Effectiveness of an Automated Walking Program Targeting Veterans with COPD
Caroline R Richardson MD
VA Ann Arbor Healthcare System, Ann Arbor, MI
Ann Arbor, MI
Funding Period: August 2010 - July 2013

BACKGROUND/RATIONALE:
Individuals with COPD who undergo a facility-based, exercise-focused pulmonary rehabilitation program experience significant improvements in health related quality of life, dyspnea, and exercise tolerance as well as reduced rates of hospitalization. Unfortunately, only a small percent of individuals with COPD who could benefit from pulmonary rehabilitation have access to and participate in such programs. Rural veterans are less likely to have access to facility-based pulmonary rehabilitation than urban veterans. Health related quality of life in rural veterans with COPD is significantly worse than for veterans with COPD who live in urban areas. An internet-mediated self-management program for veterans with COPD that focuses on walking could be disseminated widely at low marginal cost to any veteran with COPD who has internet access.

OBJECTIVE(S):
The proposed research is designed to test the effectiveness of an automated internet-mediated walking program for veterans with COPD on improving health related quality of life and reducing days of hospitalization. Additionally, the proposed research will compare measures of intervention reach, participation and satisfaction between urban and rural veterans.

METHODS:
This study will recruit approximately 300 participants nationwide by mail and randomly selected from VA medical databases to balance patients from rural and urban zip codes. Participants will be adult VA patients diagnosed with COPD who are also sedentary, ambulatory, have a physician to provide medical clearance, and who have access to a PC computer with an internet connection for e-mail. Interested participants will be directed to a secure VA website where they provide a waiver of signed informed consent and complete a baseline survey. Research staff will obtain medical clearance for walking from patients' designated providers. Participants will then be mailed a pedometer and information to enroll the Stepping Up to Health internet-mediated walking program. At 4 and 12 months, participants will complete a questionnaire measuring patient satisfaction, perceived benefits with the walking website, and the occurrence of any walking related adverse events.

The study is a two-arm randomized controlled trial of an automated internet-mediated walking program targeting veterans with COPD. The two arms are 1) SUH for COPD and 2) wait list control. All study procedures will be delivered remotely including recruitment, consent, medical clearance, intervention delivery and outcome assessment. Equal numbers of urban and rural veterans will be invited, allowing comparisons of intervention reach, participation and satisfaction between urban and rural veterans

FINDINGS/RESULTS:
There are currently no findings.

IMPACT:
Chronic Obstructive Pulmonary Disease (COPD) is a common disabling chronic condition that is more prevalent in veterans than in the general population. Limitations in daily activities due to reduced exercise tolerance along with frequent hospitalizations for COPD exacerbations contribute to poor quality of life and increased health care costs. A low cost and widely disseminated intervention that improves quality of life and exercise tolerance while decreasing rates of hospitalization for veterans with COPD could significantly improve quality of care and decrease costs. This research program addresses three HRS&D priority areas: 1) Access / Rural Health, 2) Care of Complex Chronic Conditions, and 3) Healthcare Informatics. Currently we are still in the recruitment phase of the study.

PUBLICATIONS:
None at this time.

DRA: Lung Disorders
DRE: Treatment - Comparative Effectiveness, Treatment - Observational, Prevention
Keywords: Chronic lung disease, Comparative Effectiveness, Exercise, Quality of life
MeSH Terms: none