The efficacy of a flipping education program on improving self-management in patients with chronic obstructive pulmonary disease: a randomized controlled trial

Figures & data

Figure 1 Study flowchart.

Table 1 Baseline characteristics of participants (N=60)

Characteristics	All participants (n=60)		Experimental group (n=30)		Control group (n=30)		P-value
	n	%	n	%	n	%
Gender							0.643
Male	55	91.7%	27	90%	28	93%
Female	5	8.3%	3	10%	2	7%
Age	72.03	11.14	70.5	11.26	73.55	10.99	0.293
Severity of airflow obstruction							0.418
Mild	35	58.3%	15	50.0%	25	66.7%
Moderate	17	28.3%	10	33.3%	7	23.3%
Severe	8	13.3%	5	16.7%	3	10.0%
COPD groups^a							0.267
A	31	51.7%	15	50.0%	25	66.7%
B	25	41.7%	11	36.7%	14	46.7%
C	2	3.3%	2	6.7%	0	0.0%
D	2	3.3%	2	6.7%	0	0.0%
Employment status							0.375
Full-time job	10	16.7%	7	23.3%	3	10.0%
Part-time job	6	10.0%	3	10.0%	3	10.0%
Retired	44	73.3%	20	66.7%	24	80.0%
Smoking history							0.195
Never	9	15.0%	2	6.7%	7	23.3%
Already quit	42	70.0%	23	76.7%	19	63.3%
Still smoking	9	15.0%	5	16.7%	4	13.3%
Realize diagnosed with COPD							0.197
Yes	12	20%	8	26.7%	4	13.3%
No	48	80%	22	73.3%	26	86.7%
Vaccination against influenza							0.260
Yes	42	70%	19	63.3%	23	76.7%
No	18	30%	11	36.7%	7	23.3%
Vaccination against pneumococcal conjugate							0.542
Yes	14	23.3%	6	20%	8	26.7%
No	46	76.7%	24	80%	22	73.3%

Notes: ^aCOPD groups: A, Low risk, less symptoms; B, low risk, more symptoms; C, high risk, less symptoms; D, high risk, high symptoms.

Table 2 Baseline analysis in different instruments (N=60)

Outcome measure	Experimental group (n=30) Mean ± SD	Control group (n=30) Mean ± SD	t-test	P-value
Disease knowledge (COPD-Q)	7.57±2.49	8.07±1.72	−1.139	0.259
Self-efficacy (PRAISE)	43.50±5.73	47.30±7.86	−2.144	0.036*
Patient activation level (PAM)	59.64±14.38	65.59±16.20	−1.504	0.138
Impact of COPD (CAT)	9.93±6.57	8.60±4.76	0.900	0.372

Note: *P<0.05.

Table 3 Generalized estimating equation analysis of longitudinal outcomes and effect size in different instruments (N=60)

Outcome measure (instrument)	Variable	Estimate	SE	Wald chi-square	P-value	Effect size
Disease knowledge (COPD-Q)	Intercept	7.267	0.3331	475.874	<0.001***
	Experimental group^a	−0.633	0.5465	1.343	0.247
	T2^b	0.853	0.5083	2.819	0.093
	T1^b	0.326	0.4349	0.562	0.454
	Experimental group* T2^c	1.661	0.7904	4.419	0.036*	0.525
	Experimental group* T1^c	2.300	0.6245	13.563	<0.001***	0.904
Self-efficacy (PRAISE)	Intercept	47.300	1.4065	1131.023	<0.001***
	Experimental group^a	−3.800	1.7422	4.757	0.029*
	T2^b	1.540	1.2141	1.609	0.205
	T1^b	−1.448	1.4894	0.945	0.331
	Experimental group* T2^c	4.812	1.7132	7.889	0.005**	0.138
	Experimental group* T1^c	6.763	1.8682	13.105	<0.001***	0.441
Patient activation level (PAM)	Intercept	65.593	2.9075	508.964	<0.001***
	Experimental group^a	−5.950	3.8885	2.341	0.126
	T2^b	3.641	3.1225	1.360	0.244
	T1^b	0.034	3.3237	0.000	0.992
	Experimental group* T2^c	12.158	4.2178	8.309	0.004**	0.403
	Experimental group* T1^c	13.887	4.5567	9.288	0.002**	0.483
Impact of COPD (CAT)	Intercept	8.600	0.8545	101.284	<0.001***
	Experimental group^a	1.333	1.4564	0.838	0.360
	T2^b	0.120	1.236	0.009	0.923
	T1^b	2.437	1.0803	5.089	0.024*
	Experimental group* T2^c	−2.239	1.6715	1.794	0.180	0.172
	Experimental group* T1^c	−3.926	1.5527	6.393	0.011*	0.426

Notes: *P<0.05, **P<0.01, and ***P<0.001. ^aReference group: control group, ^breference group: T0 (baseline), ^creference group: control group *T0 (T0=baseline, T1=1 month after intervention, T2=3 months after intervention).

Table 4 Generalized estimating equation analysis of longitudinal outcomes in the impact of COPD (N=60)

Category	Variable	Estimate	SE	Wald chi-square	P-value
Items 1~3 symptoms	Intercept	4.033	0.477	71.431	<0.001
	Experimental group^a	0.567	0.730	0.602	0.438
	T2^b	0.497	0.530	0.879	0.348
	T1^b	1.039	0.536	3.755	0.053
	Experimental group* T2^c	−1.794	0.7626	5.535	0.019*
	Experimental group* T1^c	−1.855	0.7215	6.606	0.010*
Items 4~6 activity	Intercept	1.733	0.3494	24.612	<0.001
	Experimental group^a	0.767	0.6086	1.587	0.208
	T2^b	0.028	0.4432	0.004	0.95
	T1^b	0.738	0.4305	2.939	0.086
	Experimental group* T2^c	−0.979	0.7575	1.671	0.196
	Experimental group* T1^c	−1.763	0.7384	5.704	0.017*
Items 7~8 impact	Intercept	2.833	0.4057	48.763	<0.001
	Experimental group^a	0.000	0.6415	0.000	1.000
	T2^b	−0.406	0.5587	0.529	0.467
	T1^b	0.693	0.4417	2.465	0.116
	Experimental group* T2^c	0.507	0.6465	0.614	0.433
	Experimental group* T1^c	−0.371	0.5580	0.442	0.506

Notes: *P<0.05. ^aReference group: control group, ^breference group: T0 (baseline), ^creference group: control group *T0 (T0=baseline, T1=1 month after intervention, T2=3 months after intervention).

Table 5 Comparisons in unexpected medical care for respiratory problems (N=52)

Outcome measure	Experimental group (n=27)		Control group (n=25)		t-test	P-value
	Frequency	Mean ± SD	Frequency	Mean ± SD
Unexpected outpatient visit	12	0.48±0.64	11	0.44±0.58	0.243	0.809
Emergency visit	8	0.30±0.61	7	0.28±0.54	0.102	0.919
Hospitalization	2	0.11±0.42	5	0.20±0.41	−0.769	0.445
Total	22	0.88±1.19	23	0.92±0.97	−0.102	0.919