Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial

Figures & data

Figure 1 CONSORT diagram.

Abbreviations: SPACE, Self-management Program of Activity, Coping, and Education; PR, pulmonary rehabilitation; MRC, Medical Research Council; UHCW, University Hospitals Coventry and Warwickshire NHS Trust; UHL, University Hospitals of Leicester NHS Trust.

Table 1 Baseline characteristics of the study population

Characteristic	Usual care	SPACE for COPD
Sex, male:female	13:26	15:24
Age, years	68.33 (7.73)	67.64 (8.54)
FEV1, L	0.95 (0.36)	0.96 (0.45)
FEV1, %	42.45 (11.73)	40.47 (15.71)
FEV1/FVC ratio, %	42.77 (10.54)	47.09 (13.95)
Body mass index	23.75 (5.61)	25.49 (5.97)
Smoking status (n)
Current:Ex:Never	18:21:0	14:24:1
Smoking pack years	48.33 (29.02)	52.39 (34.32)
Disease duration, years	6.90 (5.99)	7.89 (7.43)
Marital status (n)
Married:partner:divorced: widowed:single	12:2:11:12:2	18:4:8:7:2
Lives (n)
Alone:with partner:with family	19:12:8	14:17:8
GOLD stage (n)
I:II:III:IV	0:10:12:12	0:10:16:11
Medical Research Council dyspnea grade	4 (3–5)	4 (3–5)
2:3:4:5 (n)	6:5:13:15	4:7:12:16
Exercise history (n)
Current:previous:never	6:22:11	6:20:13

Note: Values are mean (SD) or median (interquartile range).

Abbreviations: SD, standard deviation; SPACE, Self-management Program of Activity, Coping, and Education; FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity; GOLD, Global Initiative for chronic Obstructive Lung Disease.

Figure 2 Kaplan–Meier plots showing risk of respiratory readmission by randomization.

Abbreviation: SPACE, Self-management Program of Activity, Coping, and Education.

Table 2 Hospital length of stay (for readmission)

	Usual care	SPACE for COPD	Between-group difference
Intention-to-treat
All-cause	16.5 (3.8–39.8)	9.0 (1.0–30.0)	P=0.218
Respiratory	15.0 (3.5–32.0)	12.0 (9.0–33.8)	P=0.341
Nonrespiratory	27.0 (7.5–33.8)	1.0 (1.0–3.0)	P=0.067
Per protocol
All-cause	13.0 (3.3–25.5)	9.0 (1.0–27.8)	P=0.381
Respiratory	11.0 (3.0–21.0)	11.0 (8.8–37.5)	P=0.597
Nonrespiratory	27.0 (7.5–33.8)	1.0 (0.8–2.0)	P=0.044

Note: Values are median (interquartile range) days.

Abbreviation: SPACE, Self-management Program of Activity, Coping, and Education.

Table 3 Baseline and change in secondary outcome measures at 3 months

	Usual care		SPACE for COPD		Between-group difference
	Baseline	Change	Baseline	Change
CRQ-dyspnea	2.22 (0.95)	0.45 (1.17)*	2.36 (0.99)	1.05 (1.26)**	P=0.062
CRQ-fatigue	2.40 (0.97)	0.62 (1.21)**	2.23 (1.08)	0.99 (1.22)**	P=0.245
CRQ-emotion	3.41 (1.29)	0.37 (1.60)	3.12 (0.99)	1.09 (1.51)**	P=0.077
CRQ-mastery	3.24 (1.36)	0.89 (1.51)**	2.81 (1.11)	1.41 (1.48)**	P=0.181
ISWT (m)	60 (10–167.50)	30 (0–95)**	60 (30–150)	45 (0–70)**	P=0.769
ESWT (seconds)	50 (0–171)	155 (21–618.50)**	110 (8–196.50)	178.5 (−3.75 to 443.50)**	P=0.951
HADS-anxiety	7.79 (3.84)	0.28 (3.48)	9.62 (4.33)	−0.27 (3.45)	P=0.563
HADS-depression	7.18 (3.18)	0.76 (4.30)	6.97 (4.18)	0.54 (3.29)	P=0.833
PRAISE	39.08 (9.40)	2.34 (8.73)	40.15 (7.73)	0.54 (9.48)	P=0.465
BCKQ	31.71 (9.21)	2.10 (7.19)	33.90 (8.38)	3.92 (7.14)*	P=0.364

Notes: Mean (SD) or median (IQR) are reported as appropriate.

* P<0.05 within-group difference,

** P<0.01 within-group difference.

Abbreviations: SD, standard deviation; IQR, interquartile range; SPACE, Self-management Program of Activity, Coping, and Education; CRQ, Chronic Respiratory Questionnaire; ISWT, Incremental Shuttle Walk Test; ESWT, Endurance Shuttle Walk Test; HADS, Hospital Anxiety and Depression Scale; PRAISE, Pulmonary Rehabilitation Adapted Index of Self-Efficacy; BCKQ, Bristol COPD Knowledge Questionnaire.

Table 4 Number (%) of participants who achieved the MCID

	Usual care	SPACE for COPD	Between-group difference
CRQ-dyspnea	11 (36.67%)	19 (63.33%)	P=0.039*
CRQ-fatigue	17 (56.67%)	23 (76.67%)	P=0.104
CRQ-emotion	17 (56.67%)	19 (63.33%)	P=0.605
CRQ-mastery	22 (73.33%)	22 (73.33%)	P=1.000
ISWT	9 (42.86%)	11 (50%)	P=0.648
ESWT	8 (47.06%)	10 (50%)	P=0.863
HADS-anxiety	5 (17.24%)	9 (34.62%)	P=0.151
HADS-depression	10 (34.48%)	8 (30.77%)	P=0.775

Note:

* P<0.05.

Abbreviations: MCID, minimal clinically important difference; CRQ, Chronic Respiratory Questionnaire; ISWT, Incremental Shuttle Walk Test; ESWT, Endurance Shuttle Walk Test; HADS, Hospital Anxiety and Depression Scale; SPACE, Self management Programme of Activity Coping and Education.

Figure 3 Change in Chronic Respiratory Questionnaire – self reported data from baseline to 3 months.

Note: *P<0.05, **P<0.01, within group difference.
Abbreviations: NS, not significant; SPACE, Self management Programme of Activity Coping and Education; CRQ, Chronic Respiratory Questionnaire.

Table 5 How people feel upon discharge from hospital following treatment for their COPD (% per group)

	Very		Fairly		Neither yes or no		Not really		Not at all		Don’t know		Between-group differences
	UC	SM	UC	SM	UC	SM	UC	SM	UC	SM	UC	SM
Ready (well enough) to leave hospital	39	43	39	33	7	0	11	20	4	0	0	3	P=0.976
Reassured about being able to cope at home	36	53	29	23	7	7	21	13	4	3	0	0	P=0.230
Informed about your COPD and reasons for admission	29	47	21	27	11	0	18	13	7	3	7	3	P=0.086
Confident about how/when to take medications	68	70	18	20	4	0	11	3	0	0	0	0	P=0.444
Confident that COPD medications could help	46	67	36	30	4	3	14	0	0	0	0	0	P=0.049*
Reassured that good support was available at home	46	67	18	23	14	3	7	0	7	3	7	0	P=0.022*
Positive about the future	18	27	29	43	18	10	17	10	10	0	0	0	P=0.156

Notes: Not all participants completed each question; therefore, not all scores total 100%.

* P<0.05.

Abbreviations: UC, usual care; SM, self-management (Self management Programme of Activity, Coping and Education (SPACE)).

Table 6 Effect of (baseline) hospitalization on how people felt they changed and consequently managed their COPD (%)

	Increased/better/more often		No change		Reduced/worsened/less often		Between-group difference
	UC	SPACE for COPD	UC	SPACE for COPD	UC	SPACE for COPD
Your level of exercise and general activities	14	37	57	43	29	20	P=0.097
Your ability to arrange your life to cope with COPD	11	50	79	40	11	10	P=0.012*
Taking your medications on time as prescribed	17	57	71	43	4	0	P=0.017*
Knowing when to seek help about feeling unwell	43	73	57	23	0	3	P=0.038*
Your efforts to give up/avoid smoking	36	40	46	37	7	3	P=0.438
Your participation in discussion forums/groups	0	13	75	67	7	7	P=0.161
The use of available community support services	4	30	82	60	11	3	P=0.058

Notes: Not all participants completed each question; therefore, not all scores total 100%.

* P<0.05.

Abbreviations: UC, usual care; SPACE, Self-management Program of Activity, Coping, and Education.