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Everyday technology and assistive technology supporting everyday life activities in adults living with COPD - a narrative literature review
Disability and Rehabilitation: Assistive Technology
Abstract
Introduction: People living with chronic obstructive pulmonary disease (COPD) encounter challenges in everyday life activities due to symptoms like breathlessness and fatigue. Compensatory strategies, such as using everyday technology (mechanical, electronic and digital equipment and functions encountered daily) and assistive technology (products, instruments, or equipment adapted or designed to improve functioning of people with disabilities), are crucial for supporting everyday life activities; thus, it is essential to explore therapeutic potentials of these technologies. The present review aims to synthesise research literature concerning the use of everyday technology and assistive technology to support everyday activities among persons living with COPD. Methods: A narrative review was conducted with a systematic search in five bibliographic databases. Three sets of search terms were used: (i) everyday technology, assistive technology, and related terms, (ii) everyday life activities and related terms, and (iii) chronic obstructive pulmonary disease and related terms. Results: Screening resulted in 26 included articles.Following the American Occupational Therapy Association framework, the identified articles show six categories of everyday life activities supported by everyday technologies and assistive technologies: health management, social participation, activities of daily living, instrumental activities of daily living, leisure, and rest and sleep. Conclusion: Most articles focus on everyday technology for health management; however, everyday technology may hold unexpected potential to support a broader array of everyday life activities. Little is known about assistive technology to support everyday life activities for people with COPD, though it is described as crucial for independence and energy conservation.
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(1) Background: Digital medicine is developing in the management of chronic diseases in older people, but there is still a lack of information on the use of disease management apps in older patients with COPD. This study aims to explore the views and experience of older patients with COPD on disease management apps to provide a basis for the development and promotion of apps for geriatric diseases. (2) Methods: A descriptive qualitative research method was used. Older patients with COPD (N = 32) with experience using disease management apps participated in semi-structured interviews. Thematic analysis was used to analyze the data. (3) Results: Seven themes were defined: (a) feeling curious and worried when facing disease management apps for the first time; (b) actively overcoming barriers to use; (c) gradually becoming independent by continuous online learning; (d) feeling safe in the virtual environment; (e) gradually feeling new value in online interactions; (f) relying on disease management apps under long-term use; (g) expecting disease management apps to meet personalized needs. (4) Conclusions: The adoption and use of disease management apps by older people is a gradual process of acceptance, and they can obtain a wide range of benefits in health and life.
Background
Patients with chronic obstructive pulmonary disease (COPD) often do not seek care until they experience an exacerbation. Improving self-management for these patients may increase health-related quality of life and reduce hospitalizations. Patients are willing to use wearable technology for real-time data reporting and perceive mobile technology as potentially helpful in COPD management, but there are many barriers to the uptake of these technologies.
Objective
We aimed to understand patients’ experiences using a wearable and mobile app and identify areas for improvement.
Methods
We conducted semi-structured interviews as part of a larger prospective cohort study wherein patients used a wearable and app for 6 months. We asked which features patients found accessible, acceptable and useful.
Results
We completed 26 interviews. We summarized our research findings into four main themes: (1) information, support and reassurance, (2) barriers to adoption, (3) impact on communication with health care providers, and (4) opportunities for improvement. Most patients found the feedback received through the app to be reassuring and useful. Some patients experienced technical difficulties with the app and found the wearable to be uncomfortable.
Conclusions
Patients found a wearable device and mobile application to be acceptable and useful for the management of COPD. We identified barriers to adoption and opportunities for improvement to the design of our app. Further research is needed to understand what people with COPD and their healthcare providers want and will use in a mobile app and wearable for COPD management.
Objectives
Investigate how people with chronic obstructive pulmonary disease (COPD)—an example of a progressive, potentially fatal illness—are using digital technologies (DTs) to address illness experiences, outcomes and social connectedness.
Materials and Methods
A transformative mixed methods study was conducted in Canada with people with COPD (n = 77) or with a progressive lung condition (n = 6). Stage-1 interviews (n = 7) informed the stage-2 survey. Survey responses (n = 80) facilitated the identification of participants for stage-3 interviews (n = 13). The interviews were thematically analyzed. Descriptive statistics were calculated for the survey. The integrative mixed method analysis involved mixing between and across the stages.
Results
Most COPD participants (87.0%) used DTs. However, few participants frequently used DTs to self-manage COPD. People used DTs to seek online information about COPD symptoms and treatments, but lacked tailored information about illness progression. Few expressed interest in using DTs for self- monitoring and tracking. The regular use of DTs for intergenerational connections may facilitate leaving a legacy and passing on traditions and memories. Use of DTs for leisure activities provided opportunities for connecting socially and for respite, reminiscing, distraction and spontaneity.
Discussion and Conclusion
We advocate reconceptualizing consumer health technologies to prioritize quality of life for people with a progressive, potentially fatal illness. “Quality of life informatics” should focus on reducing stigma regarding illness and disability and taboo towards death, improving access to palliative care resources and encouraging experiences to support social, emotional and mental health. For DTs to support people with fatal, progressive illnesses, we must expand informatics strategies to quality of life.
Background
The use of information technology can make pulmonary rehabilitation interventions in people with chronic obstructive pulmonary disease (COPD) more flexible and thereby has the potential to reach a larger proportion of the population. However, the success of using information technology in pulmonary rehabilitation is dependent on the end-user’s competence in information technology and access to the Internet. The aim was to describe the access to, and the use, knowledge, and preferences of information technology and technical equipment among people with COPD.
Methods
Telephone interviews were conducted using a standardised questionnaire on information technology and technical devises addressing the household, access to and usage of the Internet, contact with authorities, e-commerce, security, the workplace, digital competence, and disabilities. Questions were also posed regarding participants’ views on a future eHealth tool for COPD, appropriate content, and the potential likelihood for them to use an eHealth tool for exercise training.
Results
In total 137 persons agreed to participate, 17 dropped out resulting in 120 included participants (response rate 88%). The participants (86 women) were aged 51 to 92 years (mean: 72.5), and all severity grades of COPD according to GOLD A-D were represented. Over 90% had access to the Internet. Smartphones were used by 81%, and over 90% used apps. Participants had high knowledge of how to use the Internet, 91% had used the Internet during the last 3 months, 85% almost every day. The most common requests for a future eHealth tool for COPD were evidence-based and trustworthy information on COPD, (including medication, exercise training, inhalation and breathing techniques), communication (chat) with others and with health carers. Access to individually adjusted exercise training, and support, (motivation via prompts, chat rooms, digital information board) was also desired.
Conclusions
The present study showed that people with COPD in Sweden have high access and ability to use the Internet and information technology. They are frequent users and most of them take part in the digital society, even to a higher extent than the general population. The results show that the use of an eHealth tool could be a suitable strategy for people with COPD.
Background
People with chronic obstructive pulmonary disease (COPD) are stigmatized by smoking history. Although little is known about COPD-related stigma, it can adversely affect self-management and quality of life.
Objective
To synthesize relevant scientific literature exploring stigma experiences and their impacts on people with COPD.
Methods
CINAHL/PsycINFO/PubMed/Scopus were searched for relevant studies. Findings were organized using Major et al’s conceptual model.
Results
Fifteen studies documented COPD-related stigma processes: enacted, felt, internalized, and anticipated. Moderating factors included visibility, origin, and illness perception. Individual-level stigma responses included emotional distress, limited social interactions, and negative effects on medication adherence and help-seeking. Social/community-level stigma experiences included healthcare provider and employer behaviors. Smoking is interwoven throughout all domains of stigma processes and responses to stigma.
Conclusion
Substantial evidence documents processes, moderating factors, and individual and social/community responses to the complex phenomenon of COPD-related stigma; however, prevalence of COPD-related stigma and its health effects are unclear.
Background:
Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement.
Objective:
The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial.
Methods:
The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires.
Results:
This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20%) withdrew before the end of the study, whereas 3 (2.5%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected.
Conclusions:
This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement.
International registered report identifier (irrid):
RR2-10.2196/22125.
Background
Living with chronic obstructive pulmonary disease stage III or IV has a major impact on a person's everyday life. This qualitative study focuses on women with chronic obstructive pulmonary disease stage III or IV.
Aim
The aim of this study was to describe women's experiences of living with chronic obstructive pulmonary disease stage III or IV.
Method
A purposive sample of fifteen women with chronic obstructive pulmonary disease stage III or IV participated in the study. Data were collected through individual semi-structured interviews that were subjected to qualitative content analysis.
Findings
One theme was identified, stabilizing an ever-present breathlessness by restoring strength, and three categories are as follows: managing a restricted everyday life as an expert of their illness, being afraid of contracting infections leading to suffocation and suffering and importance of continuous help and support from significant others and digital media. Breathlessness restricted women with chronic obstructive pulmonary disease, living with a body they have to wait for. Managing everyday life was adapted to their limited abilities and energy. This required detailed planning, good knowledge of their breathing and body. Women were afraid of contracting life-threatening infections that caused suffering, especially COVID-19. The fear leads to isolation and digital media was described as an important means of communication. Significant others gave support and help that was practical and emotional. Women with chronic obstructive pulmonary disease experienced lack of continuous help and support from healthcare professionals.
Conclusion
Stabilizing an ever-present breathlessness by restoring strength required women with chronic obstructive pulmonary disease stage III or IV to conduct detailed planning to manage everyday life. Being afraid of contracting infections and the consequences of suffocation had increased since the pandemic COVID-19 outbreak, which led to self-isolation and an inactive everyday life. To get help, support and socialize, women used digital media.
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
Background
Self-management strategies are regarded as highly prioritized in chronic obstructive pulmonary disease (COPD) treatment guidelines. However, individual and structural barriers lead to a staggering amount of people with COPD that are not offered support for such strategies, and new approaches are urgently needed to circumvent these barriers. A promising way of delivering health services such as support for self-management strategies is the use of eHealth tools. However, there is a lack of knowledge about the usage of, and factors affecting the use of, eHealth tools over time in people with COPD.
Objective
This study aimed, among people with COPD, to explore and describe the experiences of an eHealth tool over time and factors that might affect usage.
Methods
The eHealth tool included information on evidence-based self-management treatment for people with COPD, including texts, pictures, videos as well as interactive components such as a step registration function with automatized feedback. In addition to the latter, automated notifications of new content and pedometers were used as triggers to increase usage. After having access to the tool for 3 months, 16 individuals (12 women) with COPD were individually interviewed. At 12 months’ access to the tool, 7 (5 women) of the previous 16 individuals accepted a second individual interview. Data were analyzed using qualitative content analysis. User frequency was considered in the analysis, and participants were divided into users and nonusers/seldom users depending on the number of logins and minutes of usage per month.
ResultsThree main categories, namely, ambiguous impact, basic conditions for usage, and approaching capability emerged from the analysis, which, together with their subcategories, reflect the participants’ experiences of using the eHealth tool. Nonusers/seldom users (median 1.5 logins and 1.78 minutes spent on the site per month) reported low motivation, a higher need for technical support, a negative view about the disease and self-management, and had problematic health literacy as measured by the Communicative and Critical Health Literacy Scale (median [range] 154 [5-2102]). Users (median 10 logins and 43 minutes per month) felt comfortable with information technology (IT) tools, had a positive view on triggers, and had sufficient health literacy (median [range] 5 [5-1400]). Benefits including behavior changes were mainly expressed after 12 months had passed and mainly among users.
Conclusions
Findings of this study indicate that the level of motivation, comfortability with IT tools, and the level of health literacy seem to affect usage of an eHealth tool over time. Besides, regarding behavioral changes, gaining benefits from the eHealth tool seems reserved for the users and specifically after 12 months, thus suggesting that eHealth tools can be suitable media for supporting COPD-specific self-management skills, although not for everyone or at all times. These novel findings are of importance when designing new eHealth tools as well as when deciding on whether or not an eHealth tool might be appropriate to use if the goal is to support self-management among people with COPD.
Trial RegistrationClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187
International Registered Report Identifier (IRRID)RR2-10.1136/bmjopen-2017-016851
Purpose
Evidence regarding everyday life activities in people living with COPD is limited. Such evidence can improve our understanding when designing interventions for pulmonary rehabilitation that aim at increasing or maintaining participation in these activities. The aim of this study was to describe how people living with COPD experience and manage everyday life activities.
Materials and Methods
The sample comprised four males and four females with an age ranging from 65–87 years. Participants were interviewed in their own homes regarding experiences of performing and managing everyday life activities. Data were transcribed verbatim and analysed using content analysis.
Results
Findings from this study comprised the theme “Juggling to manage everyday life activities with COPD” and three categories representing the elements of this theme: (1) consequences of COPD symptoms, (2) adjustment of activities, and (3) contextual aspects.
Conclusion
This study found the participants with COPD juggling the management of everyday life activities. The juggle generated a manageable daily life, which came at the expense of making deliberate choices and prioritizing everyday life activities that were necessary for participation in valued and engaging activities in order to maintain health and well-being.
•
Implications for Rehabilitation
• People living with COPD experience a complex juggling between the consequences of COPD symptoms and contextual aspects when managing everyday life activities.
• The participants had largely accepted their disease and adjusted to their situation.
• The disease was still described as frustrating and generated less focus on making deliberate choices and prioritizing everyday life activities that are necessary for participation in valued and engaging activities.
• Health professionals need to support people living with COPD in making deliberate choices in order to continue participating in valued and engaging everyday life activities as they affect health and well-being.
• Pulmonary rehabilitation should focus more on supporting participation in social relations and on using everyday technologies.
Purpose
There have been calls for more knowledge of activities of daily living (ADL) performance in order to address interventions in pulmonary rehabilitation effectively. Everyday technology (ET) has become an integrated dimension of ADL, impacting the ways in which ADL is performed. To improve everyday functioning and quality of life, the use of ADL and ET use needs to be evaluated and addressed effectively in interventions. Therefore, the aim of this study was twofold: 1) to explore the quality of ADL performance, and 2) to investigate the relationship between observation and self-reported ADL performance and ability to use everyday technologies in people living with COPD.
Methods
This cross-sectional study involved 84 participants aged 46–87 years. Participants were recruited through healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were collected using standardized assessments that investigated different ADL perspectives: self-reported ADL tasks and ET use, observed motor and process ability, and need for assistance. Data were analysed and presented using descriptive statistics and Pearson’s correlation coefficient.
Results
The most affected ADL tasks were mobility within or outside the home, lower dressing, bathing, pedicuring, cooking, shopping, cleaning and washing clothes. New insights into the quality of ADL performance in people living with COPD were presented in terms of detailed ADL motor skills and ADL process skills, as well as the predicted need for support to function in the community. Moreover, new insights into the relationship between observation and self-reported ADL performance (r=0.546, p<0.01; r=0.297, p<0.01) and between ADL performance and self-perceived ability to use ET (r=0.524, p<0.01; r=0.273, p<0.05; r=0.044, p=0.692) were presented.
Conclusion
Overall, the knowledge from the present study is valuable for focusing interventions that address challenging ADL performance and ET use through relevant and realistic activities. The ability to use ET is important to evaluate and target pulmonary rehabilitation.
Objective
The aim was to explore the experiences of a person-centred e-health intervention, in patients diagnosed with chronic obstructive pulmonary disease (COPD) or chronic heart failure (CHF).
Design
Grounded theory was applied to gather and analyse data.
Setting
The study is part of a research project evaluating the effects of person-centred care (PCC) using a digital platform and structured telephone support for people with COPD or CHF recruited from nine primary care units in Sweden.
Participants
Twelve patients from the intervention group were purposefully selected in accordance with the initial sampling criteria.
Intervention
The intervention was delivered through a digital platform and telephone support system for 6 months. The intervention relied on person-centred ethics operationalised through three core PCC components: patient narratives, partnership and shared documentation.
Results
A core category was formulated: Being welcomed through the side door when lacking the front door keys. The core category reflects how a PCC intervention delivered remotely provides access to mutual and informal meetings at times when professional contacts were desired to support patient self-management goals. According to patients’ wishes, family and friends were seldom invited as care partners in the e-health context.
Conclusions
A PCC intervention delivered remotely as a complement to standard care in a primary care setting for patients diagnosed with COPD or CHF is a viable approach to increase patients’ access and involvement in preventive care. The e-health intervention seemed to facilitate PCC, strengthen patients’ position in the health service system and support their self-management.
Patients with very severe chronic obstructive pulmonary disease (COPD) conduct their everyday lives under shortness of breath. The aim of this study was to explore telemediated exercise training to patients at home, with the conduct of everyday life as a theoretical framework. Based on ethnographic fieldwork involving a hospital, two municipalities, and homes of 11 patients from 2013 to 2017, this article shows how telemediated training became part of patients’ and partners’ everyday lives and the prioritization of time and resources for basic activities. Most of the patients found telemediated training meaningful, that it can work as an agent of hope in holding on to essential everyday life activities, but also that it may be experienced as burdensome and disciplining. The physiotherapists’ understanding of the patients’ circumstances and needs for rehabilitation changed. The article argues that telemediated training should be offered as part of a palliative approach for those severely affected by COPD.
Background
Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR).
Objective
This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness.
Methods
We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity–based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology.
Results
Overall, 47% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation.
Conclusions
mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates.
Purpose
A decline in the ability to perform activities of daily living (ADL) and ability to use everyday technology can pose threats to independent living, healthcare management and quality of life (QOL) of patients suffering from chronic obstructive pulmonary disease (COPD). Evidence of the relationship between these variables remains limited. The dual aim of this study was, first, to investigate if health-related QOL (HRQOL) was associated with quality in ADL performance and everyday technology use; second, to examine whether lung function, years with COPD diagnosis, living status or educational level affected physical and mental domains of HRQOL.
Methods
This cross-sectional study included (N=80) participants aged 46–87 years recruited at healthcare centres in the Northern Region of Denmark using a convenience sampling procedure. Data were gathered through standardized assessments and analysed using multiple regression analysis.
Results
The regression model explained 50.6% (R²=0.506) of the variation in HRQOL–physical. The following four variables were statistically significantly associated with HRQOL – physical: years since COPD diagnosis (p=0.023), ability to use everyday technology (p=0.006), amount of relevant everyday technologies (p=0.015) and ADL motor ability (p<0.01). The regression model explained 22.80% (R²=0.228) of HRQOL – mental. Only the variable ability to use everyday technology was statistically significantly associated with HRQOL – mental (p=0.009).
Conclusion
Quality of ADL performance and everyday technology use seem to be associated with HRQOL in people living with COPD. The only demographic variable associated with HRQOL was years with COPD. This indicates that healthcare professionals should enhance their attention also to ADL-performance and everyday technology use when striving to increase the HRQOL of persons living with COPD.
The primary objective of this study was to investigate the association of loneliness and the incidence of ED visits in a large and well-characterized cohort of patients with severe chronic obstructive pulmonary disease (COPD); the association of loneliness with performance measures and health perception was the secondary objective. Baseline data were used from the National Emphysema Treatment Trial (NETT), which investigated the effectiveness of lung volume reduction surgery in patients with moderate-to-severe COPD. Patients received Quality of Wellbeing questionnaires, which asked about loneliness and social isolation. For comparing baseline variables between lonely and non-lonely subjects, we used χ2 tests for categorical variables and Wilcoxon tests for continuous variables. The association of loneliness with ED visits and health perception was assessed with a logistic model that adjusted for multiple critical confounders. The study took place from December 2002, to December 2004, with a follow-up period of 5 years to assess loneliness and 24 months to assess use of the emergency department. There were 1218 patients analyzed, mean age 65 (standard deviation [SD] 12), 47% were women, FEV 1% 41 (SD 12); 7.9% of participants reported feeling lonely. These individuals had worse health ratings, 6-minute walk tests (6MWTs), and breathlessness. Loneliness was independently associated with ED visits after adjusting for age, lung function, dyspnea, 6MWT, treatment, and gender, odds ratio (OR) 1.57 (95% confidence interval [CI], 1.005-2.466), P=.04. This study suggests that loneliness in patients with COPD is significantly and independently associated to ED visits and reduced health perception. Addressing loneliness of patients with COPD in the outpatient setting may contribute to improved health perception and less health care utilization.
Background: Physical activity is an important predictor for survival in patients with COPD. Wearable technology, such as pedometer or accelerometer, may offer an opportunity to quantify physical activity and evaluate related health benefits in these patients.
Objectives: To assess the performance of wearable technology in monitoring and improving physical activity in COPD patients from published studies.
Methods: Literature search of Medline, Cochrane, Dare, Embase and PubMed databases was made to find relevant articles that used wearable technology to monitor physical activity in COPD patients.
Results: We identified 13 studies that used wearable technology, a pedometer or an accelerator, to monitor physical activity in COPD patients. Of these, six studies were randomized controlled trials (RCTs) which used the monitors as part of the intervention. Two studies reported the same outcomes and comparable units. They had measured the difference that the intervention makes on the number of steps taken daily by the patients. The results were highly heterogeneous with I²=92%. The random-effects model gave an effect outcome on the number of steps taken daily of 1,821.01 [−282.71; 3,924.74] in favor of the wearable technology. Four of the 13 studies have reported technical issues with the use of the wearable technology, including high signal-to-noise ratio, memory storage problems and inaccuracy of counts. While other studies did not mention any technical issues, it is not clear whether these did not experience them or chose not to report them.
Conclusions: Our literature search has shown that data on the use of wearable technology to monitor physical activity in COPD patients are limited by the small number of studies and their heterogeneous study design. Further research and better-designed RCTs are needed to provide reliable results before physical activity monitors can be implemented routinely for COPD patients.
Background
Narrative reviews are the commonest type of articles in the medical literature. However, unlike systematic reviews and randomized controlled trials (RCT) articles, for which formal instruments exist to evaluate quality, there is currently no instrument available to assess the quality of narrative reviews. In response to this gap, we developed SANRA, the Scale for the Assessment of Narrative Review Articles.
Methods
A team of three experienced journal editors modified or deleted items in an earlier SANRA version based on face validity, item-total correlations, and reliability scores from previous tests. We deleted an item which addressed a manuscript’s writing and accessibility due to poor inter-rater reliability. The six items which form the revised scale are rated from 0 (low standard) to 2 (high standard) and cover the following topics: explanation of (1) the importance and (2) the aims of the review, (3) literature search and (4) referencing and presentation of (5) evidence level and (6) relevant endpoint data. For all items, we developed anchor definitions and examples to guide users in filling out the form. The revised scale was tested by the same editors (blinded to each other’s ratings) in a group of 30 consecutive non-systematic review manuscripts submitted to a general medical journal.
Results
Raters confirmed that completing the scale is feasible in everyday editorial work. The mean sum score across all 30 manuscripts was 6.0 out of 12 possible points (SD 2.6, range 1–12). Corrected item-total correlations ranged from 0.33 (item 3) to 0.58 (item 6), and Cronbach’s alpha was 0.68 (internal consistency). The intra-class correlation coefficient (average measure) was 0.77 [95% CI 0.57, 0.88] (inter-rater reliability). Raters often disagreed on items 1 and 4.
Conclusions
SANRA’s feasibility, inter-rater reliability, homogeneity of items, and internal consistency are sufficient for a scale of six items. Further field testing, particularly of validity, is desirable. We recommend rater training based on the “explanations and instructions” document provided with SANRA. In editorial decision-making, SANRA may complement journal-specific evaluation of manuscripts—pertaining to, e.g., audience, originality or difficulty—and may contribute to improving the standard of non-systematic reviews.
Systematic reviews are generally placed above narrative reviews in an assumed hierarchy of secondary research evidence.
We argue that systematic reviews and narrative reviews serve different purposes and should be viewed as complementary.
Conventional systematic reviews address narrowly focused questions; their key contribution is summarising data.
Narrative reviews provide interpretation and critique; their key contribution is deepening understanding.
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Introduction
Understanding the breadth of patients’ support needs is important for the delivery of person-centered care, particularly in progressive long-term conditions such as chronic obstructive pulmonary disease (COPD). Existing reviews identify important aspects of managing life with COPD with which patients may need support (support needs); however, none of these comprehensively outlines the full range of support needs that patients can experience. We therefore sought to systematically determine the full range of support needs for patients with COPD to inform development of an evidence-based tool to enable person-centered care.
Methods
We conducted a systematic search and narrative review of the literature. Medline (Ovid), EMBASE, PsycINFO, Cochrane Library, and CINAHL were systematically searched for papers which included data addressing key aspects of support need, as identified by patients with COPD. Relevant data were extracted, and a narrative analysis was conducted.
Results
Thirty-one papers were included in the review, and the following 13 domains (broad areas) of support need were identified: 1) understanding COPD, 2) managing symptoms and medication, 3) healthy lifestyle, 4) managing feelings and worries, 5) living positively with COPD, 6) thinking about the future, 7) anxiety and depression, 8) practical support, 9) finance work and housing, 10) families and close relationships, 11) social and recreational life, 12) independence, and 13) navigating services. These 13 domains of support need were mapped to three of the four overarching categories of need commonly used in relevant national strategy documents (ie, physical, psychological, and social); however, support needs related to the fourth category (spiritual) were notably absent.
Conclusion
This review systematically identifies the comprehensive set of domains of support need for patients with COPD. The findings provide the evidence base for a tool to help patients identify and express their support needs, which underpins a proposed intervention to enable the delivery of person-centered care: the Support Needs Approach for Patients (SNAP).
Facets of participation have changed with the growing pervasiveness of digital technology in daily life. To enable older adults as active participants in an evolving digital society, it is relevant to examine how they engage in and situate digital technology-mediated occupations in daily life. Narrative inquiry was used to elucidate features in older adults’ engagement in occupations involving digital technology situated in everyday life. Analysis was based on data gathered through concurrent think aloud protocol and observations from 10 older adults in Northern Sweden. In line with narrative analysis, findings were presented as three stories about negotiating needs and values while interacting with the technological and social environments, entitled playing by the rules, being on the same wavelength, and calling the shots. Looking at these stories with an occupational lens resulted in an understanding that older adults’ participation involving digital technology likewise deals with negotiating and refining identities, as well as finding and experiencing meaning in daily life. There is potential for older adults to become active participants through digital technology, and new challenges in research and practice emerge.
As the size of the published scientific literature has increased exponentially over the past 30 years, review articles play
an increasingly important role in helping researchers to make sense of original research results. Literature reviews can
be broadly classified as either “systematic” or “narrative”. Narrative reviews may be broader in scope than systematic
reviews, but have been criticised for lacking synthesis and rigour. The submission of more scientific manuscripts requires
more researchers acting as peer reviewers, which requires adding greater numbers of new reviewers to the reviewing
population over time. However, whereas there are many easily accessible guides for reviewers of primary research
manuscripts, there are few similar resources to assist reviewers of narrative reviews. Here, I summarise why literature
reviews are valued by their diverse readership and how peer reviewers with different levels of content expertise can
improve the reliability and accessibility of narrative review articles. I then provide a number of recommendations for
peer reviewers of narrative literature reviews, to improve the integrity of the scientific literature, while also ensuring that narrative review articles meet the needs of both expert and non-expert readers.
Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition where activities of daily living (ADLs) may be very restricted; people with COPD need to prioritize what is important to them. We conducted a meta-ethnography to understand which ADLs are valued and why, systematically searching for articles including experiences of ADLs and organizing themes from the articles into five linked concepts: (a) caring for the body, (b) caring for the personal environment, (c) moving between spaces, (d) interacting with others, and (e) selfhood across time. In addition, we identified three key aspects of personal integrity: effectiveness, connectedness, and control. We found that ADLs were valued if they increased integrity; however, this process was also informed by gendered roles and social values. People whose sense of control depended on effectiveness often found accepting help very difficult to bear; therefore, redefining control as situational and relational may help enjoyment of activities that are possible.
Background
Comprehensive multidisciplinary pulmonary rehabilitation is vital in the management of chronic obstructive pulmonary disease (COPD) and is considered for any stage of the disease. Rehabilitation programmes are often centre-based and organised in groups. However, the distance from the patient’s home to the centre and lack of transportation may hinder participation. Rehabilitation at home can improve access to care for patients regardless of disease severity. We had previously studied the technology usability and acceptability of a comprehensive home rehabilitation programme designed for patients with very severe COPD receiving long-term oxygen therapy. The acceptability of such comprehensive home programmes for those with less severe COPD, who may be less homebound, is not known. The aims of this feasibility study were to assess patient acceptability of the delivery mode and components of a comprehensive pulmonary rehabilitation programme for any stage of COPD, as well as the technology usability, patient outcomes and economic aspects.
Methods
Ten participants with COPD in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) grade I–IV were enrolled in a 9-week home programme and divided into two rehabilitation groups, with five patients in each group. The programme included exercise training and self-management education in online groups of patients, and individual online consultations. The patients also kept a digital health diary. To assess the acceptability of the programme, the patients were interviewed after the intervention using a semi-structured interview guide. In addition the number of sessions attended was observed. The usability of the technology was assessed using interviews and the System Usability Scale questionnaire. The St George’s Respiratory Questionnaire (SGRQ) was used to measure health-related quality of life.
Results
The mode of delivery and the components of the programme were well accepted by the patients. The programme provided an environment for learning from both healthcare professionals and peers, for asking questions and discussing disease-related issues and for group exercising. The patients considered that it facilitated health-enhancing behaviours and social interactions with a social group formed among the participants. Even participants who were potentially less homebound appreciated the home group and social aspects of the programme. The participants found the technology easy to learn and use. The acceptability and usability results were consistent with those in our previous study of patients with very severe COPD. Only the mean change in the SGRQ total score of −6.53 (CI 95 % −0.38 to −12.68, p = 0.04) indicates a probable clinically significant effect. Economic calculations indicated that the cost of the programme was feasible.
Conclusions
The results of this study indicate that comprehensive pulmonary rehabilitation delivered in home-based online groups may be feasible in COPD. The mode of delivery and components of the programme appeared to be acceptable across patients with different disease severity. The results in terms of patient outcomes are inconclusive, and further assessment is needed.
Loneliness is a prevalent and global problem for adult populations and has been linked to multiple chronic conditions in quantitative studies. This paper presents a systematic review of quantitative studies that examined the links between loneliness and common chronic conditions including: heart disease, hypertension, stroke, lung disease, and metabolic disorders. A comprehensive literature search process guided by the PRISMA statement led to the inclusion of 33 articles that measure loneliness in chronic illness populations. Loneliness is a significant biopsychosocial stressor that is prevalent in adults with heart disease, hypertension, stroke, and lung disease. The relationships among loneliness, obesity, and metabolic disorders are understudied but current research indicates that loneliness is associated with obesity and with psychological stress in obese persons. Limited interventions have demonstrated long-term effectiveness for reducing loneliness in adults with these same chronic conditions. Future longitudinal randomized trials that enhance knowledge of how diminishing loneliness can lead to improved health outcomes in persons with common chronic conditions would continue to build evidence to support the translation of findings to recommendations for clinical care.
This article presents results from a small qualitative study investigating the experiences of patients who have chronic obstructive pulmonary disease (COPD) with televideo consultations at home, as a supplement to conventional control and treatment. The research question was: what are the experiences and preferences of COPD patients in relation to discharge from hospital with televideo consultations? The study shows that the patients' assessments of the effectiveness and value of the televideo consultations in their everyday lives are based on tough cost-benefit calculation of the extent to which the intervention makes their lives easier or more difficult. In public settings, the expectations are high that digital mediation between clients' everyday lives and the healthcare system can strengthen patients' abilities regarding their self-management. Nonetheless, the study shows that patients have a number of reservations concerning televideo consultations at home. The patients' assessments of the service must be understood in relation to the routines and strategies developed to handle the array of problems related to a life affected by chronic illness.
Under-recognised and untreated depression and anxiety symptoms have deleterious effects on physical functioning and social interaction increasing fatigue and healthcare utilisation in patients with chronic obstructive pulmonary disease (COPD). Depression and anxiety are challenging to identify and treat because their symptoms often overlap with those of COPD. The cause(s) of depression and anxiety symptoms are multifactorial and include behavioural, social and biological factors. Less than one-third of COPD patients with comorbid depression or anxiety symptoms are receiving appropriate treatment. Factors that contribute to the lack of provision of treatment are varied, they include patient perceived barriers, for example lack of knowledge and reluctance to receive antidepressant drug therapy; poor treatment compliance and lack of a standardised diagnostic approach; and scarcity of adequate resources for mental health treatment.
The evidence for the efficacy of antidepressant drug therapy in patients with COPD with comorbid depression and anxiety is inconclusive. There are some promising findings regarding pulmonary rehabilitation, psychological therapy and the collaborative care model in reducing depression and anxiety symptoms in patients with COPD, but these findings are limited by short-term follow-up periods. Further work is required to examine the efficacy of these interventions in randomised controlled trials with larger samples and long-term follow-up.
Background:
Telehealth shows promise for supporting patients in managing their long-term health conditions, such as chronic obstructive pulmonary disease (COPD). However, it is currently unclear how patients, and particularly older people, may benefit from these technological interventions.
Aim:
To explore patients' expectations and experiences of using a mobile telehealth-based (mHealth) application and to determine how such a system may impact on their perceived wellbeing and ability to manage their COPD.
Design and setting:
Embedded qualitative study using interviews with patients with COPD from various community NHS services: respiratory community nursing service, general practice, and pulmonary rehabilitation.
Method:
An embedded qualitative study was conducted to which patients were recruited using purposive sampling to achieve maximum variation. Interviews were carried out prior to receiving the mHealth system and again after a 6-month period. Data were analysed using a grounded theory approach.
Results:
The sample comprised 19 patients (aged 50-85 years) with varied levels of computer skills. Patients identified no difficulties in using the mHealth application. The main themes encapsulating patients' experience of using the mHealth application related to an increased awareness of the variability of their symptoms (onset of exacerbation and recovery time) and reassurance through monitoring (continuity of care).
Conclusion:
Patients were able to use the mHealth application, interpret clinical data, and use these within their self-management approach regardless of previous knowledge. Telehealth interventions can complement current clinical care pathways to support self-management behaviour.
Background
Chronic obstructive pulmonary disease (COPD) is characterized by a persistent blockage of airflow, prompting episodes of shortness of breath, commonly leading to hospitalization. Hospitalization may lead to a decline in physical activity following discharge. Physical activity has been shown to improve symptoms of COPD and reduce readmissions, and to decrease morbidity and mortality. This study aims to explore, from the perspectives of people with COPD, the barriers to and enablers of participation in physical activity following hospitalization for COPD.
Methods
This study had a qualitative descriptive design and included semistructured interviews with 28 adult COPD patients who had been admitted to hospital with a primary diagnosis of exacerbation of COPD.
Results
A plethora of barriers to but fewer enablers of participation in physical activity and pulmonary rehabilitation were identified for this cohort of people. The main barriers identified were health-related (comorbidities, COPD symptoms, and physical injury or illness) environment-related (weather, transport, and finance), and self-related. The main enabling factors reported were access to health professionals and equipment, social support, routine and extracurricular activities, personal goals and motivation, and the effect of physical activity and “feeling better”.
Conclusion
This research provides a snapshot of the barriers to and enablers of physical activity and pulmonary rehabilitation in people with COPD. It is evident that there are significant barriers which hinder the ability of people with COPD to undertake and continue participation in physical activity and pulmonary rehabilitation. While there are some enablers that may counter these barriers, it is clear that health professionals dealing with people suffering from COPD need to actively recognize and address barriers to physical activity and pulmonary rehabilitation. Hospital admission may create an opportunity for implementation of interventions promoting physical activity (such as referral to pulmonary rehabilitation), which may assist in reducing hospital readmission, as well as decreasing morbidity and mortality.
The aim of this paper is to describe patients' attitudes towards tele-rehabilitation in the Danish TELEKAT (for Telehomecare, Chronic Patients and the Integrated Healthcare System) project, in order to better understand patients' behavior when performing tele-rehabilitation activities in home surroundings. A total of 111 COPD patients were included in the study, and they were randomized into an intervention group (n = 60) and a control group (n = 51). However, a non-randomized design was used to analyze the qualitative perspectives of the patients' attitudes towards tele-rehabilitation. From the intervention group, 22 COPD patients were selected for qualitative interviews and participant observation in their homes. The theoretical framework for this study is based on learning theory and the "communities of practice" approach inspired by Etienne Wenger. COPD patients exhibit four types of attitudes about their tele-rehabilitation: indifference, learning as part of situations in everyday life, feeling of security and motivation for performing physical training. The patients express the view that they circulate between these attitudes depending on their physical and emotional state as they perform their training. The COPD patients and healthcare professionals have created a community of tele-rehabilitation across sectors, exchanging experiences, stories and strategies for how to manage rehabilitation in home surroundings.
Purpose
Understanding the experiences of people with Chronic Obstructive Pulmonary Disease (COPD) using activity monitors in daily life could support the utilisation of technology within healthcare to increase physical activity and support self-management. This qualitative study aimed to explore the experiences of people with COPD using activity monitors at home in everyday life.
Methods
Semi-structured face-to-face or telephone interviews were conducted with seven people with COPD between August 2018 and June 2020. Participants had all used an activity monitor within the last year (Fitbit, Garmin, or Apple Watch). Interviews were analysed in-depth using Interpretative Phenomenological Analysis (IPA).
Results
Four themes, developed using IPA, highlight participants’ engagement with activity monitors and integrating them into their lives: (1) Motivational features to monitor activity, (2) Importance of setting achievable goals, (3) Developing knowledge and awareness, and (4) Integration into everyday life for self-management.
Conclusion
Activity monitors were perceived to be beneficial and useful to people with COPD, not just for monitoring their activity, but also helping to self-manage their condition. Activity monitors may be a useful tool within rehabilitation and healthcare services for COPD.
Modern Western biomedical research and clinical practice are primarily focused on disease. This disease-centric approach has yielded an impressive amount of knowledge around what goes wrong in illness. However, in comparison, researchers and physicians know little about health. What is health? How do we quantify it? And how do we improve it? We currently do not have good answers to these questions. Our lack of fundamental knowledge about health is partly driven by three main factors: (i) a lack of understanding of the dynamic processes that cause variations in health/disease states over time, (ii) an excessive focus on genes, and (iii) a pervasive psychological bias towards additive solutions. Here I briefly discuss potential reasons why scientists and funders have generally adopted a gene- and disease-centric framework, how medicine has ended up practicing “diseasecare” rather than healthcare, and present cursory evidence that points towards an alternative energetic view of health. Understanding the basis of human health with a similar degree of precision that has been deployed towards mapping disease processes could bring us to a point where we can actively support and promote human health across the lifespan, before disease shows up on a scan or in bloodwork.
An argument that health is optimal responsiveness and is often best treated at the system level.
Medical education centers on the venerable “no-fault” concept of homeostasis, whereby local mechanisms impose constancy by correcting errors, and the brain serves mainly for emergencies. Yet, it turns out that most parameters are not constant; moreover, despite the importance of local mechanisms, the brain is definitely in charge. In this book, the eminent neuroscientist Peter Sterling describes a broader concept: allostasis (coined by Sterling and Joseph Eyer in the 1980s), whereby the brain anticipates needs and efficiently mobilizes supplies to prevent errors.
Allostasis evolved early, Sterling explains, to optimize energy efficiency, relying heavily on brain circuits that deliver a brief reward for each positive surprise. Modern life so reduces the opportunities for surprise that we are driven to seek it in consumption: bigger burgers, more opioids, and innumerable activities that involve higher carbon emissions. The consequences include addiction, obesity, type 2 diabetes, and climate change. Sterling concludes that solutions must go beyond the merely technical to restore possibilities for daily small rewards and revivify the capacities for egalitarianism that were hard-wired into our nature.
Sterling explains that allostasis offers what is not found in any medical textbook: principled definitions of health and disease: health as the capacity for adaptive variation and disease as shrinkage of that capacity. Sterling argues that since health is optimal responsiveness, many significant conditions are best treated at the system level.
Purpose
To investigate COPD patients’ experience on the mastering of their illness during participation in a long-term interprofessional and cross-sectoral telerehabilitation programme called > C☺PD-Life≫.
Materials and methods
A phenomenological-hermeneutic study design with combined participant observations and individual interviews formed a continuous data generation among fifteen patients while they participated in the programme. Data underwent a three-levelled interpretation inspired by the theory of the French philosopher Paul Ricoeur.
Results
During participation in > C☺PD-Life≫ patients experienced an improvement in how to master their living with COPD. They felt invigorated by an interprofessional rehabilitation team to raise how to deal with physical, mental, social and relational challenges. Programme participation was experienced as surprisingly easy by the patients.
Conclusions
The telerehabilitation solution > C☺PD-Life≫ provides benefits for COPD patients who report improved illness-mastering, attendance and outcome of rehabilitation, as well as enhanced physical and social activity. As an assistive technology intervention, > C☺PD-Life≫ appears to be a valuable addition to existing rehabilitation programmes. However, more knowledge is required to further understand the full-range capacity and impact of tele-based pulmonary rehabilitation.
•
Implications for Rehabilitation
• New models of rehabilitation to patients with Chronic Obstructive Pulmonary Disease (COPD) is imperative for the development of more suitable health care support to these patients.
• > C☺PD-Life≫ is a twenty-six-long telerehabilitation intervention program for COPD patients, delivered by an interdisciplinary team collaborating between hospital and the municipality health care service.
• This paper aims to explore COPD patients' experiences on the mastering of their illness while participating in > C☺PD-Life≫.
• Patients report improved illness-mastering, attendance, and outcome of rehabilitation, as well as enhanced physical and social activity by participating in the program.
• As an assistive technology solution, > C☺PD-Life≫ is shown to provide the potential to expand equally assessable support in improving independence, functioning, and well-being to COPD patients.
Purpose
Assistive technology can provide a key tool to enabling independence, greater inclusion and participation in society for individuals with chronic conditions. This potential is currently not always realized due to barriers to accessing and using assistive technology. This review aims to identify the common barriers to acquiring and using assistive technology for users with chronic conditions through a systematic meta-synthesis. This differs from other systematic reviews by applying a transdiagnostic approach to identify if barriers are common across chronic conditions.
Materials and methods
A systematic literature search of five scientific databases (PubMed, SCOPUS, PsycINFO, CINAHL and Medline) was conducted to identify relevant qualitative studies. The search was conducted in November 2019. For the identified articles, thematic content analysis was conducted and the methodological quality was evaluated using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research.
Results
Forty papers met the inclusion criteria and were included in the analysis. Fifty-one descriptive themes grouped into six overarching analytical themes were identified from the studies. The analytical themes identified were: the design and function of the assistive technology, service provision, information and awareness, psychological barriers, support network and societal barriers.
Conclusions
The barriers are interconnected and common across different health conditions. More involvement in personalized care for developing strategies, adaptation of home technologies and provision of assistive technology could overcome the service provision and design barriers to assistive technology. Accessible information and providing greater awareness will be important to overcoming information, psychological and societal barriers to assistive technology.
•
Implications for rehabilitation
• Individuals with chronic conditions face complex barriers to acquiring and using assistive technology as a result of the devices themselves, their individual context, the healthcare context where assistive technology is provided and wider societal barriers.
• The provision of assistive technology needs to change away from the traditional medical model of the “expert” clinician and instead focus on more user involvement to deliver personalised care that utilises the users lived knowledge and experiences.
• Assistive technology provision should be considered alongside how to adapt everyday mainstream technology to meet user needs; the provision of devices should encourage creative problem solving rather then relying on pre-defined prescription lists of assistive technology.
In recent years, assistive technologies have gained acceptance as tools for supporting chronically ill patients in achieving improvements in physical activity. However, various healthcare and sociological studies show contradicting results regarding the physical and social impact of using such devices. This paper explores real‐time user appropriation of an assistive monitoring/tracking device, the pedometer, in a healthcare intervention, with a particular focus on the technology identities users attribute to the pedometer. The study site was a rehabilitation programme at a local Danish health centre supporting patients with chronic obstructive pulmonary disease. As part of this empirical study, six focus‐group interviews were conducted with patients before and after they used pedometers. The analysis of respondents’ accounts shows that monitoring devices become part of users’ complex socio‐technical ensembles in which the use of the device and its tracking of activity is constantly negotiated through experimentation with type and frequency of use; interpretation of knowledge and experience gained via the device; and negotiation of expectations, wellbeing, and the value of quantified knowledge for the management of chronic illness. On the basis of these findings the paper brings together and advances sociological scholarship on chronic illness, embodiment, the quantified self and technology adoption.
Aim:
To examine the effect of a 6-month, smartphone app-based self-management program for people with chronic obstructive pulmonary disease (COPD).
Background:
Technological interventions have been used for chronic disease management, but the effect of a self-management program using a smartphone app has not been evaluated in people with COPD.
Methods:
For this randomized controlled trial, patients with COPD (N = 44) were recruited in pulmonary medicine outpatient clinics at two, metropolitan, tertiary care, academic hospitals. Eligible participants were randomized into two groups and received group education and exercise sessions in the first month of the 6-month intervention. Participants in the experimental group received a smartphone app-based self-management program, which included education, exercises, self-monitoring of symptoms and exercise, and social support. Participants in the control group received one call a month from the research staff. Self-care behavior was measured as a primary outcome. All measures were administered at baseline and at 6 months.
Results:
After randomization, the experimental group numbered 22, the control group numbered 20, and 2 participants dropped out. Significant differences between groups were found in change score for self-care behavior, total activity count per wear time, and percent time spent in moderate-to-vigorous physical activity over 6 months.
Conclusion:
A self-management program, using a smartphone app, can effect behavioral change in people with COPD. This program could be a boon to patients with COPD who have limited access to a health care provider, no opportunities for pulmonary rehabilitation, and frequent exacerbations.
Background: Older adults manage increasing numbers of everyday technologies to participate in home and community activities. Purpose: We investigated how assessing use of everyday technologies enhanced predictions of overall needed assistance among urban older adults. Method: We used a cross-sectional design to analyze responses from 114 participants completing the Everyday Technology Use Questionnaire, the Montreal Cognitive Assessment, and a sociodemographic questionnaire. We estimated overall needed assistance based on definitions in the Assessment of Motor and Process Skills. We created logistic regression models and receiver operator characteristic curves to analyze variables predicting overall needed assistance. Findings: With high specificity and sensitivity, the Everyday Technology Use Questionnaire and the Montreal Cognitive Assessment were the strongest predictors of overall needed assistance. Implications: Assessing everyday technology use enhanced predictions of overall needed assistance among urban older adults.
Background/aim
Proxies of patients with COPD are often unable to identify the patients’ most important problematic activities of daily life (ADLs). The aim was to explore causes of perceptual differences between patients with COPD and their proxies about the problematic ADLs of the patient.
Methods
Ten open structured interviews were conducted in the presence of both the patient and proxy. Patients’ five most important problematic ADLs identified by the couple were compared and discussed. For data analysis, open coding, axial coding and selective coding were conducted.
Results
Ten main causes were identified: differences in the level of satisfaction, or acceptance; estimation of own capabilities; problematic ADL goes unnoticed; proxy is not present during problematic ADL; problematic ADL is not performed (often or anymore), or not (longer) talked about; masked by another problematic ADL; value judgement; solution for problematic ADL.
Conclusion
The causes of perceptual differences between patients and proxies about patients’ problematic ADLs were related to both the patient's and the proxy's perception.
Objective:
We investigated associations among activity engagement (AE), number of available and relevant everyday technologies, ability to use everyday technologies, and cognitive status among older adults in an urban area.
Method:
This cross-sectional study included 110 participants and used three assessments: the Frenchay Activities Index to measure AE, the Everyday Technology Use Questionnaire to measure the number of and ability to use available and relevant everyday technologies, and the Montreal Cognitive Assessment to measure cognitive status. Data analyses used a one-way analysis of variance and a multiple linear regression model.
Results:
The number of available and relevant everyday technologies was significantly different (p < .001) among groups that varied in level of AE. Ability to use everyday technologies did not significantly differ among groups. Cognitive status did not explain level of AE when the number of available and relevant everyday technologies was considered.
Conclusion:
Increasing the accessibility of available and relevant everyday technologies among older adults in an urban area may increase AE.
Purpose:
To identify, synthesize, and evaluate existing literature concerning the process of becoming a user of assistive technology (AT).
Method:
A systematic review and meta-synthesis were carried out. Five bibliographic databases (MEDLINE via PubMed, CINAHL, Web of Science, PsycINFO and SocINDEX) were systematically searched up to 13th of March 2017, using two sets of search terms: (i) elderly and synonyms and (ii) assistive technology and similar words, and combined with a qualitative research filter. Articles were screened, read and critically assessed. The meta-synthesis was guided by Ricoeur's theory of interpretation.
Results:
Seventeen out of 4645 articles were included. Five phases emerged relating to the process of becoming a user of AT: phase A: Evaluating need, phase B: Acknowledging need, phase C: Incorporating the AT into daily life, phase D: Using the AT, and phase E: Future use. Three transitions, describing factors essential to moving from one phase to the next, were identified; from phase A-B: Valued activities are threatened, from phase B-C: Obtaining the AT and from phase C-D: Trust in the AT. No transition was identified from phase D-E.
Conclusion:
The meta-synthesis led to a deeper understanding of the process of older adults becoming users of AT, by exploring findings across the included articles. The identified phases and transitions in the systematic review serve as an analytical framework for understanding the process from the older adult's perspective. This review advocates for using a client-centred approach throughout the entire delivery process. Implications for rehabilitation The process of the older adult becoming a user of AT involves an individualized time factor, and this supports the practice of individualized follow-up. The process of becoming a user of AT is closely related to self-image; healthcare professionals should support not only the use of AT but also the older adult's emotional adjustment to a new self-image. The process is highly influenced by the older adult's social context; healthcare professionals should consider involving the client's social network in the AT delivery process.
Network biologists, in focusing on interrelational structures emerging from complex interactions among genes, proteins, internal milieu, and external environment, echo the social science view that biomedical reductionism misses crucial aspects of human disease.
This panel study investigates how temperature, humidity, and their interaction affect chronic obstructive pulmonary disease (COPD) patients' self-reported symptoms. One hundred and six COPD patients from Shanghai, China, were enrolled, and age, smoking status, St. George Respiratory Questionnaire (SGRQ) score, and lung function index were recorded at baseline. The participants were asked to record their indoor temperature, humidity, and symptoms on diary cards between January 2011 and June 2012. Altogether, 82 patients finished the study. There was a significant interactive effect between temperature and humidity (p < 0.0001) on COPD patients. When the indoor humidity was low, moderate, and high, the indoor temperature ORs were 0.969 (95% CI 0.922 to 1.017), 0.977 (0.962 to 0.999), and 0.920 (95% CI 0.908 to 0.933), respectively. Low temperature was a risk factor for COPD patients, and high humidity enhanced its risk on COPD. The indoor temperature should be kept at least on average at 18.2 °C, while the humidity should be less than 70%. This study demonstrates that temperature and humidity were associated with COPD patients' symptoms, and high humidity would enhance the risk of COPD due to low temperature.
Purpose:
To synthesize qualitative study findings on the meaning ascribed to wheelchairs and wheeled mobility devices (WMD) by WMD users.
Method:
Bibliographic databases were systematically searched up to January 2015 to identify relevant papers. Reviewers selected studies, assessed methodological quality and thematically synthesized findings using a metasynthesis process described by Thomas and Harden (2008).
Results:
Twenty articles were included. Four descriptive themes emerged: physical environment interaction; sociocultural experiences; participation in activities and occupations; and WMD-self relationship. WMD use was found to be a complex experience that can fluctuate through interaction with aspects of the environment and opportunities for participation. The analytic theme, dynamic duality of WMD experience, addressed the simultaneous enabling and disabling aspects of WMD use.
Conclusions:
Metasyntheses enable researchers to gain a deeper understanding of issues by examining findings across studies. Findings of this study provide a framework for understanding the complexity of WMD use. The framework has practical applications for clinicians and users of WMD in understanding the experience of WMD to be neither singular nor static. Implications for Rehabilitation The meaning of wheeled mobility device (WMD) use is dynamically influenced by the environment and opportunities afforded for occupational and social participation. A duality of experiences can emerge for WMD users, where wheeled mobility use can be at the same time positive and negative, based on the interaction with the environment. Clinicians need to determine the meaning that each individual user ascribes to the WMD, and to consider how that meaning may change over time. By understanding the meaning ascribed to WMD use by individuals, clinicians can be better prepared to work with the WMD users to address negative reinforcers of the experience in physical and sociocultural environments as well as highlighting the positive experiences.
Introduction : Recently, our department has executed a focusgroup study to evaluation the preferences and emotions of asthma and COPD patients regarding a patient web portal (PWP). Remarkable was that during these sessions lack of social support from friends, family and colleagues was often mentioned. This led to emotional conversations because it severely effects patients' quality of life. It is striking that this topic is rarely discussed in scientific publications or clinical settings. We would like to draw attention to the lack of social support and empathy experienced by asthma and COPD patients.
Method: These are secondary findings from a focus group study in 29 patients. All data was transcribed verbatim and analyzed using grounding theory.
Results: Patient citation: “People don't see many signs of illness, but the reality is that I have to deal with my chronic condition on a daily basis ” COPD patients have to deal with the stigmatization of a self-inflicting disease. Asthma and COPD patients experience lack of empathy when avoiding triggers (e.g. smoke, allergens). The fluctuating severity of the diseases makes it even worse to understand for bystanders. Lack of social support is experienced from family, colleagues and friends and led to sadness, anger and in some of our patients it has led to social isolation.
Conclusion: Health care professionals should pay more attention to this issue. Patients would like to have access to information (booklet/video ect.) specifically for their social network to explain what it means to have asthma or COPD.
Objectives: This study aims to explore in depth the experience of living with chronic obstructive pulmonary disease (COPD) from the perspective of people with the condition in northern regional Australia.
Methods: Qualitative research design was employed. Data was obtained from eight participants from a health service for chronic illness using semi-structured interviews to capture participants' diverse experiences. The interviews were audio-taped, transcribed and analyzed using a computer software programme. Data was coded and analyzed thematically.
Results: Participant narratives illustrated the severe functional impairments and subsequent psychosocial consequences of this disease. In relation to the participants' experience of COPD, six major themes were identified. These were: emotional wellbeing, physical experience, knowledge and understanding, social relationships, external factors, and experience of intervention in relation to their COPD.
Conclusions: This study provides a depth of insight into the day to day experience of people with COPD in a northern Australian location. Findings highlight the importance of the effect that climate, anxiety, and patient education have on participation in daily life and indicate a need for further research into these factors.