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      Impact of a smartphone application (KAIA COPD app) in combination with Activity Monitoring as a maintenance pr Ogram following PUlmonary Rehabilitation in COPD: the protocol for the AMOPUR Study, an international, multicenter, parallel group, randomized, controlled study

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          Abstract

          Background

          Increasing physical activity (PA) is considered to be an important factor for the efficient management of chronic obstructive pulmonary disease (COPD). Successful methods required to achieve improvements in PA following pulmonary rehabilitation (PR), however, are rarely reported. Therefore, we will conduct this trial to evaluate the effectiveness of using a COPD management program delivered to the patient via the KAIA COPD app, a mobile medical application, after the completion of PR.

          Methods

          This is the protocol for a randomized, controlled, open-label, multicentered trial that will be carried out at inpatient PR hospital centers in Germany and Switzerland. The interventions will involve the use of the KAIA COPD app program (Arm 1) or an active comparator, i.e., usual care (Arm 2). Patients completing an in-hospital PR program and consenting to participate in the study will be screened with the inclusion and exclusion criteria and enrolled in the study. After fulfilling the screening requirements, the patients will be randomized into one of the two arms with parallel group assignment in a 1:1 ratio. The training program will be delivered to the participants grouped in Arm 1 via the KAIA COPD app and to participants grouped in Arm 2 via the regular recommendations or standard of care by the PI. In total, 104 participants will be included in the trial. The treatment period will last for 24 weeks. Electronic versions of questionnaires will be used to collect patient-reported assessments remotely. The primary outcome measure is the change in physical activity of the intervention group in comparison to the control group, measured over 1 week as the mean steps per day with a Polar A 370 activity tracker, from baseline (end of PR) to the 6-month follow-up. The secondary outcome measures are functional exercise capacity, health status, sleep quality, exacerbation rate, and depression and anxiety symptoms assessed at several intervals.

          Discussion

          This study seeks to prove the effects of the KAIA COPD mobile application in COPD patients after PR. The app offers educational, exercise training plus activity monitoring and motivational programs that can be easily implemented in the patient’s home setting, enabling patients to maintain the effects that are typically elicited in the short term after pulmonary rehabilitation for the long term.

          Trial registration

          German Clinical Trials Register ( DRKS00017275). Protocol version 2.0 dated 3 June 2019.

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          Most cited references12

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          Barriers to pulmonary rehabilitation: characteristics that predict patient attendance and adherence.

          Pulmonary rehabilitation (PR) is efficacious in chronic obstructive pulmonary disease (COPD). As completion rates of PR are poor, we wished to assess predictors of attendance and adherence. We performed a retrospective analysis of 711 patients with COPD, who were invited to attend PR. Data were compared to allow predictors (gender, smoking status, attending partner, referral route, employment status, body mass index, forced expiratory volume in 1 s (FEV(1)), oxygen therapy (LTOT), oxygen saturations, chronic respiratory questionnaire (CRQ), shuttle walk distance, travel distance and time) of attendance (0 or >0 attendance) and adherence ( 63% attendance) to be identified. 31.8% of patients referred for PR did not attend and a further 29.1% were non-adherent. Predictors of non-attendance were female gender, current smoker, and living alone. Predictors of non-adherence were extremes of age, current smoking, LTOT use, FEV(1), CRQ score and travelling distance. Multiple logistic regression revealed that LTOT and living alone were independent predictors of poor attendance and current smoking, poor shuttle walking distance and hospitalisations were independent predictors of poor adherence. Smoking status, availability of social support and markers of disease severity were predictors of attendance and adherence to PR. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Benefits of Long-Term Pulmonary Rehabilitation Maintenance Program in Patients with Severe Chronic Obstructive Pulmonary Disease. Three-Year Follow-up

            In chronic obstructive pulmonary disease (COPD), the benefits of pulmonary rehabilitation (PR) tend to wane over time. Whether maintenance techniques may help sustain the benefits achieved after completion of the initial PR program remains controversial.
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              Quality of life in patients with chronic obstructive pulmonary disease improves after rehabilitation at home.

              We have developed a rehabilitation programme at home and have investigated its effects on quality of life (QOL), lung function, and exercise tolerance in patients with chronic obstructive pulmonary disease (COPD). We studied 43 patients with severe airflow obstruction: forced expiratory volume in one second (FEV1) 1.3 +/- 0.4 l (mean +/- SD), FEV1/inspiratory vital capacity (IVC) 37 +/- 7.9%. After stratification, 28 patients were randomly allocated in a home rehabilitation programme for 12 weeks. Fifteen patients in a control group received no rehabilitation. The rehabilitation group received physiotherapy by the local physiotherapist, and supervision by a nurse and a general practitioner. Quality of life was assessed by the four dimensions of the Chronic Respiratory Questionnaire (CRQ). We found a highly significant improvement in the rehabilitation group compared to the control group for the dimensions dyspnoea, emotion, and mastery. Lung function showed no changes in the rehabilitation group. The exercise tolerance improved significantly in the rehabilitation group compared to the control group. The improvement in quality of life was not correlated with the improvement in exercise tolerance. Rehabilitation of COPD patients at home may improve quality of life; this improvement is not correlated with an improvement in lung function and exercise tolerance.
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                Author and article information

                Contributors
                spielmanns@me.com
                Journal
                Trials
                Trials
                Trials
                BioMed Central (London )
                1745-6215
                11 July 2020
                11 July 2020
                2020
                : 21
                : 636
                Affiliations
                [1 ]Pneumologie, Zürcher RehaZentren Klinik Wald, Faltigbergstrasse 7, 8636 Wald, Switzerland
                [2 ]GRID grid.412581.b, ISNI 0000 0000 9024 6397, Faculty of Health, Department of Pulmonary Medicine, , University of Witten/Herdecke, ; 58448 Witten, Germany
                [3 ]GRID grid.10253.35, ISNI 0000 0004 1936 9756, Department of Pulmonary Rehabilitation, , Philipps-University of Marburg, German Center for Lung Research (DZL), ; Marburg, Germany
                [4 ]Fa. Kaia Health GmbH, Siegfriedstr.8, 80797 Munich, Germany
                [5 ]Unabhängiges statistische Beratung Berhard Ulm, Kochelseestr 11, D-81371 Munich, Germany
                [6 ]GRID grid.490689.a, Institute for Pulmonary Rehabilitation Research, , Schoen Klinik Berchtesgadener Land, ; Schoenau am Koenigssee, Germany
                [7 ]GRID grid.6936.a, ISNI 0000000123222966, Department of Prevention, Rehabilitation and Sports Medicine, , Technical University of Munich (TUM), ; Munich, Germany
                Article
                4538
                10.1186/s13063-020-04538-1
                7353698
                32653025
                b24e0c4d-405d-4722-bce5-8a027c056318
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 25 March 2020
                : 19 June 2020
                Funding
                Funded by: Kaia Health Software GmbH
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2020

                Medicine
                physical activity,smartphone application,kaia copd,copd,digital therapeutics,maintenance,medical mobile application

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