ciências e Tecnologias da SaúdeSelf-management has been acknowledged as a critical part of Chronic Obstructive Pulmonary Disease (COPD) management. However, evidence to support this type of intervention is still limited. This Thesis focuses on understanding whether self-management interventions can support patients with COPD to manage their disease and impact significantly on their health. Specifically, it aimed to: (i) gain more insight on the role of home telemonitoring to reduce the frequency of COPD exacerbations and healthcare utilisation and improve health-related outcomes; and (ii) investigate the impact of a physical activity (PA)-focused behaviour intervention combined with pulmonary rehabilitation (PR) on patients with COPD. Five studies were conducted. Two systematic reviews (Chapter 3) addressed the first aim of this Thesis by updating the body of evidence on home telemonitoring in COPD regarding its effectiveness, methodologies, patients’ adherence and satisfaction. Findings showed that there is still no clear indication that home telemonitoring improves health-related outcomes and reduces healthcare utilisation in COPD. A number of limitations, such as the small sample sizes and the telemonitoring technology, may have accounted for these results. Therefore, further work needs to be conducted before home telemonitoring can be incorporated into clinical practice. The second aim of this Thesis was addressed with three original studies. One study (Chapter 4) assessed the step-count accuracy of activity monitors (Yamax PW/EX-510 pedometer, GT3X+ accelerometer) which supported the feasibility study (Chapter 5) and the main study (Chapter 6). The main findings suggest that a PA-focused behavioural intervention combined with PR can be used to support patients with COPD in achieving a more active lifestyle. Nevertheless, it did not produce further improvements in health-related outcomes. More robust research is warranted to support these findings and assess the short- and long-term impact of this intervention in COPD. In conclusion, the role of patient self-management through home telemonitoring and a PA-focused behavioural intervention is not fully understood. This Thesis contributes for advancing the knowledge in this area and provides important recommendations for future research.A autogestão tem sido reconhecida como parte fundamental da gestão da Doença Pulmonar Obstrutiva Crónica (DPOC). No entanto, a evidência deste tipo de intervenções é ainda limitada. Esta Tese tem como objetivo compreender se as intervenções de autogestão podem ajudar os pacientes com DPOC a gerir melhor a sua doença e se têm um impacto significativo na sua saúde. Especificamente, esta Tese pretendeu: (i) aprofundar o papel da telemonitorização no domicílio para reduzir a frequência de exacerbações e a utilização de cuidados de saúde por parte dos pacientes com DPOC, bem como melhorar os resultados relacionados com a saúde; e (ii) investigar o impacto de uma intervenção comportamental para a promoção da atividade física (AF) em pacientes com DPOC (Walk2Bactive) durante e após um programa de reabilitação respiratória (RR). Foram realizados cinco estudos. Duas revisões sistemáticas (Capítulo 3) responderam ao primeiro objetivo desta Tese, sistematizando o conhecimento acerca da telemonitorização no domicílio no que diz respeito à sua eficácia, metodologias, adesão e satisfação de pacientes com DPOC. Os resultados revelaram que ainda não existe uma indicação clara de que a telemonitorização no domicílio produz melhorias nos resultados de saúde e na redução da utilização de cuidados de saúde em pacientes com DPOC. O número reduzido de participantes e a tecnologia utilizada em alguns estudos pode ter influenciado estes resultados. Assim, existe a necessidade de mais investigação nesta área antes de a telemonitorização poder ser incorporada na prática clínica. O segundo objetivo desta Tese foi alcançado através de três estudos originais. O primeiro estudo (Capítulo 4) avaliou a precisão dos monitores de AF (pedómetro Yamax PW/EX-510, acelerómetro GT3X+) utilizados no estudo piloto (Capítulo 5) e estudo principal (Capítulo 6). Os resultados principais sugerem que a intervenção comportamental para a promoção da AF pode ajudar os pacientes com DPOC a alcançar um estilo de vida mais ativo. No entanto, não produz melhorias nos resultados relacionados com a saúde. É necessário realizar investigação mais robusta nesta área para corroborar estes resultados e avaliar os efeitos da intervenção a curto e longo prazo. Em suma, o papel da autogestão na DPOC através da telemonitorização no domicílio e de uma intervenção comportamental para a promoção da AF ainda não é totalmente compreendido. Esta Tese contribuiu para avançar o conhecimento nesta área e apresenta recomendações importantes para pesquisas futuras

A Virtual Reality–Supported Intervention for Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease: Mixed Methods Study

Background: Uptake of traditional pulmonary rehabilitation classes from Chronic Obstructive Pulmonary Disease (COPD) patients is poor due to personal factors preventing accessibility to the venue. Therefore, there is a need for innovative methods of pulmonary rehabilitation and Virtual Reality (VR) could be the promising technology for COPD patients to access services remotely. Objectives: This study aims to investigate whether VR improves COPD patient’s compliance with pulmonary rehabilitation, particularly vulnerable patient group (MRC four or five), and whether VR provides a credible alternative to traditional pulmonary rehabilitation programmes. Methods: Eight-week patient trial using an innovative VR pulmonary rehabilitation programme. Purposive sample of ten COPD patients graded MRC four or five registered at a selected healthcare centre and a hospital in Cumbria, UK. Qualitative (focus groups and interviews) data were collected and to further support the qualitative findings, quantitative data (self-report patient surveys) were also gathered before and after the eight-week trial. The five self-report surveys included the Patient Activation Measure (PAM), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Short Physical Performance Battery (SPPB), and the Edmonton Frail Scale (EFS). Results: Using thematic analysis for the qualitative data, eleven themes emerged specific to delivering pulmonary rehabilitation using VR. The quantitative data further supports the qualitative findings by revealing significant improvements in all physical measures. Conclusion: Overall, this study demonstrates how remotely supervised VR-based pulmonary rehabilitation could help to overcome current issues and limitations associated with providing this service to COPD patients at scal