Please select the eligibility criteria that correspond to the clinical trial below.
Title: Long-Term Integrated Telerehabilitation of COPD Patients. A Multi-Center Randomized Controlled Trial
Brief Summary: This research project aims to conduct a three-arm multi-center randomized controlled trial (RCT) on an innovative telerehabilitation intervention for patients with chronic obstructive pulmonary disease (COPD). The overall purpose of the RCT is to demonstrate whether long-term integrated telerehabilitation involving exercise training at home, telemonitoring, and education/self-management will prevent hospital readmissions, thus reducing healthcare costs, for patients with COPD, and will improve patient status and quality of life.


Options:
A: Inclusion Criteria:

* COPD new GOLD classification (B, C and D class) and a spirometry in the previous year and
* Systolic and/or diastolic CHF defined at least by an echocardiogram performed in clinical stability; II, III and IV New York Heart Association class and optimized drug therapy.
* Informed consent signed

Exclusion Criteria:

* Physical activity limitations caused by non-cardiac and/or pulmonary problems
* Obstructive Cardiomyopathies and/or myocarditis
* Non cardiac and/or pulmonary pathologies that would cause the death of the patient during the study
* Poor adherence and compliance of the patient
B: Inclusion Criteria:

* COPD Patients willing and able to sign informed consent for use of their pseudonymized clinical data within the scope of the present interventional trial
* COPD patients who have completed an in-hospital pulmonary rehabilitation program with an average duration of 2-3 weeks.
* Diagnosis of COPD, defined as forced expiratory volume in 1s/forced vital capacity (FEV1/FVC) \<70% predicted, FEV1\<80 % predicted after bronchodilation, with or without chronic symptoms (cough, sputum production) corresponding to a GOLD stage II-IV
* Completion of the screening period and fulfilling of the randomization criteria as defined by the protocol
* Ability to use a smartphone and smartphone-apps
* Willingness to wear an activity tracker during study period of 6 months
* Patients ≥40 years of age.
* Knowledge of German language to understand study material, assessments and contents of the COPD-App

Exclusion Criteria:

* The Patient is not able to conduct the exercise training program due to physical, cognitive or safety reasons, as judged by investigator; e.g., lower limb joint surgery within preceding 3 months, unstable cardiac disease, predominant neurological limitations, planned surgical or other interventions disturbing the study intervention.
* Significant psychiatric disorders, legal incapacity or limited legal capacity.
* Patients participation in another clinical trial with an investigational medication within 30 days prior to study entry.
* Patients already using the KAIA COPD App
C: Inclusion Criteria:

* Veterans
* Moderate or severe COPD with a forced expiratory volume in 1 second - forced vital capacity ratio (FEV1/FVC) \< 0.70 and FEV1 \< 80% predicted
* Hospitalization with a primary diagnosis of AECOPD, defined as an increase in shortness of breath, cough, and/or sputum production beyond the normal day-to-day variation necessitating a change in regular medication when other causes of increased shortness of breath, cough, and/or sputum production have been ruled out
* Capable of operating a tablet independently with adequate vision and hearing

Exclusion Criteria:

* Acute hypercapneic respiratory failure with a requirement for either non-invasive (i.e. bilevel positive airway pressure) or invasive mechanical ventilation during hospitalization
* Hospitalization \< 72 hours
* A secondary diagnosis of acute congestive heart failure, myocardial infarction, or pneumonia during hospitalization or unstable cardiac or neurologic disease at discharge
* Enrollment in a pulmonary rehabilitation program within 12 months of hospitalization
* A medical condition that makes exercise unsafe (includes upper and lower limb strength training and lower limb cycle ergometry)

  * This will be determined by the following- screen for these through chart review, discussion with the patient (do they have any known cardiac issues, do they have chest pain with exertion, are they lightheaded with exertion), discussion with the physicians caring for the patient in the hospital, and direct observation and assessment during the bedside pulmonary rehab sessions (that were built into this study for safety purposes)
* Inclusion in another greater than minimal risk study
D: Inclusion Criteria:

* Diagnosis of COPD
* At least one COPD-related hospitalization or COPD-related emergency department presentation in the previous 12 months to enrollment
* Capable to provide signed written informed consent

Exclusion Criteria:

* Attendance to a rehabilitation program in the previous 6 months of enrollment
* Participation in another study that may have an impact on the outcome of this study
* Deemed by the health care team to be physically uncapable to perform the study procedures
* Presence of comorbidities wich might prevent the patient from safely undertake an exercise program at home
* Home environment not suitable for installation and use of rehabilitation and monitoring equipment (e.g. physical space, Wi-FI Internet or mobile Internet via 4G)

Answer: D