Frontiers in Public Health (Oct 2015)
The feasibility of a home-based sedentary behaviour intervention for hospitalised chronic obstructive pulmonary disease (COPD) patients: Sitting and ExacerbAtions Trial (COPD-SEAT)
Abstract
Introduction Chronic Obstructive Pulmonary Disease (COPD) is characterised by persistent airflow limitation. After an acute exacerbation of COPD, pulmonary rehabilitation is offered to patients typically 4 weeks after hospital discharge (McCarthy et al., 2015). As only just over 50% of UK patients accept a referral to pulmonary rehabilitation with only 9% of these completing the program (Harrison et al., 2014) we may need to precondition patients for effective rehabilitation. Targeting sedentary behaviour, ‘any waking behaviour characterised by an energy expenditure ≤1.5 metabolic equivalents while in a sitting or reclining posture’ (Sedentary Behaviour Research Network, 2012), may provide a more palatable conduit for at-home disease management. Wearable technology, such as the LUMO posture sensor, may facilitate successful interventions at home (Chiauzzi, Rodarte, & DasMahapatra, 2015). The LUMO provides validated (Rosenberger, Buman, Haskell, McConnell, & Carstensen, 2015) real-time feedback on sitting, standing and walking via a mobile application; prompting the wearer to stop sitting by gently vibrating on the lower back after a pre-defined period of consecutive sitting (e.g. 30 minutes). These self-monitoring and feedback features are well-supported behaviour change techniques (Michie, Abraham, Whittington, McAteer, & Gupta, 2009; Gardiner, Smith, Lorencatto, Hamer, & Biddle, 2015). Aims COPD-SEAT will assess (i) the feasibility of implementing a home-based sedentary behaviour program using self-monitoring wearable technology; (ii) the acceptability of the intervention among patients and health professionals; and (iii) the short-term effectiveness of the intervention in reducing prolonged periods of sedentary behaviour. Methods Up to 60 COPD patients will be randomly stratified into three groups (1:1:1): Usual Care, Education, and Feedback. Additional to their usual care, the Education and Feedback groups will receive verbal and written information (adapted from Gardiner and colleagues (2014)) during hospital admission which will provide suggestions for reducing sedentary time and breaking up prolonged periods of sitting with standing and/or light activity. The Feedback group will also receive real-time feedback and vibration prompts from the LUMO at home. Physical activity and sedentary behaviour at home will be measured following discharge using waist-worn accelerometry and the LUMO, respectively, for 28 days. Within existing sedentary behaviour interventions, there is a lack of strong evidence of ‘what works’ and ‘why’ (Gardiner, Smith, Lorencatto, Hamer, & Biddle, 2015). A process evaluation will thus be conducted using a combination of ethnographic methods including observations of usual care, interviews and audio recordings of intervention delivery. Results Primary outcomes of the trial will focus on the feasibility of the trial implementation (e.g. uptake, refusal and acceptability); delivery (e.g. patient burden, time commitments and consistency) and completeness (e.g. monitor compliance, missing data and follow-up attendance). For the Feedback group, engagement with the LUMO application will be assessed using Flurry analytics; providing time-stamped user interactions with the LUMO application such as screen-time for feedback panels (e.g. step count or sit-stand transitions). These analytics will supplement the feedback group patient interviews which will examine experiences of the intervention for both the educational and LUMO components (e.g. the vibration prompts and clarity of the visual feedback). Education group patient interviews will explore experiences of the intervention regarding the educational information provided (e.g. barriers to performing the tips to reduce sitting and patient understanding of the information). All interviews will explore patient perceptions on the timing and duration of the intervention in the context of their recovery from an exacerbation of COPD. Secondary outcomes will include changes in sedentary behaviour and physical activity across groups as well as any alterations in physical function (e.g. 20m gait analysis, short physical performance battery and fear of falling), symptoms (e.g. breathlessness, anxiety and depression) and body composition (e.g. body mass index and waist circumference). Conclusion COPD-SEAT will be one of the first trials aimed at reducing sedentary behaviour at home in patients hospitalised for an acute exacerbation of COPD. This trial will provide valuable insight into the feasibility of implementing an at-home technology-based feedback intervention for reducing sedentary behaviour into patients existing care. Findings will inform a future large-scale trial acting as an adjuvant to pulmonary rehabilitation.
Keywords
