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      A randomized controlled trial evaluating the effectiveness of a web-based, computer-tailored self-management intervention for people with or at risk for COPD

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          Abstract

          Introduction

          COPD is a leading cause of morbidity and mortality. Self-management interventions are considered important in order to limit the progression of the disease. Computer-tailored interventions could be an effective tool to facilitate self-management.

          Methods

          This randomized controlled trial tested the effectiveness of a web-based, computer-tailored COPD self-management intervention on physical activity and smoking behavior. Participants were recruited from an online panel and through primary care practices. Those at risk for or diagnosed with COPD, between 40 and 70 years of age, proficient in Dutch, with access to the Internet, and with basic computer skills (n=1,325), were randomly assigned to either the intervention group (n=662) or control group (n=663). The intervention group received the web-based self-management application, while the control group received no intervention. Participants were not blinded to group assignment. After 6 months, the effect of the intervention was assessed for the primary outcomes, smoking cessation and physical activity, by self-reported 7-day point prevalence abstinence and the International Physical Activity Questionnaire – Short Form.

          Results

          Of the 1,325 participants, 1,071 (80.8%) completed the 6-month follow-up questionnaire. No significant treatment effect was found on either outcome. The application however, was used by only 36% of the participants in the experimental group.

          Conclusion

          A possible explanation for the nonsignificant effect on the primary outcomes, smoking cessation and physical activity, could be the low exposure to the application as engagement with the program has been shown to be crucial for the effectiveness of computer-tailored interventions. (Netherlands Trial Registry number: NTR3421.)

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          Most cited references 45

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          The natural history of chronic airflow obstruction.

          A prospective epidemiological study of the early stages of the development of chronic obstructive pulmonary disease was performed on London working men. The findings showed that forced expiratory volume in one second (FEV1) falls gradually over a lifetime, but in most non-smokers and many smokers clinically significant airflow obstruction never develops. In susceptible people, however, smoking causes irreversible obstructive changes. If a susceptible smoker stops smoking he will not recover his lung function, but the average further rates of loss of FEV1 will revert to normal. Therefore, severe or fatal obstructive lung disease could be prevented by screening smokers' lung function in early middle age if those with reduced function could be induced to stop smoking. Infective processes and chronic mucus hypersecretion do not cause chronic airflow obstruction to progress more rapidly. There are thus two largely unrelated disease processes, chronic airflow obstruction and the hypersecretory disorder (including infective processes).
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            Understanding tailoring in communicating about health.

            'Tailoring' refers to any of a number of methods for creating communications individualized for their receivers, with the expectation that this individualization will lead to larger intended effects of these communications. Results so far have been generally positive but not consistently so, and this paper seeks to explicate tailoring to help focus future research. Tailoring involves either or both of two classes of goals (enhancing cognitive preconditions for message processing and enhancing message impact through modifying behavioral determinants of goal outcomes) and employs strategies of personalization, feedback and content matching. These goals and strategies intersect in a 2 x 3 matrix in which some strategies and their component tactics match better to some goals than to others. The paper illustrates how this framework can be systematically applied in generating research questions and identifying appropriate study designs for tailoring research.
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              Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports.

              To systematically evaluate the published evidence regarding the characteristics and effectiveness of disease management programmes. Meta-analysis. Computerised databases for English language articles during 1987-2001. 102 articles evaluating 118 disease management programmes. Pooled effect sizes calculated with a random effects model. Patient education was the most commonly used intervention (92/118 programmes), followed by education of healthcare providers (47/118) and provider feedback (32/118). Most programmes (70/118) used more than one intervention. Provider education, feedback, and reminders were associated with significant improvements in provider adherence to guidelines (effect sizes (95% confidence intervals) 0.44 (0.19 to 0.68), 0.61 (0.28 to 0.93), and 0.52 (0.35 to 0.69) respectively) and with significant improvements in patient disease control (effect sizes 0.35 (0.19 to 0.51), 0.17 (0.10 to 0.25), and 0.22 (0.1 to 0.37) respectively). Patient education, reminders, and financial incentives were all associated with improvements in patient disease control (effect sizes 0.24 (0.07 to 0.40), 0.27 (0.17 to 0.36), and 0.40 (0.26 to 0.54) respectively). All studied interventions were associated with improvements in provider adherence to practice guidelines and disease control. The type and number of interventions varied greatly, and future studies should directly compare different types of intervention to find the most effective.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                International Journal of COPD
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove Medical Press
                1176-9106
                1178-2005
                2015
                08 June 2015
                : 10
                : 1061-1073
                Affiliations
                [1 ]Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, Netherlands
                [2 ]Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center, Maastricht, Netherlands
                [3 ]Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
                [4 ]Department of Methodology and Statistics, CAPHRI, Maastricht University Medical Center, Maastricht, Netherlands
                Author notes
                Correspondence: Huibert Tange, Maastricht University, PO Box 616, 6200MD, Maastricht, Netherlands, Tel +31 43 388 2230, Fax +31 43 361 9344, Email h.tange@ 123456maastrichtuniversity.nl
                Article
                copd-10-1061
                10.2147/COPD.S81295
                4467652
                © 2015 Voncken-Brewster et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Respiratory medicine

                copd, smoking cessation, tailoring, internet intervention, physical activity

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