Real-Time Telehealth for COPD Self-Management Using Skype™

Abstract

The utility of real-time interactive voice and video telehealth for teaching pursed-lips breathing (PLB) in chronic obstructive pulmonary disease (COPD) is unknown. This was a pilot study to determine its feasibility and efficacy on the key variables of social support and dyspnea. A randomized control study design with repeated measures (baseline, 4 and 12 weeks) was used. All participants in the control and intervention groups received PLB instruction at baseline, but only the intervention group received one weekly PLB reinforcement session for 4 weeks via home computer and Skype™ software. Outcome measures were Medical Outcomes Study Social Support Survey and dyspnea assessment (visual analogue scales for intensity and distress, modified Borg after six-minute walk distance, and Shortness of Breath Questionnaire for activity-associated dyspnea). A total of 22 participants with COPD (mean FEV₁% predicted = 56) were randomized; 16 (9 telehealth, 7 control) completed the protocol. Intent-to-treat analysis at week 4, but not week 12, demonstrated significantly improved total social support (P = 0.02) and emotional/informational subscale (P = 0.03) scores. Dyspnea intensity decreased (P = 0.08) for the intervention group with a minimal clinical important difference of 10.4 units. Analysis of only participants who completed the protocol demonstrated a significant decrease in dyspnea intensity (P = < 0.01) for the intervention group at both week 4 and 12. Real-time telehealth is a feasible, innovative approach for PLB instruction in the home with outcomes of improved social support and decreased dyspnea.

Keywords :

• Social support
• Dyspnea
• Breathing strategy
• Telecommunication.

Acknowledgments

The authors acknowledge the assistance of Ian Pagano, PhD, University of Hawaii at Manoa, for data analysis and interpretation, Curtis Ikehara, PhD, University of Hawaii at Manoa, Information and Computer Science, for technical aspects of the study protocol, and Joan Dodgson, PhD, RN, Arizona State University, for critical review of the manuscript. The assistance of research team members Samar Kadi, Flor Ayala, Mohammad Farkhondehpour, and Ahnnya Slaughter for subject recruitment, data collection, and data entry as well as the participation of veterans of West Los Angeles VA Healthcare Center are gratefully acknowledged.