[MA 2024 16] Blended care for patients with COPD
eHealth Living & Learning Lab, Department of Medical Informatics, AMC
Proposed by: Harm Gijsbers, MSc, Assistant Professor. [h.j.gijsbers@amsterdamumc.nl]
Introduction
Lung diseases such as Chronic Obstructive Pulmonary Diseases (COPD) cause problems with daily functioning due to reduced fitness, shortness of breath and fear of exercise. 1 In pulmonary rehabilitation, exercise training and learning to cope with daily physical limitations (such as shortness of breath on exertion) is the cornerstone of treatment. Patients find it difficult to maintain an active lifestyle. 2,3 After participation in rehabilitation, training effects are lost due to a reduced supply of training stimuli (reversibility). In addition, up to 20% of patients are readmitted to hospital with an exacerbation one year after rehabilitation. 4
By shifting from (expensive) third line to primary care, more patients will have access to the care they need. 5 This can help to prevent the condition from worsening. In addition to physical training, it is important for exercise therapists and physiotherapists to provide patients with a sustainable active lifestyle and increase patient self-management. 6
A blended exercise intervention to improve self-management (regarding exercise, breathlessness and fear of exercise) of COPD patients, both in practice and at home using an eHealth application, may offer a solution. 7 The term blended care intervention, basically, describes the coordinated combination of therapist-guided interventions and digital interventions. 8 However, therapists lack knowledge and tools to apply blended care in practice. The aim of this project is to work with physiotherapists and exercise therapists to develop a blended care programme for COPD patients.
Description of the SRP Project/Problem
How can physiotherapists and exercise therapists working in the field of pulmonary rehabilitation create a blended intervention to support the self-management of patients with COPD with COPD with regard to physical activity, breathing and the reduction of psychosocial symptoms in their own home environment?
Research questions
What do patients need to start using a blended care intervention?
What do therapists need to use a blended care intervention?
How can the results of the above sub-questions be translated into a blended care intervention for COPD patients, appropriate in various care networks?
This research project is part of a larger study of the INSPIRE consortium ( INfluencing Self management during Pulmonary rehabIlitation to EmpoweR patiEnts). Different research methods are used for the orientation and design phase of this eHealth tool. As an example: panel groups, focus group interviews and usability research methods.
Expected results
The aim of this study is to design a blended care intervention to support self-management of COPD patients during and after their rehabilitation, by physio/practice therapists working in first/second or third-line pulmonary rehabilitation.
As a result, we expect a scientific manuscript that is ready in draft form to be submitted for publication to a peer-reviewed journal
Time period
November – June
May – November
Both time periods are possible.
Contact
Harm Gijsbers, MSc, Assistant professor, eHealth Living & Learning Lab, Department of Medical Informatics, AmsterdamUMC, location University of Amsterdam, h.j.gijsbers@amsterdamumc.nl
Paul Keessens, PhD, Assistant Professor, Amsterdam University of Applied Sciences
References
1. https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
2. Nici L., Donner C., Wouters E., Zuwallack R., Ambrosino N., Bourbeau J., Carone M., Celli B., Engelen M., Fahy B., et al. American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. Am. J. Respir. Crit. Care Med. 2006;173:1390–1413. doi: 10.1164/rccm.200508-1211ST
3. Janssens T, De Peuter S, Stans L, Verleden G, Troosters T, Decramer M, Van den Bergh O. Dyspnea perception in COPD: association between anxiety, dyspnea-related fear, and dyspnea in a pulmonary rehabilitation program. Chest. 2011 Sep;140(3):618-625. doi: 10.1378/chest.10-3257. Epub 2011 Apr 14. PMID: 21493698.
4. Longalliantie Nederland. Landelijk Zorgpad COPD longaanval met ziekenhuisopname – Betere zorg voor de patiënt met COPD. Amersfoort: Longalliantie Nederland (LAN); 2019.
5. Zorginstituut Nederland. Verbetersignalement ‘Zorgtraject van mensen met COPD’. Zorginstituut Nederland 2019.
6. Morrison D, Mair FS, Yardley L, Kirby S, Thomas M. Living with asthma and chronic obstructive airways disease: Using technology to support self-management – An overview. Chron Respir Dis. 2016 Aug 10;14(4):407–419. doi: 10.1177/1479972316660977. 7. Tabak, M., Brusse-Keizer, M., van der Valk, P., Hermens, H., & Vollenbroek-Hutten, M. (2014). A telehealth program for self-management of COPD exacerbations and promotion of an active lifestyle: a pilot randomized controlled trial. International Journal of Chronic Obstructive Pulmonary Disease, 9, 935–944. https://doi.org/10.2147/COPD.S60179
8. Hohberg, V., Fuchs, R., Gerber, M. et al. Blended Care Interventions to Promote Physical Activity: A Systematic Review of Randomized Controlled Trials. Sports Med - Open 8, 100 (2022). https://doi.org/10.1186/s40798-022-00489-w