The Impact of a Home-based Pulmonary Telerehabilitation Program in Acute Exacerbations of COPD
Condition: Pulmonary Disease, Chronic Obstructive
MeSH terms: Lung Diseases; Pulmonary Disease, Chronic Obstructive; Chronic Disease
Study type: Interventional

Summary: 
      COPD impacts a significant proportion of the Veteran population. Acute exacerbations, or
      flare-ups, of COPD are associated with impaired muscle function and worse quality of life.
      Pulmonary rehabilitation, a formal exercise program for patients with lung disease that
      includes both endurance and strength training exercises, has been shown to improve muscle
      function and quality of life after an acute exacerbation of COPD. However, lack of
      geographically accessible rehabilitation facilities and/or transportation issues are often
      barriers to pulmonary rehabilitation attendance in the Veteran population. This study will
      assess the feasibility and impact of an eight-week, three sessions per week, home-based,
      pulmonary telerehabilitation program in Veterans with COPD following hospitalization for an
      acute exacerbation of their lung disease. We will measure adherence and satisfaction with the
      program and muscle strength, physical activity, quality of life, and exercise tolerance pre
      and post-intervention in Veterans randomized to the pulmonary telerehabilitation arm versus
      Veterans randomized to the control arm who do not participate in pulmonary rehabilitation.
    

Detailed description: 
      Pulmonary telerehabilitation programs have been shown to have a high acceptance and adherence
      rate and lead to improvement in exercise capacity and quality of life in stable COPD.
      However, data regarding the feasibility and impact of pulmonary telerehabilitation following
      hospitalization for an Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD)
      on physical activity levels, muscle function, exercise capacity, and health-related quality
      of life are lacking. The primary hypothesis is that a home-based pulmonary telerehabilitation
      program initiated at hospital discharge following an AECOPD is feasible in the Veteran
      population and will result in increased physical activity and greater improvement in muscle
      function, exercise capacity, and health-related quality of life compared to usual care. This
      hypothesis will be tested with the following specific aims: (1) To determine the feasibility
      of an eight-week home-based pulmonary telerehabilitation program in Veterans with moderate to
      severe COPD initiated in the immediate post-hospitalization period following an AECOPD. (2)
      To determine physical activity levels and the magnitude and variability in changes of
      measurements of muscle strength, functional exercise performance, and health-related quality
      of life following an eight-week home-based pulmonary telerehabilitation program versus usual
      care initiated in Veterans with moderate to severe COPD immediately following hospitalization
      for an AECOPD. The study will randomize (1:1 allocation) 30 male and female Veterans
      hospitalized with an AECOPD to either an eight-week, three sessions per week, home-based
      pulmonary telerehabilitation program that includes lower extremity endurance exercises with a
      cycle ergometer and upper and lower extremity strength training with 1:1 supervision via
      video conferencing with an exercise physiologist as well as a twice-monthly online support
      group via video conferencing versus usual care. Changes from baseline in physical activity
      levels, handgrip and quadriceps muscle strength, exercise endurance, and health-related
      quality of life will be assessed following the pulmonary telerehabilitation program versus
      usual care. Findings from this project will contribute to the growing field of pulmonary
      telerehabilitation and will provide critical preliminary data for the design and
      implementation of a larger, randomized control trial assessing the impact of pulmonary
      telerehabilitation on long-term clinical outcomes following AECOPD.
    

Intervention name(s): Pulmonary Telerehabilitation
Intervention type(s): Behavioral
Intervention description(s): The intervention will consist of an eight-week, three sessions per week, home-based pulmonary telerehabilitation program that will incorporate both lower extremity endurance exercise and upper and lower extremity resistance training. Subjects randomized to the study intervention will also participate in a one hour, twice-monthly support group via group video conferencing consisting of an educational topic (i.e. inhaler use, understanding COPD) and group discussion.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: The intervention will consist of an eight-week, three sessions per week, home-based pulmonary telerehabilitation program that will incorporate both lower extremity endurance exercise and upper and lower extremity resistance training. Subjects randomized to the study intervention will also participate in a one hour, twice-monthly support group via group video conferencing consisting of an educational topic (i.e. inhaler use, understanding COPD) and group discussion.
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: pulmonary disease, chronic obstructive; pulmonary rehabilitation; muscle atrophy