A randomized controlled trial of telephone-mentoring with home-based walking preceding rehabilitation in COPD

Figures & data

Table 1 Outcomes and measures

Outcomes	Measures
Primary outcome
Physical capacity	6MWD, a field walking test^Citation27
Secondary outcomes
Health-related quality of life	CAT (0–40, 0= best)^Citation48
Health behaviors	“SNAPPS” snapshot questionnaire (total score 0–60, 60= best; domain score 0–10, 10= best)
Physical activity (1)	Self-reported walking (retrospective report) from SNAPPS snapshot questionnaire, Physical activity domain:  Days per week  Minutes per day
Physical activity (2)	Home-based walking action plan recorded in a personal walking diary (self-recorded in real time)

Notes: We had planned to measure hospital admissions but there were insufficient data obtainable. Data were collected regarding participant and mentor experiences but are not reported here. (1) =First measure of physical activity; (2) =second measure of physical activity.

Abbreviations: 6MWD, 6-minute walk test distance; CAT, COPD assessment Test; COPD, chronic obstructive pulmonary disease; SNAPPS, smoking, nutrition, alcohol consumption, physical activity, psychosocial well-being, and symptom management.

Figure 1 Flowchart depicting flow of participants through the study.

Abbreviations: COPD, chronic obstructive pulmonary disease; PR, pulmonary rehabilitation.

Table 2 Participant characteristics

Variable	Participants (n=65)	Intervention (n=35)	Control (n=30)	P-value (I versus C)
Female	36 (55%)	19 (54%)	17 (57%)	0.52
Age (years)	69±8.6	68±9.9	70±6.8	0.49
Married	31 (48%)	19	12	0.18
Years of education	10 (3)	10 (3)	10 (3)	0.99
Referral source
Physiotherapist, respiratory nurse (public hospital ward)	37 (57%)	20 (57%)	17 (57%)
Respiratory physicians (public and private practice)	26 (40%)	13 (37%)	13 (43%)	0.40
Community (doctors, other)	2 (3%)	2 (6%)	0
Body mass index (m^2/kg)	27±6.8 (n=63)	27±5.9 (n=34)	28±7.7 (n=29)	0.48
COPD severity
Mild (FEV1 >80%)	4 (6%)	3 (9%)	1 (3%)	0.46
Moderate (FEV1 59%–79%)	22 (34%)	12 (34%)	10 (33%)
Severe (FEV1 30%–49%)	24 (37%)	10 (29%)	14 (47%)
Very severe (FEV1 <30%)	8 (12%)	6 (17%)	2 (7%)
Missing data	7 (11%)	4 (11%)	3 (10%)

Notes: Data are reported as either mean ± standard deviation, median (interquartile range), or raw number (percent) within study group status. The P-values are from student’s t-tests, Mann–Whitney U-tests, or chi-squared analyses. I = intervention, C = control with a level of significance P<0.05. COPD severity classified according to GOLD classification.¹

Abbreviations: COPD, chronic obstructive pulmonary disease; GOLD, Global Initiative for Chronic Obstructive Lung Disease; FEV₁, forced expiratory volume in 1 second.

Table 3 Baseline outcomes: intervention versus control group

Variable	Intervention (tele-rehab + PR phase) n=35	Control (usual waiting time + PR phase) n=30	P-value
6MWD (meters)	333.3±120.9	344.8±113.7	0.69
CAT, scale 0–40	22±6	20±8	0.27
“SNAPPS” snapshot, scale 0–60	n=34 38±7 (n=34)	n=29 39±9 (n=29)	0.78
SNAPPS snapshot domains scores, scale 0–10
Smoking	10 (1)	10 (0)	0.50
Nutrition	9 (5)	8 (7)	0.27
Alcohol	10 (3)	10 (4)	0.81
Physical activity	5 (8)	0 (8)	0.40
Psychosocial	5±2	6±2	0.13
Symptom management	5 (3)	5 (3)	0.16
SNAPPS snapshot self-reported walking
Days per week	3 (5)	0 (4)	0.20
Minutes per day	10 (30)	3 (23)	0.62

Notes: Data are reported as either mean ± standard deviation or median (interquartile range). The P-values are from student’s t-tests or Mann–Whitney U-tests with a level of significance P<0.05 for the primary outcome.

Abbreviations: 6MWD, 6-minute walk distance; CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; PR, pulmonary rehabilitation; SNAPPS, smoking, nutrition, alcohol consumption, physical activity, psychosocial well-being, and symptom management.

Table 4 Changes in outcomes between groups: intervention group versus control group

Variable	Intervention	Control	P-value	Intervention	Control	P-value
	n=35 (effect of tele-rehab)	n=30 (effect of usual waiting time)		n=35 (effect of tele-rehab)	n=30 (effect of PR phase)
	Change TP1/2	Change TP1/2		Change TP2/3	Change TP2/3
Primary outcome
6MWD (meters)	0 (41)	12 (39)	0.01	0 (23)	0 (19)	0.51
Secondary outcomes
CAT, scale 0–40	0 (6)	0 (6)	0.48	0 (3)	0 (2)	0.81
“SNAPPS” snapshot, scale 0–60	2 (6)	1 (4)	0.42	0 (5)	0 (4)	0.70
SNAPPS snapshot domains, scale 0–10
Smoking	0 (0)	0 (0)	0.99	0 (0)	0 (0)	0.36
Nutrition	0 (0)	0 (0)	0.989	0 (0)	0 (0)	1.00
Alcohol	0 (0)	0 (0)	0.28	0 (0)	0 (0)	0.74
Physical activity	0 (4)	0 (4)	0.4	0 (1)	0 (0)	0.80
Psychosocial	0 (0)	0 (0)	0.737	0 (0)	0 (0)	0.47
Symptom management	0 (1)	0 (2)	0.85	0 (2)	0 (2)	0.30
SNAPPS snapshot self-reported walking
Days per week	0 (5)	0 (0)	0.64	0 (1)	0 (1)	0.81
Minutes per day	14 (26)	16 (40)	0.10	16 (23)	17 (29)	0.96

Notes: Data are reported as median (interquartile range). The P-values are from Mann–Whitney U-tests with a level of significance P<0.05. TP1/2= change between time-point 1 and time-point 2, TP2/3= change between time-point 2 to time-point 3. As there were no statistically or clinically significant changes between TP1 and TP3, we report the effect of tele-rehab, usual waiting time, and PR phase.

Abbreviations: 6MWD, 6-minute walk distance; CAT, COPD assessment test; COPD, chronic obstructive pulmonary disease; PR, pulmonary rehabilitation; SNAPPS, smoking, nutrition, alcohol consumption, physical activity, psychosocial well-being, and symptom management.

Table 5 Comparison of two 6-minute walk test distances conducted 30 minutes apart at different time-points

Time-point (TP)	Walk distance 1	Walk distance 2	Change in distance	P-value
TP1	318.2±116.4	331.6±119.4	13.5±41.0	0.01
TP2	331.3±112.4	346.4±117.1	15.2±28.0	<0.001
TP3	338.4±111.5	346.8±117.0	8.4±28.0	0.02

Notes: Data are reported as mean ± standard deviation. The P-values are from student’s t-tests. Walk distance is measured in meters. number of participants =65. Time-point 1, baseline; time-point 2, after 8–12 weeks of tele-rehab or usual waiting time; time-point 3, after 8 weeks of pulmonary rehabilitation phase.

Table 6 Walking diary data: intervention versus controls; exercise attendees versus nonattendees

Variable	Intervention (tele-rehab + PR phase) n=13	Control (usual waiting time + PR phase) n=11	P-value	Supervised exercise		P-value
				Attendees, n=16	Nonattendees, n=49
Week 1, beginning of group-rehab
Days per week	5 (2)	4 (6)	0.30	5 (3)	4 (3)	0.87
Minutes per day	27 (20)	19 (23)	0.09	23 (17)	20 (20)	1.00
Average over 8 weeks of group-rehab
Days per week	4±1	4±1	0.81	4±1	4±1	0.70
Minutes per day	33±18	29±8	0.57	28±10	34±18	0.30

Notes: Data are reported as either mean ± standard deviation or median (interquartile range). The P-values are from student’s t-tests or Mann–Whitney U-tests with a level of significance P<0.05 for the primary outcome. As there was no statistically or clinically significant difference between the intervention or control groups, we have also reported data for those attending supervised exercise and those who did not.

Abbreviation: PR, pulmonary rehabilitation.

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