title: Effectiveness of Telemonitoring in Patients with Chronic Obstructive Pulmonary Disease in Taiwan-A Randomized Controlled Trial Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial Self-Management Support Using a Digital Health System Compared With Usual Care for Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial Telemonitoring in Chronic Obstructive Pulmonary Disease (CHROMED). A Randomized Clinical Trial A telehealth program for self-management of COPD exacerbations and promotion of an active lifestyle: a pilot randomized controlled trial A feasibility study to investigate the acceptability and potential effectiveness of a telecare service for older people with chronic obstructive pulmonary disease Home telemonitoring for patients with acute exacerbation of chronic obstructive pulmonary disease: a randomized controlled trial The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation Tele-assistance in chronic respiratory failure patients: a randomised clinical trial A randomised clinical trial of the effectiveness of home-based health care with telemonitoring in patients with COPD The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Implementation of a Telehealth Programme for Patients with Severe Chronic Obstructive Pulmonary Disease Treated with Long-Term Oxygen Therapy Telecare for Diabetes, CHF or COPD: Effect on Quality of Life, Hospital Use and Costs. A Randomised Controlled Trial and Qualitative Evaluation Randomized Controlled Trial of an Internet-Based Versus Face-to-Face Dyspnea Self-Management Program for Patients With Chronic Obstructive Pulmonary Disease: Pilot Study Efficacy of multiparametric telemonitoring on respiratory outcomes in elderly people with COPD: a randomized controlled trial A pilot randomised controlled trial of a Telehealth intervention in patients with chronic obstructive pulmonary disease: challenges of clinician-led data collection Proactive integrated care improves quality of life in patients with COPD Tele-monitoring reduces exacerbation of COPD in the context of climate change–a randomized controlled trial Pilot study of remote telemonitoring in COPD. Generic and specific measurement of health-related quality of life in a clinical trial of respiratory rehabilitation. Home telemonitoring and quality of life in stable, optimised chronic obstructive pulmonary disease Using preventive home monitoring to reduce hospital admission rates and reduce costs: a case study of telehealth among chronic obstructive pulmonary disease patients A systematic review of the cost and cost-effectiveness of telehealth for patients suffering from chronic obstructive pulmonary disease Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients: a randomized trial. Does Home Telemonitoring after Pulmonary Rehabilitation Reduce Healthcare Use in Optimized COPD?? A Pilot Randomized Trial Telehealth remote monitoring for community-dwelling older adults with chronic obstructive pulmonary disease. A telerehabilitation intervention for patients with Chronic Obstructive Pulmonary Disease: a randomized controlled pilot trial
abstract: Chronic obstructive pulmonary disease ( COPD ) is the leading cause of death worldwide , and poses a substantial economic and social burden . Telemonitoring has been proposed as a solution to this growing problem , but its impact on patient outcome is equivocal . This r and omized controlled trial aim ed to investigate effectiveness of telemonitoring in improving COPD patient outcome . In total , 106 subjects were r and omly assigned to the  telemonitoring  ( n = 53 ) or  usual care ( n = 53 ) group . During the two months following discharge , telemonitoring group patients had to report their symptoms daily using an electronic diary . The primary outcome measure was time to first re-admission for COPD exacerbation within six months of discharge . During the follow-up period , time to first re-admission for COPD exacerbation was significantly increased in the telemonitoring group than in the usual care group ( p = 0.026 ) . Telemonitoring was also associated with a reduced number of all-cause re-admissions ( 0.23 vs. 0.68/patient ; p = 0.002 ) and emergency room visits ( 0.36 vs. 0.91/patient ; p = 0.006 ) . In conclusion , telemonitoring intervention was associated with improved outcomes among COPD patients admitted for exacerbation in a country characterized by a small territory and high accessibility to medical services . The findings are encouraging and add further support to implementation of telemonitoring as part of COPD care Objective To test the effectiveness of telemonitoring integrated into existing clinical services such that intervention and control groups have access to the same clinical care . Design Research er blind , multicentre , r and omised controlled trial . Setting UK primary care ( Lothian , Scotl and ) . Participants Adults with at least one admission for chronic obstructive pulmonary disease ( COPD ) in the year before r and omisation . We excluded people who had other significant lung disease , who were unable to provide informed consent or complete the study , or who had other significant social or clinical problems . Interventions Participants were recruited between 21 May 2009 and 28 March 2011 , and central ly r and omised to receive telemonitoring or conventional self monitoring . Using a touch screen , telemonitoring participants recorded a daily question naire about symptoms and treatment use , and monitored oxygen saturation using linked instruments . Algorithms , based on the symptom score , generated alerts if readings were omitted or breached thresholds . Both groups received similar care from existing clinical services . Main outcome measures The primary outcome was time to hospital admission due to COPD exacerbation up to one year after r and omisation . Other outcomes included number and duration of admissions , and vali date d question naire assessment s of health related quality of life ( using St George ’s respiratory question naire ( SGRQ ) ) , anxiety or depression ( or both ) , self efficacy , knowledge , and adherence to treatment . Analysis was intention to treat . Results Of 256 patients completing the study , 128 patients were r and omised to telemonitoring and 128 to usual care ;  baseline characteristics of each group were similar . The number of days to admission did not differ significantly between groups ( adjusted hazard ratio 0.98 , 95 % confidence interval 0.66 to 1.44 ) . Over one year , the mean number of COPD admissions was similar in both groups ( telemonitoring 1.2 admissions per person ( st and ard deviation 1.9 ) v control 1.1 ( 1.6 ) ; P=0.59 ) . Mean duration of COPD admissions over one year was also similar between groups ( 9.5 days per person ( st and ard deviation 19.1 ) v 8.8 days ( 15.9 ) ; P=0.88 ) . The intervention had no significant effect on SGRQ scores between groups ( 68.2 ( st and ard deviation 16.3 ) v 67.3 ( 17.3 ) ; adjusted mean difference 1.39 ( 95 % confidence interval −1.57 to 4.35 ) ) , or on other question naire outcomes . Conclusions In participants with a history of admission for exacerbations of COPD , telemonitoring was not effective in postponing admissions and did not improve quality of life . The positive effect of telemonitoring seen in previous trials could be due to enhancement of the underpinning clinical service rather than the telemonitoring communication . Trial registration IS RCT N96634935 . Funding : The trial was funded by an NHS applied research programme grant from the Chief Scientist Office of the Scottish government ( ARPG/07/03 ) . The funder had no role in study design and the collection , analysis , and interpretation of data and the writing of the article and the decision to su bmi t it for publication . NHS Lothian supported the telemonitoring service and the clinical services Background We conducted a r and omized controlled trial of a digital health system supporting clinical care through monitoring and self-management support in community-based patients with moderate to very severe chronic obstructive pulmonary disease ( COPD ) . Objective The aim of this study was to determine the efficacy of a fully automated Internet-linked , tablet computer-based system of monitoring and self-management support ( EDGE ‚ sElf-management anD support proGrammE ) in improving quality of life and clinical outcomes . Methods We compared daily use of EDGE with usual care for 12 months . The primary outcome was COPD -specific health status measured with the St George ’s Respiratory Question naire for COPD ( SGRQ-C ) . Results A total of 166 patients were r and omized ( 110 EDGE , 56 usual care ) . All patients were included in an intention to treat analysis . The estimated difference in SGRQ-C at 12 months ( EDGE−usual care ) was −1.7 with a 95 % CI of −6.6 to 3.2 ( P=.49 ) . The relative risk of hospital admission for EDGE was 0.83 ( 0.56 - 1.24 , P=.37 ) compared with usual care . Generic health status ( EQ-5D , EuroQol 5-Dimension Question naire ) between the groups differed significantly with better health status for the EDGE group ( 0.076 , 95 % CI 0.008 - 0.14 , P=.03 ) . The median number of visits to general practitioners for EDGE versus usual care were 4 versus 5.5 ( P=.06 ) and to practice nurses were 1.5 versus 2.5 ( P=.03 ) , respectively . Conclusions The EDGE clinical trial does not provide evidence for an effect on COPD -specific health status in comparison with usual care , despite uptake of the intervention . However , there appears to be an overall benefit in generic health status ; and the effect sizes for improved depression score , reductions in hospital admissions , and general practice visits warrants further evaluation and could make an important contribution to supporting people with COPD . Trial registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 40367841 ; http://www.is rct n.com/IS RCT N40367841 ( Archived by WebCite at http://www.webcitation.org/6pmfIJ9KK Rationale : Early detection of chronic obstructive pulmonary disease ( COPD ) exacerbations using telemonitoring of physiological variables might reduce the frequency of hospitalization . Objectives : To evaluate the efficacy of home monitoring of lung mechanics by the forced oscillation technique and cardiac parameters in older patients with COPD and comorbidities . Methods : This multicenter , r and omized clinical trial recruited 312 patients with Global Initiative for Chronic Obstructive Lung Disease grade s II to IV COPD ( median age , 71 yr [ interquartile range , 66‐76 yr ] ; 49.6 % grade II , 50.4 % grade s III‐IV ) , with a history of exacerbation in the previous year and at least one nonpulmonary comorbidity . Patients were r and omized to usual care ( n = 158 ) or telemonitoring ( n = 154 ) and followed for 9 months . All telemonitoring patients self‐assessed lung mechanics daily , and in a subgroup with congestive heart failure ( n = 37 ) cardiac parameters were also monitored . An algorithm identified deterioration , triggering a telephone contact to determine appropriate interventions . Measurements and Main Results : Primary outcomes were time to first hospitalization ( TTFH ) and change in the EuroQoL EQ‐5D utility index score . Secondary outcomes included : rate of antibiotic/corticosteroid prescription ; hospitalization ; the COPD Assessment Tool , Patient Health Question naire‐9 , and Minnesota Living with Heart Failure question naire scores ; quality ‐adjusted life years ; and healthcare costs . Telemonitoring did not affect TTFH , EQ‐5D utility index score , antibiotic prescriptions , hospitalization rate , or question naire scores . In an exploratory analysis , telemedicine was associated with fewer repeat hospitalizations ( −54 % ; P = 0.017 ) . Conclusions : In older patients with COPD and comorbidities , remote monitoring of lung function by forced oscillation technique and cardiac parameters did not change TTFH and EQ‐5D . Clinical trial registered with www . clinical trials.gov ( NCT 01960907 ) The objective of this pilot study was to investigate the use of and satisfaction with a  chronic obstructive pulmonary disease ( COPD ) telehealth program applied in both primary and secondary care . The program consisted of four modules : 1 ) activity coach for ambulant activity monitoring and real-time coaching of daily activity behavior , 2 ) web-based exercise program for home exercising , 3 ) self-management of COPD exacerbations via a triage diary on the web portal , including self-treatment of exacerbations , and 4 ) teleconsultation .  Twenty-nine COPD patients were r and omly assigned to either the intervention group ( telehealth program for 9 months ) or the control group ( usual care ) . Page hits on the web portal showed the use of the program , and the Client Satisfaction Question naire showed satisfaction with received care . The telehealth program with decision support showed good satisfaction ( mean 26.4 , maximum score 32 ) . The program was accessed on 86 % of the treatment days , especially the diary . Patient adherence with the exercise scheme was low ( 21 % ) . Health care providers seem to play an important role in patients ’ adherence to telehealth in usual care . Future research should focus on full-scale implementation in daily care and investigating technological advances , like gaming , to increase adherence AIMS To investigate the feasibility , acceptance and potential effectiveness of delivering a telecare service on the health outcomes and hospital service utilization of community-dwelling patients with chronic obstructive pulmonary disease . METHODS Eligible participants were older people , with moderate or severe chronic obstructive pulmonary disease , and who had been admitted to hospital at least once for exacerbation during the previous year . The participants were r and omly assigned to the intervention or control group . Participants in the intervention group received a telecare device kit and they were asked to monitor their oxygen saturation , pulse rate and respiration rate using the device and to transmit the data to an online network platform . A medication and purse-lip breathing reminder with a feedback function is also provided in the device kit . A community nurse monitors changes in the physiological parameters and takes immediate action to address the patients ' needs . Participants in the control group received no other extra care . Study outcomes include user satisfaction , health-related quality of life , pulmonary function , hospital re-admission and use of emergency room services . RESULTS Twenty-two participants in the intervention group and 18 in the control group were included in the analysis . The mean age of all 40 participants was 72.93 years . Overall , the participants in the intervention group expressed satisfaction with the telecare service . Some patients reported difficulty in reading the screen of the mobile phone and manipulating the tiny key-in buttons . No significant differences were found between the two time points ( baseline and post-test period ) with regard to health-related quality of life . No significant differences in pulmonary function and in the number of emergency department visits and hospital re-admissions between the study groups were found . CONCLUSION The high level of user satisfaction indicated the feasibility of conducting a large-scale r and omized control trial to evaluate the effects of a telecare service on health outcomes of patients with chronic obstructive pulmonary disease Background Although a number of studies have suggested that the use of Telemonitoring ( TM ) in patients with Chronic Obstructive Pulmonary Disease ( COPD ) can be useful and efficacious , its real utility in detecting Acute Exacerbation ( AE ) signaling the need for prompt treatment is not entirely clear . The current study aim ed to investigate the benefits of a TM system in managing AE in advanced-stage COPD patients to improve their Health-Related Quality of Life ( HRQL ) and to reduce utilization of healthcare services . Methods A 12-month R and omised Controlled Trial ( RCT ) was conducted in the Veneto region ( Italy ) . Adult patients diagnosed with Class III-IV COPD in accordance with the Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) classification were recruited and provided a TM system to alert the clinical staff via a trained operator whenever variations in respiratory parameters fell beyond the individual ’s normal range . The study ’s primary endpoint was HRQL , measured by the Italian version of the two Short Form 36-item Health Survey ( SF36v2 ) . Its secondary endpoints were : scores on the Hospital Anxiety and Depression Scale ( HADS ) ; the number and duration of hospitalizations ; the number of readmissions ; the number of appointments with a pulmonary specialist ; the number of visits to the emergency department ; and the number of deaths . Results Three hundred thirty-four patients were enrolled and r and omized into two groups for a 1 year period . At its conclusion , changes in the SF36 Physical and Mental Component Summary scores did not significantly differ between the TM and control groups [ ( -2.07 ( 8.98 ) vs -1.91 ( 7.75 ) ; p = 0.889 and -1.08 ( 11.30 ) vs -1.92 ( 10.92 ) ; p = 0.5754 , respectively ] . Variations in HADS were not significantly different between the two groups [ 0.85 ( 3.68 ) vs 0.62 ( 3.6 ) ; p = 0.65 and 0.50 ( 4.3 ) vs 0.72 ( 4.5 ) ; p = 0.71 ] . The hospitalization rate for AE COPD and /or for any cause was not significantly different in the two groups [ IRR = 0.89 ( 95 % CI 0.79–1,04 ) ; p = 0.16 and IRR = 0.91 ( 95 % CI 0,75 – 1.04 ) ; p = 0.16 , respectively ] . The readmission rate for AE COPD and /or any cause was , however , significantly lower in the TM group with respect to the control one [ IRR = 0.43 ( 95 % CI 0.19–0.98 ) ; p = 0.01 and 0.46 ( 95 % CI 0.24–0.89 ) ; p = 0.01 , respectively ] . ConclusionS tudy results showed that in areas where medical services are well established , TM does not significantly improve HRQL  in patients with COPD who develop AE . Although not effective in reducing hospitalizations , TM can nevertheless facilitate continuity of care during hospital-to-home transition by reducing the need for early readmission . Trial registration Retrospectively registered on January 2012 , Clinical Trials.gov Identifier : NCT01513980 Summary We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation . Patients admitted with acute exacerbation of chronic obstructive pulmonary disease ( AE COPD ) at two hospitals were recruited at hospital discharge . They were r and omly assigned to intervention or control . The telemedicine equipment consisted of a briefcase with built-in computer including a web camera , microphone and measurement equipment . The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge . A total of 266 patients ( mean age 72 years ) were allocated to either intervention ( n = 132 ) or control ( n = 134 ) . There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks : mean 1.4 ( SD 2.1 ) in the intervention group and 1.6 ( SD 2.4 ) in the control group . In a secondary analysis , there was no significant difference between the two groups in mortality , time to readmission , mean number of total hospital readmissions , mean number of readmissions with AE COPD , mean number of total hospital readmission days or mean number of readmission days with AE COPD calculated at 4 , 8 , 12 and 26 weeks . Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality Chronic respiratory patients requiring oxygen or home mechanical ventilation experience frequent exacerbations and hospitalisations with related costs . Strict monitoring and care have been recommended . The aim of the present study was to primarily evaluate reduction in hospitalisations and , secondly , exacerbations , general practitioner ( GP ) calls and related cost-effectiveness of  tele-assistance ( TA ) for these patients . A total of 240 patients ( 101 with chronic obstructive pulmonary disease ( COPD ) ) were r and omised to two groups : an intervention group entered a 1-yr TA programme  while  controls received traditional care . No anthropometric and clinical differences were found between groups both in baseline and in mortality ( 18 % for TA , 23 % for controls ) . Compared with controls , the TA group experienced significantly fewer hospitalisations ( -36 % ) , urgent GP calls ( -65 % ) and acute exacerbations ( -71 % ) . Only COPD patients , as a separate group , had fewer hospitalisations , emergency room admissions , urgent GP calls or exacerbations . Each patient referred to staff a mean±sd 36±25 times . After deduction of TA costs , the average overall cost for each patient was 33 % less than that for usual care . In chronic respiratory failure patients on oxygen or home mechanical ventilation , a nurse-centred tele-assistance prevents hospitalisations while it is cost-effective . The chronic obstructive pulmonary disease group seems to have a greater advantage from tele-assistance We studied the effect of telemonitoring in addition to usual care compared to usual care alone in patients with chronic obstructive pulmonary disease ( COPD ) . A total of 110 patients with moderate to severe COPD were recruited from a specialist respiratory service in Northern Irel and . Patients had at least two of : emergency department admissions , hospital admissions or emergency general practitioner ( GP ) contacts in the 12 months before the study . Exclusion criteria were patients who had any respiratory disorder other than COPD , or were cognitively unable to learn the process of monitoring . Patients were r and omised to receive six months of home telemonitoring with usual care , or six months of usual care . The primary outcome measure was disease-specific quality of life , as measured by the St George ’s Respiratory Question naire for COPD patients ( SGRQ-C ) . Of 100 patients completing the study , 48 patients were r and omised to telemonitoring and 52 patients were r and omised to the control group . The SGRQ-C scores improved significantly in the intervention group compared to usual care ( P = 0.001 ) . The HADS anxiety score was significantly higher in the telehealth group compared to the usual care group ( P = 0.01 ) . There were significantly more contacts with the Community Respiratory Team in the telemonitoring group compared to the control group ( P = 0.029 ) . There were no significant between group differences in EQ-5D scores , HADS depression scores , GP activity , emergency department visits , hospital admissions or exacerbations . The total cost to the health service of the intervention over the 6-month study period was £ 2039 , giving an estimated ICER of £ 203,900 . In selected patients with COPD , telemonitoring was effective in improving health-related quality of life and anxiety , but was not a cost-effective intervention Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more We conducted a pilot study of the effectiveness of home telehealth for patients with advanced chronic obstructive pulmonary disease treated with long-term oxygen therapy . Patients were r and omized into a telehealth group ( n = 24 ) and a control group ( n = 21 ) who received usual care .  Patients in the telehealth  group  measured their vital signs on weekdays and performed spirometry on two days per week . The data were transmitted automatically to a clinical call centre . After four months of monitoring the mean number of accident and emergency department visits in the telehealth group was slightly lower than in the control group ( 0.29 versus 0.43 , P = 0.25 ) . The mean number of hospital admissions was 0.38 in the telehealth group and 0.14 in the control group ( P = 0.47 ) . During the study a total of 40 alerts were detected . The clinical triage process detected eight clinical exacerbations which were escalated by the case manager for a specialist consultation . There were clinical ly important differences in health-related quality of life in both groups . The mean score on the SGRQ was 10.9 versus 4.5 in the control group ( P = 0.53 ) . The EuroQol-5D score improved by 0.036 in the telehealth group and by 0.003 in the control group ( P = 0.68 ) . Both patients and healthcare professionals showed a high level of satisfaction with the telehealth programme Objectives To assess the effect of telecare on health related quality of life , self-care , hospital use , costs and the experiences of patients , informal carers and health care professionals . Methods Patients were r and omly assigned either to usual care or to additionally entering their data into a commercially-available electronic device that uploaded data once a day to a nurse-led monitoring station . Patients had congestive heart failure ( Site A ) , chronic obstructive pulmonary disease ( Site B ) , or any long-term condition , mostly diabetes ( Site C ) . Site C contributed only intervention patients – they considered a usual care option to be unethical . The study took place in New Zeal and between September 2010 and February 2012 , and lasted 3 to 6 months for each patient . The primary outcome was health-related quality of life ( SF36 ) . Data on experiences were collected by individual and group interviews and by question naire . Results There were 171 patients ( 98 intervention , 73 control ) . Quality of life , self-efficacy and disease-specific measures did not change significantly , while anxiety and depression both decreased significantly with the intervention . Hospital admissions , days in hospital , emergency department visits , outpatient visits and costs did not differ significantly between the groups . Patients at all sites were universally positive . Many felt safer and more cared-for , and said that they and their family had learned more about managing their condition . Staff could all see potential benefits of telecare , and , after some initial technical problems , many staff felt that telecare enabled them to effectively monitor more patients . Conclusions Strongly positive patient and staff experiences and attitudes complement and contrast with small or non-significant quantitative changes . Telecare led to patients and families taking a more active role in self-management . It is likely that subgroups of patients benefitted in ways that were not measured or visible within the quantitative data , especially feelings of safety and being cared-for . Trial Registration Australian New Zeal and Clinical Trials Registry Background People with chronic obstructive pulmonary disease ( COPD ) continue to experience dyspnea with activities of daily living ( ADL ) despite optimal medical management . Information and communication technologies may facilitate collaborative symptom management and could potentially increase the reach of such interventions to those who are unable to attend face-to-face pulmonary rehabilitation or self-management programs . Objective The purpose of this r and omized study was to test the efficacy of two 6-month dyspnea self-management programs , Internet-based ( eDSMP ) and face-to-face ( fDSMP ) , on dyspnea with ADL in people living with COPD . Methods We r and omly assigned 50 participants with moderate to severe COPD who were current Internet users to either the  eDSMP ( n = 26 ) or  fDSMP ( n = 24 ) group . The content of the two programs was similar , focusing on education , skills training , and ongoing support for dyspnea self-management , including independent exercise . The only difference was the mode ( Internet/personal digital assistant [ PDA ] or face-to-face ) in which the education sessions , reinforcement contacts , and peer interactions took place . Participants returned to one of two academic clinical sites for evaluation at 3 and 6 months . The primary outcome of dyspnea with ADL was measured with the Chronic Respiratory Question naire . Secondary outcomes of exercise behavior , exercise performance , COPD exacerbations , and mediators , such as self-efficacy and social support , were also measured . A satisfaction survey was administered and a semistructured exit interview was conducted at the final visit . Results The study was stopped early due to multiple technical challenges with the eDSMP , but follow-up was completed on all enrolled participants . Data were available for 39 participants who completed the study ( female : 44 % ; age : 69.5 ± 8.5 years ; percent predicted forced expiratory volume in 1 s : 49.6 ± 17.0 % ) . The fDSMP and eDSMP showed similar clinical ly meaningful changes in dyspnea with ADL from baseline to 3 months ( fDSMP : + 3.3 points ; eDSMP : + 3.5 points ) and sustained these improvements at 6 months ( fDSMP : + 4.0 points ; eDSMP : + 2.5 points ; time effects P < .001 ; group by time P = .51 ) . Self-reported endurance exercise time ( P = .001 ) , physical functioning ( P = .04 ) , and self-efficacy for managing dyspnea ( P = .02 ) also showed positive improvements over time in both groups with no significant differences with respect to program modality . Participants who completed the study reported favorable satisfaction with the programs . Conclusions Although there were numerous technical challenges with the eDSMP , both dyspnea self-management programs were effective in reducing dyspnea with ADL in the short term . Our findings will need to be confirmed in a larger r and omized trial with more mature Web and personal digital assistant tools , use of a control group , and longer follow-up . Trial registration clinical trials.gov NCT00102401 , Background Chronic obstructive pulmonary disease ( COPD ) is a highly prevalent condition associated with a high health care re source consumption and health care expenditures , driven mainly by exacerbations-related hospitalizations . Telemedicine has been proposed as a mean for timely detection of exacerbation , but the available evidence is inadequate to provide conclusive information on its efficacy . The aim of this study is to evaluate the efficacy of a telemonitoring system in reducing COPD -related hospitalizations in an elderly population with COPD . Methods This is a parallel arms , r and omized trial including patients aged 65 or older with COPD in GOLD stages II and III enrolled in a Pulmonary Medicine outpatient facility . Patients were r and omly assigned to receive a non-invasive system able to telemonitor vital signs ( oxygen saturation , heart rate , near-body temperature , overall physical activity ) or st and ard care , and were followed up for 9 months . The outcome measures were the number of exacerbations and exacerbation-related hospitalization . Results Fifty patients were included in the telemonitoring group and 49 in the control group . The incidence rate of respiratory events was 28/100 person/years in the telemonitoring group vs. 42/100 person/years in the control group ( incidence rate ratio : 0.67 , 95 % CI : 0.32 – 1.36 ) . The corresponding figures for hospital admissions where 13/100 person/years and 20/100 person/years , respectively ( IRR : 0.66 , 95 % CI : 0.21 – 1.86 ) . Conclusions In our study , COPD patients followed up with the aid of a multiparametric remote monitoring system experienced a lower rate of exacerbations and COPD -related hospitalizations compared to patients followed up using the st and ard model of care . These results need to be replicated in larger studies before they can be applied to the general COPD population . Trial registration number : NCT01481506 ( clinical trials.gov ) . Funding : co-financed by Lazio Region and Intersistemi Background The increasing prevalence and associated cost of treating chronic obstructive pulmonary disease ( COPD ) is unsustainable , and focus is needed on self-management and prevention of hospital admissions . Telehealth monitoring of patients ’ vital signs allows clinicians to prioritise their workload and enables patients to take more responsibility for their health . This paper reports the results of a pilot r and omised controlled trial ( RCT ) of Telehealth-supported care within a community-based COPD supported-discharge service . Methods A two-arm pragmatic pilot RCT was conducted comparing the st and ard service with a Telehealth-supported service and assessed the potential for progressing into a full RCT . The co- primary outcome measures were the proportion of COPD patients readmitted to hospital and changes in patients ’ self-reported quality of life . The objectives were to assess the suitability of the methodology , produce a sample size calculation for a full RCT , and to give an indication of cost-effectiveness for both pathways . Results Sixty three participants were recruited ( n = 31 St and ard ; n = 32 Telehealth ) ; 15 participants were excluded from analysis due to inadequate data completion or withdrawal from the Telehealth arm . Recruitment was slow with significant gaps in data collection , due predominantly to an unanticipated 60 % reduction of staff capacity within the clinical team . The sample size calculation was guided by estimates of clinical ly important effects and COPD readmission rates derived from the literature . Descriptive analyses showed that the st and ard service group had a lower proportion of patients with hospital readmissions and a greater increase in self-reported quality of life compared to the Telehealth-supported group . Telehealth was cost-effective only if hospital admissions data were excluded . Conclusions Slow recruitment rates and service reconfigurations prevented progression to a full RCT . Although there are advantages to conducting an RCT with data collection conducted by a frontline clinical team , in this case , challenges arose when re sources within the team were reduced by external events . Gaps in data collection were resolved by recruiting a research nurse . This study reinforces previous findings regarding the difficulty of undertaking evaluation of complex interventions , and provides recommendations for the introduction and evaluation of complex interventions within clinical setting s , such as prioritisation of research within the clinical remit . Trial registration Current Controlled Trials IS RCT N68856013 , registered Nov 2010 Self-management strategies improve a variety of health-related outcomes for patients with chronic obstructive pulmonary disease ( COPD ) . These strategies , however , are primarily design ed to improve chronic disease management and have not focused on early detection and early treatment of exacerbations . In COPD , the majority of exacerbations go unreported and treatment is frequently delayed , result ing in worsened outcomes . Therefore , a r and omised clinical trial was design ed to determine whether integration of self-management education with proactive remote disease monitoring would improve health-related outcomes . A total of 40 Global Initiative for Chronic Obstructive Lung Disease stage 3 or 4 COPD patients were r and omised to receive proactive integrated care ( PIC ) or usual care ( UC ) over a 3-month period . The primary and secondary outcomes were change in quality of life , measured by the St George ’s Respiratory Question naire ( SGRQ ) , and change in healthcare costs . PIC dramatically improved SGRQ by 10.3 units , compared to 0.6 units in the UC group . Healthcare costs declined in the PIC group by US$ 1,401 , compared with an increase of US$ 1,709 in the UC group , but this was not statistically significant . PIC uncovered nine exacerbations , seven of which were unreported . Therefore , proactive integrated care has the potential to improve outcomes in chronic obstructive pulmonary disease patients through effects of self-management , as well as early detection and treatment of exacerbations Background A home based tele-monitoring system was developed to assess the effects of heat stress ( days > 25 ° C ) on clinical and functional status in patients with chronic obstructive pulmonary disease ( COPD ) . Methods Sixty-two COPD patients ( GOLD II – IV ) were r and omized into a tele-monitoring Group ( TG , N = 32 ) or Control Group ( CG , N = 30 ) . Tele-monitoring included 1 ) daily clinical status ( COPD Assessment Test-CAT ) , 2 ) daily lung function and 3 ) weekly 6-minute walk test ( 6MWT ) . Duration of monitoring lasted a total of nine months ( 9 M ) . Results From June 1st – August 31st 2012 , 32 days with heat stress ( 29.0 ± 2.5 ° C ) were recorded and matched with 32 thermal comfort days ( 21.0 ± 2.9 ° C ) . During heat stress , the TG showed a significant reduction in lung function and exercise capacity ( FEV1 % predicted : 51.1 ± 7.2 vs. 57.7 ± 5.0 % ; P < 0.001 and 6MWT performance : 452 ± 85 vs. 600 ± 76 steps ; P < 0.001 ) and increase in CAT scores ( 19.2 ± 7.9 vs. 16.2 ± 7.2 ; P < 0.001).Over summer , significantly fewer TG patients suffered exacerbation of COPD compared to CG patients ( 3 vs. 14 ; P = 0.006 ) . Over entire 9 M follow-up , the TG group had fewer exacerbations compared to CG ( 7 vs. 22 ; P = 0.012 ) , shorter cumulative hospital stay ( 34 vs. 97 days ) and 43 % fewer specialist consultations ( 24 . vs. 42 ; P = 0.04 ) . Conclusion Heat stress affects clinical and functional status in COPD . Tele-monitoring reduces exacerbation frequency and health care utilization during heat stress and other periods of the year . Trial registration DRKS-ID : DRK00000705 BACKGROUND Remote in-home monitoring ( RM ) of symptoms and physiological variables may allow early detection and treatment of exacerbations of chronic obstructive pulmonary disease ( COPD ) . It is unclear whether RM improves patient outcomes or healthcare re source utilization . This study determined whether RM is feasible in patients with COPD and if RM  reduces hospital admissions or length of stay ( LOS ) or improves health-related quality of life ( HRQOL ) . SUBJECTS AND METHODS Forty-four patients were r and omized to st and ard best practice care ( SBP ) ( n=22 ) or SBP+RM ( n=22 ) . RM involved daily recording of physiological variables , symptoms , and medication usage . RESULTS There were no differences ( mean±SD , SBP versus SBP+RM ) in age ( 68±8 versus 70±9 years ) , gender ( male : female 10:12 in both groups ) , or previous computer familiarity ( 59 % versus 50 % ) between groups . The SBP group had a lower forced expiratory volume in 1 s ( 0.66±0.24 versus 0.91±0.34 L , p<0.01 ) and more current smokers ( six versus none , p<0.05 ) . There were no differences in number of COPD -related admissions/year ( 1.5±1.8 versus 1.3±1.7 , p=0.76 ) , COPD -related LOS days/year ( 15.6±19.4 versus 11.4±19.6 , p=0.66 ) , total admissions/year ( 2.2±2.1 versus 2.0±2.3 , p=0.86 ) , total LOS days/year ( 22.1±29.9 versus 21.6±30.4 , p=0.88 ) , or HRQOL between the two groups . CONCLUSIONS The addition of RM to SBP was feasible but did not reduce healthcare utilization or improve quality of life in this group of patients already receiving comprehensive respiratory care The purpose of this study was to compare the performance of measures of health-related quality of life in a r and omized controlled trial of respiratory rehabilitation versus conventional community care for patients with chronic airflow limitation . The study included 89 stable patients with moderate to severe chronic airflow limitation with measurement of health status at 12 , 18 , and 24 weeks . Outcomes included two disease-specific ( the Oxygen Cost Diagram and the Chronic Respiratory Question naire [ CRQ ] ) measures , a generic health profile ( the Sickness Impact Profile [ SIP ] ) , and two utility measures ( the St and ard Gamble and the Quality of Well-Being index [ QWB ] ) . Of the measures , only the four domains of the CRQ ( dyspnea , fatigue , mastery , and emotional function ) showed statistically significant differences ( P < or = 0.05 ) between treatment and control groups . Correlation between change in the CRQ and change in other relevant measures , including the 6-minute walk test and global ratings of change in dyspnea , fatigue , and emotional function were generally weak to moderate ( from 0.19 to 0.51 ) . All correlations between change in the QWB , SIP , and St and ard Gamble and other measures were very weak or weak ( up to 0.30 ) . Correlation between change in the three generic measures were all very weak ( < 0.15 ) . The results suggest that unless investigators include responsive and valid disease-specific measures of health-related quality of life in controlled trials in chronic diseases , they risk misleading conclusions about the effect of treatments on health status We conducted a six-month r and omised controlled trial of home telemonitoring for patients with chronic obstructive pulmonary disease ( COPD ) . A total of 40 stable patients with moderate to severe COPD who had completed pulmonary rehabilitation took part . They were r and omised to receive st and ard care ( controls ) or st and ard care plus home telemonitoring ( intervention ) . During the monitoring period , patients in the telemonitoring group recorded their symptoms and physical observations twice daily . The data were transmitted automatically at night via the home telephone line . Nurses could access the data through a website and receive alerting email messages if certain conditions were detected . The patients completed the St George 's Respiratory Question naire , Hospital Anxiety and Depression and the EuroQoL EQ-5D quality of life scores before and after pulmonary rehabilitation , and then periodically during the trial . There were significant and clinical ly important improvements in the scores immediately following pulmonary rehabilitation , but thereafter there were no differences in quality of life scores between the groups at any time , or consistently within either group over time . The study showed that telemonitoring was safe but , despite being well used , it was not associated with changes in quality of life in patients who had stable COPD We studied whether preventive home monitoring of patients with chronic obstructive pulmonary disease ( COPD ) could reduce the frequency of hospital admissions and lower the cost of hospitalization .  Patients were recruited from a health centre , general practitioner ( GP ) or the pulmonary hospital ward . They were r and omized to usual care or tele-rehabilitation  with a telehealth monitoring device installed in their home for four months . A total of 111 patients were suitable for inclusion and consented to be r and omized : 60 patients were allocated to intervention and three were lost to follow-up . In the control group 51 patients were allocated to usual care and three patients were lost to follow-up . In the tele-rehabilitation group , the mean hospital admission rate was 0.49 per patient per 10 months compared to the control group rate of 1.17 ; this difference was significant ( P = 0.041 ) . The mean cost of admissions was € 3461 per patient in the intervention group and € 4576 in the control group ; this difference was not significant . The Kaplan-Meier estimates for time to hospital admission were longer for the intervention group than the controls , but the difference was not significant . Future work requires large-scale studies of prolonged home monitoring with more extended follow-up We conducted a systematic review of the evidence on the costs and cost-effectiveness of telehealth for patients with chronic obstructive pulmonary disease ( COPD ) . A literature search identified six relevant economic evaluations that were assessed according to the Consensus Health Economic Criteria list ( CHEC list ) . Three studies were from North America and three studies were from Europe . All studies reported the use of home monitoring devices that measured and transmitted different physical indicators to nurses who provided personalised feedback to patients during weekdays . The six studies involved a total of 559 COPD patients of whom 281 were r and omised to telehealth .  The review demonstrated a potential for cost savings . All six studies reported a lower average cost per patient with telehealth plus usual care compared with usual care alone . However , the quality of the economic evidence was poor . Five studies were evaluated as low quality and one study was evaluated as moderate quality , with CHEC list scores of 21–68 % . Caution is advised for healthcare decision-makers seeking large-scale implementation of telehealth in routine clinical practice . The clinical effectiveness of such implementations with follow-up exceeding 12 months has not yet been demonstrated BACKGROUND AND OBJECTIVE Telemedicine , care provided by electronic communication , may serve as an alternative or extension to traditional outpatient visits . This pilot study determined the effects of telemedicine on health-care utilization and health status of chronic obstructive pulmonary disease ( COPD ) patients . METHODS One hundred and one patients were r and omized , 52 patients received telemedicine care and 49 had traditional outpatient visits . The primary outcome was COPD -specific health status , measured with the Clinical COPD Question naire ( CCQ ) . Secondary outcomes included St. George 's Respiratory Question naire ( SGRQ ) and the Short Form-36 ( SF-36 ) and re source use in primary and secondary care . RESULTS The mean age of the participants was 68 ± 9 years and the mean per cent of predicted forced expiratory volume in 1 s was 40.4 ± 12.5 . The CCQ total score deteriorated by 0.14 ± 0.13 in the telemedicine group , and improved by -0.03 ± 0.14 in the control group ( difference 0.17 ± 0.19 , 95 % confidence interval ( CI ) : -0.21 - 0.55 , P = 0.38 ) . The CCQ symptom domain showed a significant and clinical ly relevant difference in favour of the control group , 0.52 ± 0.24 ( 95 % CI : 0.04 - 0.10 , P = 0.03 ) . Similar results were found for the SGRQ , whereas results for SF-36 were inconsistent . Patients in the control group had significantly fewer visits to the pulmonologist in comparison to patients in the telemedicine group ( P = 0.05 ) . The same trend , although not significant , was found for exacerbations after 6 months . CONCLUSIONS This telemedicine model of initiated phone calls by a health-care provider had a negative effect on health status and re source use in primary and secondary care , in comparison with usual care and therefore can not be recommended in COPD patients in its current form ABSTRACT Aim . To see if home telemonitors reduce healthcare use in those with optimized chronic obstructive pulmonary disease ( COPD ) . Methods . We r and omized 40 stable patients with moderate to severe COPD , who had completed at least 12 sessions of outpatient pulmonary rehabilitation ( PR ) , to receive st and ard care ( Controls ) for 52 weeks or st and ard care plus Docobo HealthHUB monitors at home for 26 weeks followed by 26 weeks st and ard care ( Tm Group ) . During the monitoring period , the Tm Group completed  symptoms and physical observations  twice daily which were stored and then uploaded at 2 am through a freephone l and line . Nurses could access the data through a secure web site and received alerting e-mails if certain combinations of data occurred . Results . There were fewer primary care contacts for chest problems ( p < 0.03 ) in the Tm group , but no differences between the groups in emergency room visits , hospital admissions , days in hospital or contacts to the specialist COPD community nurse team , during the monitoring period . After the monitors were removed , there were no differences between the groups for any of the health care contacts ( p > 0.20 throughout ) . Conclusion . In stable , optimized COPD patients who have already completed PR , telemonitoring in addition to best care , reduces primary care chest contacts but not hospital or specialist team utilization OBJECTIVE To determine if self-monitoring via home-based telehealth equipment could , when combined with ongoing remote monitoring by a nurse , reduce the incidence of hospitalizations and emergency department ( ED ) presentations for people with chronic obstructive pulmonary disease ( COPD ) . SUBJECTS AND METHODS A r and omized controlled trial was used to compare the outcomes for participants receiving the telehealth equipment and monitoring  with those for participants in an information-only control group  , over a period of 6 months . Participants receiving the telehealth intervention were taught to measure and record their vital signs ( blood pressure , weight , temperature , pulse , and oxygen saturation levels ) on a daily basis . These were then transmitted automatically via telephone to a secure Web site where they were monitored each day by the telehealth nurse . RESULTS The telehealth group had fewer ED presentations and hospital admissions and a reduced length of stay in comparison with the control group . These results were not statistically significant . However , the reduction in health service use was large enough to result in significant cost savings , with the annual cost savings of the telehealth group compared with the control group being $ 2,931 per person . CONCLUSIONS Telehealth monitoring of patient vital signs reduced health service utilization for individuals with COPD and result ed in significant cost savings . In terms of individual health benefits , improvements in participants ' self-management behaviors and control over their condition was evident Objective : First , to investigate the effects of a telerehabilitation intervention on health status and activity level of patients with Chronic Obstructive Pulmonary Disease ( COPD ) , compared to usual care . Second , to investigate how patients comply with the intervention and whether compliance is related to treatment outcomes . Design : a r and omized controlled pilot trial Subjects : Thirty-four patients diagnosed with COPD . Intervention : The telerehabilitation application consists of an activity coach ( 3D-accelerometer with smartphone ) for ambulant activity registration and real-time feedback , complemented by a web portal with a symptom diary for self-treatment of exacerbations . The intervention group used the application for 4 weeks . The control group received usual care . Main measures : Activity level measured by a pedometer ( in steps/day ) , health status by the Clinical COPD Question naire at baseline and after intervention . Compliance was expressed as the time the activity coach was worn . Results : Fourteen intervention and 16 control patients completed the study .  Activity level ( steps/day ) was not significantly affected by the intervention over time . There was a non-significant difference in improvement in health status between the intervention ( −0.34±0.55 ) and control group ( 0.02±0.57 , p=0.10 ) . Health status significantly improved within the intervention group ( p=0.05 ) . The activity coach was used more than prescribed ( 108 % ) and compliance was related to the increase in activity level for the first two feedback weeks ( r=0.62 , p=0.03 ) . Conclusions : This pilot study shows the potential of the telerehabilitation intervention : compliance with the activity coach was high , which directly related to an improvement in activity levels
target: Subgroup analysis showed that telemonitoring reduced exacerbation rates when the intervention continued for longer than six months or pulmonary function was monitored .
  Conclusions Telemonitoring for chronic obstructive pulmonary disease was unlikely to result in statistically significant improvements in health outcomes .
  However , our novel finding was that at least six months of intervention duration and monitoring of pulmonary function play roles in activating the effects of telemonitoring
background: Aims The purpose of this research was to investigate the effectiveness of telemonitoring for chronic obstructive pulmonary disease .