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A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial

A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial
A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial
Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days. The primary efficacy outcome was recovery rate of symptoms measured by COPD assessment test (CAT) score. Exacerbations, readmission, inhaler technique quality of life and patient activation (PAM) scores were also captured by a blinded team. The app was acceptable in this care setting and was used by 17 of the 20 patients with sustained use over the study period. The treatment effect on the CAT score was 4.49 (95% CI: −8.41, −0.58) points lower in the myCOPD arm. Patients’ inhaler technique improved in the digital intervention arm (101 improving to 20 critical errors) compared to usual care (100 to 72 critical errors). Exacerbations tended to be less frequent in the digital arm compared to usual care; 34 vs 18 events. Hospital readmissions risk was numerically lower in the digital intervention arm: OR for readmission 0.383 (95% CI: 0.074, 1.987; n = 35). In this feasibility study of the digital self-management platform myCOPD, the app has proven acceptable to patients to use and use has improved exacerbation recovery rates, with strong signals of lower re-exacerbation and readmission rates over 90 days. myCOPD reduced the number of critical errors in inhaler technique compared to usual care with written self-management. This provides a strong basis for further exploration of the use of app interventions in the context of recently hospitalised patients with COPD and informs the potential design of a large multi-centre trial.
2398-6352
North, Mal
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Bourne, Simon
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Green, Ben
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Chauhan, Anoop
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Brown, Tom
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Winter, Jonathan
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Jones, Tom
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Neville, Dan
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Blythin, Alison
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Watson, Alastair
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Johnson, Matthew James
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Culliford, David
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Elkes, Jack
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Cornelius, Victoria
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Wilkinson, Thomas
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North, Mal
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Bourne, Simon
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Green, Ben
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Chauhan, Anoop
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Brown, Tom
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Winter, Jonathan
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Jones, Tom
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Neville, Dan
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Blythin, Alison
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Watson, Alastair
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Johnson, Matthew James
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Culliford, David
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Elkes, Jack
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Cornelius, Victoria
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Wilkinson, Thomas
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North, Mal, Bourne, Simon, Green, Ben, Chauhan, Anoop, Brown, Tom, Winter, Jonathan, Jones, Tom, Neville, Dan, Blythin, Alison, Watson, Alastair, Johnson, Matthew James, Culliford, David, Elkes, Jack, Cornelius, Victoria and Wilkinson, Thomas (2020) A randomised controlled feasibility trial of E-health application supported care vs usual care after exacerbation of COPD: the RESCUE trial. npj Digital Medicine, 3 (1), [145]. (doi:10.1038/s41746-020-00347-7).

Record type: Article

Abstract

Exacerbations of COPD are one of the commonest causes of admission and readmission to hospital. The role of digital interventions to support self-management in improving outcomes is uncertain. We conducted an open, randomised controlled trial of a digital health platform application (app) in 41 COPD patients recruited following hospital admission with an acute exacerbation. Subjects were randomised to either receive usual care, including a written self-management plan (n = 21), or the myCOPD app (n = 20) for 90 days. The primary efficacy outcome was recovery rate of symptoms measured by COPD assessment test (CAT) score. Exacerbations, readmission, inhaler technique quality of life and patient activation (PAM) scores were also captured by a blinded team. The app was acceptable in this care setting and was used by 17 of the 20 patients with sustained use over the study period. The treatment effect on the CAT score was 4.49 (95% CI: −8.41, −0.58) points lower in the myCOPD arm. Patients’ inhaler technique improved in the digital intervention arm (101 improving to 20 critical errors) compared to usual care (100 to 72 critical errors). Exacerbations tended to be less frequent in the digital arm compared to usual care; 34 vs 18 events. Hospital readmissions risk was numerically lower in the digital intervention arm: OR for readmission 0.383 (95% CI: 0.074, 1.987; n = 35). In this feasibility study of the digital self-management platform myCOPD, the app has proven acceptable to patients to use and use has improved exacerbation recovery rates, with strong signals of lower re-exacerbation and readmission rates over 90 days. myCOPD reduced the number of critical errors in inhaler technique compared to usual care with written self-management. This provides a strong basis for further exploration of the use of app interventions in the context of recently hospitalised patients with COPD and informs the potential design of a large multi-centre trial.

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s41746-020-00347-7 - Version of Record
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Accepted/In Press date: 17 September 2020
e-pub ahead of print date: 30 October 2020
Published date: 1 December 2020
Additional Information: © The Author(s) 2020.

Identifiers

Local EPrints ID: 444850
URI: http://eprints.soton.ac.uk/id/eprint/444850
ISSN: 2398-6352
PURE UUID: 8f54b1a8-7d0b-4307-9099-5188af858e3c
ORCID for David Culliford: ORCID iD orcid.org/0000-0003-1663-0253

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Date deposited: 06 Nov 2020 17:32
Last modified: 26 Nov 2021 02:48

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Contributors

Author: Mal North
Author: Simon Bourne
Author: Ben Green
Author: Anoop Chauhan
Author: Tom Brown
Author: Jonathan Winter
Author: Tom Jones
Author: Dan Neville
Author: Alison Blythin
Author: Alastair Watson
Author: Matthew James Johnson
Author: David Culliford ORCID iD
Author: Jack Elkes
Author: Victoria Cornelius

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