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The effects of a video intervention on post-hospitalization pulmonary rehabilitation uptake: a randomized controlled trial.

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Title: The effects of a video intervention on post-hospitalization pulmonary rehabilitation uptake: a randomized controlled trial.
Authors: Barker, RE
Jones, SE
Banya, W
Fleming, S
Kon, SSC
Clarke, SF
Nolan, CM
Patel, S
Walsh, JA
Maddocks, M
Farquhar, M
Bell, D
Wedzicha, JA
Man, WD-C
Item Type: Journal Article
Abstract: RATIONALE: Pulmonary rehabilitation following hospitalizations for exacerbations of chronic obstructive pulmonary disease (COPD) improves exercise capacity and health-related quality of life, and reduces readmissions. However, post-hospitalization pulmonary rehabilitation uptake is low. To date, no trials of interventions to increase uptake have been conducted. OBJECTIVE: Effect of a co-designed education video as an adjunct to usual care on post-hospitalization pulmonary rehabilitation uptake. METHODS: An assessor- and statistician-blinded randomized controlled trial with nested qualitative interviews of participants in the intervention group. Participants hospitalized with COPD exacerbations were assigned 1:1 to receive either usual care (COPD discharge bundle including pulmonary rehabilitation information leaflet) or usual care plus the co-designed education video delivered via a handheld tablet device at discharge. Randomization used minimization to balance age, sex, forced expiratory volume in 1 second (FEV1) % predicted, frailty, transport availability and previous pulmonary rehabilitation experience. MEASUREMENTS AND MAIN RESULTS: The primary outcome was pulmonary rehabilitation uptake within 28 days of hospital discharge. 200 patients were recruited with 196 randomized (51% female, median (interquartile range) FEV1 % predicted 36(27, 48)). Pulmonary rehabilitation uptake was 41% and 34% in the usual care and intervention groups respectively (p=0.37), with no differences in secondary (pulmonary rehabilitation referral and completion) or safety (readmissions and death) endpoints. Six of the fifteen participants interviewed could not recall receiving the video. CONCLUSION: A co-designed education video delivered at hospital discharge did not improve post-hospitalization pulmonary rehabilitation uptake, referral or completion. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Issue Date: 15-Jun-2020
Date of Acceptance: 16-Mar-2020
URI: http://hdl.handle.net/10044/1/79108
DOI: 10.1164/rccm.201909-1878OC
ISSN: 1073-449X
Publisher: American Thoracic Society
Start Page: 1517
End Page: 1524
Journal / Book Title: American Journal of Respiratory and Critical Care Medicine
Volume: 201
Issue: 12
Copyright Statement: © 2020 by the American Thoracic Society. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/). For commercial usage and reprints, please contact Diane Gern (dgern@thoracic.org).
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: N/A
Keywords: Pulmonary Disease; Chronic Obstructive; hospitalization; rehabilitation
Pulmonary Disease; Chronic Obstructive; hospitalization; rehabilitation
11 Medical and Health Sciences
Respiratory System
Publication Status: Published
Conference Place: United States
Online Publication Date: 2020-03-17
Appears in Collections:National Heart and Lung Institute
National Heart and Lung Institute
Faculty of Medicine
School of Public Health