Taking Charge After Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Feasibility Trial of a Psychologically Informed Self-Management Intervention

Abstract

William MM Levack,1 Mark Weatherall,1 Harry K McNaughton,2 Amanda A McNaughton,2 Anna Hobman,1 Bernadette Jones,1 Tristram R Ingham,1 James Fingleton3 1Department of Medicine, University of Otago, Wellington, New Zealand; 2Medical Research Institute of New Zealand, Wellington, New Zealand; 3Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New ZealandCorrespondence: William MM Levack, Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, 6242, New Zealand, Tel [phone], Email [email protected]: Few interventions improve outcomes for people with Chronic Obstructive Pulmonary Disease (COPD), particularly higher risk groups such as those admitted to hospital with an acute exacerbation of COPD (AECOPD). The aim of the study was to test the feasibility and acceptability of a modified version of the Take Charge program in people after AECOPD and to determine the potential to improve self-reported limitations, health-related quality of life and reduce future hospitalizations.Patients and Methods: A prospective, parallel group randomized trial with blinded endpoint assessment. Participants had been discharged from hospital with a diagnosis of AECOPD and were randomized to receive either a single 60– 90 minute session of “Take Charge for COPD” from a trained facilitator in their own home or usual care. Take Charge is a “talking therapy” that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the rate of moderate or severe episodes of AECOPD in the subsequent 12 months.Results: Fifty-six people were randomized (study target 60): predominantly European (71%), female (61%), older (mean [SD] age 70 [11] years), and non-smokers (89%). Charlson Comorbidity Index mean (SD) score was 2.3 (1.6) indicating mild to moderate comorbidity severity. There were 85 moderate or severe AECOPD episodes in the 12 months after the index admission for the Take Charge participants and 84 episodes in the control group (relative rate 0.93; 95% confidence interval (CI) 0.69 to 1.26). COPD Clinical Questionnaire (CCQ) scores were significantly lower (better) in the Take Charge group (mean difference − 1.26; 95% CI − 2.06 to − 0.45).Conclusion: The Take Charge intervention proved feasible with a population of people recently discharged from hospital with AECOPD. The direction of change in the primary outcome and some secondary outcomes suggest that an adequately powered study is justified.Keywords: COPD, self-management, Take Charge, randomized controlled trial

Keywords

• copd
• self-management
• rehospitalization
• self-efficacy
• taking charge