Stepping up to Health - for Veterans With Chronic Obstructive Pulmonary Disease (COPD)

• Self-Reported Respiratory-Specific Quality of Life [ Time Frame: assessments taken at four months and twelve months from randomization ] [ Designated as safety issue: No ]
  

• Self Reported Dyspnea [ Time Frame: four months and twelve months from enrollment ] [ Designated as safety issue: No ]
  
• Days of Hospitalization [ Time Frame: assessed at twelve months from enrollment ] [ Designated as safety issue: No ]
  
• Increase in Average Daily Step Counts [ Time Frame: during the final month of the intervention ] [ Designated as safety issue: No ]
  
• Goal Commitment, Intervention Reach, Participant Retention, Participant Satisfaction & Adverse Events Rates [ Time Frame: four months and twelve months from enrollment ] [ Designated as safety issue: No ]
  

Background:

Individuals with COPD who undergo a facility-based, exercise-focused pulmonary rehabilitation program experience significant improvements in health related quality of life, dyspnea, and exercise tolerance as well as reduced rates of hospitalization. Unfortunately, only a small percent of individuals with COPD who could benefit from pulmonary rehabilitation have access to and participate in such programs. Rural veterans are less likely to have access to facility-based pulmonary rehabilitation than urban veterans. Health related quality of life in rural veterans with COPD is significantly worse than for veterans with COPD who live in urban areas. An internet-mediated self-management program for veterans with COPD that focuses on walking could be disseminated widely at low marginal cost to any veteran with COPD who has internet access.

Objectives:

The proposed research is designed to test the effectiveness of an automated internet-mediated walking program for veterans with COPD on improving health related quality of life and reducing days of hospitalization. Additionally, the proposed research will compare measures of intervention reach, participation and satisfaction between urban and rural veterans.

Methods:

This study will recruit approximately 300 participants nationwide by mail and randomly selected from VA medical databases to balance patients from rural and urban zip codes. Participants will be adult VA patients diagnosed with COPD who are also sedentary, ambulatory, have a physician to provide medical clearance, and who have access to a PC computer with an internet connection for e-mail. Interested participants will be directed to a secure VA website where they provide a waiver of signed informed consent and complete a baseline survey. Research staff will obtain medical clearance for walking from patients' designated providers. Participants will then be mailed a pedometer and information to enroll the Stepping Up to Health internet-mediated walking program. At 4 and 12 months, participants will complete a questionnaire measuring patient satisfaction, perceived benefits with the walking website, and the occurrence of any walking related adverse events.

The study is a two-arm randomized controlled trial of an automated internet-mediated walking program targeting veterans with COPD. The two arms are 1) SUH for COPD and 2) wait list control. All study procedures will be delivered remotely including recruitment, consent, medical clearance, intervention delivery and outcome assessment. Equal numbers of urban and rural veterans will be invited, allowing comparisons of intervention reach, participation and satisfaction between urban and rural veterans

Status:

Recruitment began December 2011, and is expected to continue through the fall of 2012. To date we have consented 292 patients and randomized 151.