Can the COPD web be used to promote self-management in patients with COPD in swedish primary care: a controlled pragmatic pilot trial with 3 month- and 12 month follow-up

Figures & data

Figure 1. An overview of the content of the COPD-web with focus on the parts targeting patients with COPD [14]. Reprinted with permission from the indicated reference.

Figure 2. Flow of patients with COPD across the different stages of the trial.

Table 1. Sociodemographic and baseline data of patients by group allocation.

	Intervention (n = 43)	Control (n = 40)
Age (years.)	65 (7)	71 (8)
Sex (Male)	23 (52%)	24 (60%)
FVC% predicted	81 (21)	76 (18)
FEV1 % predicted	60 (17)	59 (17)
FEV1/FVC	54 (10)	57 (10)
Stage of COPD^a
A (%)	24 (56%)	20 (51%)
B (%)	8 (19%)	9 (23%)
C (%)	5 (12%)	2 (5%)
D (%)	6 (14%)	9 (21%)
Smoking status
Never smoker (%)	4 (9%)	2 (5%)
Ex-smoker (%)	29 (67%)	30 (75%)
Current smoker (%)	8 (19%)	8 (20%)
Pack years	28 (15)	32 (15)
Employment status
Currently working (%)	10 (23%)	5 (13%)
Retired (%)	33 (67%)	34 (85%)
Sickness benefits (%)		1 (2%)
Living with
Alone (%)	20 (47%)	23 (58%)
Family (%)	23 (53%)	17 (42%)
Education level
Primary (%)	26 (60%)	22 (55%)
Secondary (%)	7 (17%)	10 (25%)
Tertiary (%)	10 (23%)	8 (20%)

Data is mean and standard deviation or percentages (%).

FVC: forced vital capacity; FEV₁: Forced expiratory volume in 1 second.

a based on [28].

No significant differences were seen between groups (p > .05).

Table 2. Difference between groups on impact of COPD in daily life, dyspnea, generic quality of life, health literacy and PA.

	Data collection timepoints						GEE effects between groups - mean (95% CI), P-value
	Month 0		Month 3		Month 12		Month 0 vs Month 3	Month 0 vs Month 12
Outcome	Exp (n = 43)	Con (n = 40)	Exp (n = 43)	Con (n = 40)	Exp (n = 43)	Con (n = 40)	Exp vs. Con	Exp vs. Con
Impact of COPD in daily life, dyspnea, generic quality of life and health literacy
CAT	12.2 (5.7)	14.0 (6.0)	12.5 (6.1)	14.9 (6.3)	12.8 (7.2)	15.6 (7.7)	B = −0.7 (−2.6 to 1.2), P = 0.483	B = −1.1 (−2.2 to 4.3), P = 0.521
mMRC	1.45 (0.96)	1.64 (0.90)	1.23 (0.81)	1.61 (0.90)	1.36 (0.84)	1.62 (1.1)	B = −0.2 (−0.5 to 0.2), P = 0.283	B = −0.1 (−0.4 to 0.3), P = 0.709
EQ-5D	0.90 (0.09)	0.89 (0.07)	0.91 (0.09)	0.88 (0.09)	0.91 (0.08)	0.88 (0.11)	B = 0.02 (−0.02 to 0.06), P = 0.342	B = 0.02 (−0.03 to 0.07), P = 0.980
C&CHL	85.1%	76.9%	82.5%	76.5%	82.9%	66.7%	OR = 1.5 (0.5–4.9), P = 0.491	OR = 0.9 (0.3–3.2), P = 0.878
PA (PA)
SoS-PA	9.1 (3.5)	9.2 (4.2)	10.8 (3.4)	8.6 (3.1)	9.7 (3.8)	8.7 (3.5)	B = 2.2 (0.6–3.9), P = 0.008	B = 1.1 (−0.8 to 3.0), P = 0.260
Grimby-PA	3 (2; 3)	3 (3; 3)	3 (3; 4)	3 (3; 3)	3 (3; 3)	3 (2.3; 3)	OR = 4.4 (1.9–10.4), P < 0.001	OR = 2.7 (0.9–7.8), P = 0.071
Inactivity^a	5 (4.8;5)	4 (4;5)	5 (4;6)	5 (4;5)	5 (4; 5)	4 (4;5)	OR = 1.1 (0.6–2.1), P = 0.667	OR = 1.4 (0.7–2.7), P = 0.365
ESES	24.9 (1.1)	22.7 (1.3)	25.1 (1.1)	20.2 (1.2)	24.3 (1.3)	22.0 (1.2)	B = 3.1 (0.1–6.3), P = 0.059	B = 0.9 (−2.2 to 4.1), P = 0.554

Data is mean (SD), median (IQR 25;75) or percentage (%) of groups at 0, 3 and 12 months. General estimates equation (GEE) (beta/Odds ratio [OR] [95% confidence intervals], p-value) are presented for between group comparisons.

SD: standard deviation; IQR: interquartile range; Exp: intervention; Con: control; CAT: COPD Assessment Test; mMRC: modified Medical Research Council scale; EQ-5D: EuroQol five dimension scale; C&CHL: the Swedish Critical Health Literacy Scale; SoS: the Swedish National Board of Health and Welfare indicator questions for PA & exercise; ESES: Exercise Self-Efficacy Scale.

^a Measured with the Swedish National Board of Health and Welfare scale indicator question for physical inactivity.

Table 3. Difference between groups on conceptual knowledge related to knowledge on how to take/perform/use different activities/measures to feel as good as possible in their disease.

	Data collection timepoints						GEE effects between groups - mean (95% CI), P-value
	Month 0		Month 3		Month 12		Month 0 vs Month 3	Month 0 vs Month 12
Outcome	Exp (n = 43)	Con (n = 40)	Exp (n = 43)	Con (n = 40)	Exp (n = 43)	Con (n = 40)	Exp vs. Con	Exp vs Con
Conceptual knowledge: I have sufficient knowledge to affect/take/perform/use
My health and wellbeing in my COPD	4 (3; 5)	4 (3; 5)	4 (3; 5)	4 (3; 4)	4 (3; 5)	4 (3; 4)	OR = 2.8 (1.1 to 6.9) P = .028	OR = 2.9 (0.9 to 8.6) P = .062
Daily physical activities	4 (3; 5)	4 (3; 5)	4 (4; 5)	4 (3; 5)	4 (3; 5)	4 (3; 5)	OR = 2.9 (1.3–6.3) P = .007	OR = 2.0 (0.8–5.1) P = .158
Exercise training	4 (3; 4)	4 (3; 5)	4 (3.3; 5)	3 (2.8; 4)	4 (3; 4.8)	3.41 (3; 4)	OR = 4.2 (1.7 to 10.5) P = .002	OR = 1.8 (0.7–4.8) P = .260
Breathing techniques at rest	3 (2; 4)	3 (1; 4)	4 (2; 4)	3 (1.8; 4)	3 (2; 5)	3 (2; 4)	OR = 2.6 (1.1–6.6) P = .038	OR = 1.8 (0.6–5.1) P = .302
Breathing techniques during activity/exercise	3 (2; 4)	3 (1.8; 4)	4 (2; 4)	3 (2; 4)	3 (2; 5)	3 (2; 4)	OR = 2.5 (0.9 to 6.7) P = .066	OR = 2.1 (0.7 to 6.5) P = .186
Techniques for mucus mobilization	2 (1; 3)	3 (1; 4)	3 (2; 4)	2.5 (1.8; 3)	3 (1; 4)	3 (2; 4)	OR = 3.2 (1.1 to 9.1) P = .029	OR = 1.6 (0.5–5.1) P = .419
Energy conservation techniques	3 (2; 4)	3 (1; 4)	3 (3; 4.3)	3 (2; 4)	4 (3; 4)	3 (1; 4)	OR = 1.2 (0.4–3.4) P = .725	OR = 1.4 (0.5–4.1) P = 0.549
Food adapted for my condition	2.5 (2; 4)	3 (1; 4)	3 (2; 5)	3 (2; 4)	4 (2; 5)	3 (2; 4)	OR = 1.6 (0.7–3.9) P = .282	OR = 2.3 (0.96–5.7) P = .061
Medication in accordance to ordination	5 (4; 5)	5 (4; 5)	5 (4; 5)	5 (4; 5)	5 (4; 5)	5 (4; 5)	OR = 1.5 (0.6–3.5) P = .365	OR = 1.3 (0.5–3.3) P = .626
Medication with accurate inhaler techniques	5 (3.8; 5)	5 (4; 5)	5 (4; 5)	5 (3.8; 5)	5 (3; 5)	5 (4; 5)	OR = 0.9 (0.4 = 2.2) P = .853	OR = 0.7 (0.3–1.9) P = .464
Contact health care if having symptoms for exacerbations	4.5 (3; 5)	5 (4; 5)	4 (3; 5)	4 (3; 4)	4 (3; 5)	5 (4; 5)	OR = 2.6 (0.8–8.0) P = .095	OR = 0.9 (0.3–2.8) P = .868

Data is mean (SD), median (IQR 25;75) or percentage (%) of groups at 0, 3 and 12 months. General estimates equation (GEE) (beta/Odds ratio [OR] [95% confidence intervals], p-value) are presented for between group comparisons.

SD: standard deviation; IQR: interquartile range; Exp: intervention; Con: control.

Table 4. Difference between groups on activities/methods/measures patients currently do to manage their disease.

	Data collection timepoints						GEE effects between groups - mean (95% CI), P -value
	Month 0		Month 3		Month 12		Month 0 vs Month 3	Month 0 vs Month 12
Outcome	Exp (n = 43)	Con (n = 40)	Exp (n = 43)	Con (n = 40)	Exp (n = 43)	Con (n = 40)
To manage my COPD I currently
Am physical active in my daily life	84.2%	89.7%	92.3%	76.5%	85.4%	72.4%	OR = 6.3 (1.2–33.1) P = .030	OR = 3.7 (1.0–13.4) P = 0.044
Perform physical exercise at least once a week	39.5%	43.6%	46.2%	35.3%	48,8%	44,8%	OR = 1.9 (0.8–4.5) P = .158	OR = 1.4 (0.5–3.9) P = .493
Use breathing technique’s at rest	23.7%	35.9%	33,3%	29.4%	41.5%	34.5%	OR = 2.2 (0.9–5.4) P = .097	OR = 2.4 (0.8–7.4) P = .116
Use breathing technique’s during ADL	23.7%	25.6%	30.8%	29.4%	39.0%	31.0%	OR = 1.2 (0.4–3.3) P = 0.744	OR = 1.6 (0.5–4.9) P = 0.417
Use techniques for mucus elimination	15.8%	17.9%	23.1%	23.5%	19.5%	24.1%	OR = 1.1 (0.3–4.1) P = .844	OR = 0.9 (0.3–3.1) P = .852
Use energy conservation techniques in my daily life	39.5%	33.3%	43.6%	52.9%	51.2%	37.9%	OR = 0.5 (0.2–1.4) P = .192	OR = 1.3 (0.5–3.3) P = 0.557
Eat food adapted to my condition.	15.8%	7.7%	15.4%	8.8%	19.5%	10.3%	OR = 0.8 (0.2–4.6) P = .835	OR = 0.9 (0.2–5.1) P = 0.939
Take medication in accordance to ordination.	92.1%	89.7%	97.4%	88.2%	95.1%	89.7%	OR = 3.8 (0.5–27.1) P = 0.179	OR = 1.7 (0.3–8.6) P = 0.518
Take medication with accurate techniques.	68.4%	71.8%	82.1%	67.6%	65.9%	82.8%	OR = 2.7 (1.1–6.6) P = .026	OR = 0.5 (0.1–1.7) P = 0.255
Contact health services if experiencing symptoms for exacerbations	57.9%	64.1%	76.9%	67.6%	61.0%	69.0%	OR = 2.1 (0.7–6.2) P = .181	OR = 0.9 (0.3–2.5) P = .876

Data is mean (SD), median (IQR 25;75) or percentage (%) of groups at 0, 3 and 12 months. General estimates equation (GEE) (beta/Odds ratio [OR] [95% confidence intervals], p-value) are presented for between group comparisons.

SD: standard deviation; IQR: interquartile range; Exp: intervention; Con: control.

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