Leicester Respiratory Biomedical Research Unit, Department of Respiratory Medicine, Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester, Leicester, UK.
Department of Primary Care and Health Sciences, Keele University, Keele, UK.
BMJ Open. 2017 Mar 31;7(3):e013682. doi: 10.1136/bmjopen-2016-013682.
OBJECTIVES: The aim of this study was to determine if an interactive web-based pulmonary rehabilitation (PR) programme is a feasible alternative to conventional PR. DESIGN: Randomised controlled feasibility trial. SETTING: Participants with a diagnosis of chronic obstructive pulmonary disease were recruited from PR assessments, primary care and community rehabilitation programmes. Patients randomised to conventional rehabilitation started the programme according to the standard care at their referred site on the next available date. PARTICIPANTS: 103 patients were recruited to the study and randomised: 52 to conventional rehabilitation (mean (±SD) age 66 (±8) years, Medical Research Council (MRC) 3 (IQR2-4)); 51 to the web arm (mean (±SD) age 66 (±10) years, MRC 3 (IQR2-4)). Participants had to be willing to participate in either arm of the trial, have internet access and be web literate. INTERVENTIONS: Patients randomised to the web-based programme worked through the website, exercising and recording their progress as well as reading educational material. Conventional PR consisted of twice weekly, 2 hourly sessions (an hour for exercise training and an hour for education). OUTCOME MEASURES: Recruitment rates, eligibility, patient preference and dropout and completion rates for both programmes were collected. Standard outcomes for a PR assessment including measures of exercise capacity and quality of life questionnaires were also evaluated. RESULTS: A statistically significant improvement (p≤0.01) was observed within each group in the endurance shuttle walk test (WEB: mean change 189±211.1; PR classes: mean change 184.5±247.4 s) and Chronic Respiratory disease Questionnaire-Dyspnoea (CRQ-D; WEB: mean change 0.7±1.2; PR classes: mean change 0.8±1.0). However, there were no significant differences between the groups in any outcome. Dropout rates were higher in the web-based programme (57% vs 23%). CONCLUSIONS: An interactive web-based PR programme is feasible and acceptable when compared with conventional PR. Future trials maybe around choice-based PR programmes for select patients enabling stratification of patient care. TRIAL REGISTRATION NUMBER: ISRCTN03142263; Results.
目的：本研究旨在确定交互式网络肺康复（PR）方案是否是传统 PR 的可行替代方案。 设计：随机对照可行性试验。 设置：从 PR 评估、初级保健和社区康复计划中招募诊断为慢性阻塞性肺疾病的参与者。随机分配至常规康复的患者按照其在指定地点下一个可用日期的标准护理开始该方案。 参与者：103 名患者被招募参加研究并随机分组：52 名接受常规康复（平均（±SD）年龄 66（±8）岁，医学研究委员会（MRC）3（IQR2-4））；51 名接受网络组（平均（±SD）年龄 66（±10）岁，MRC 3（IQR2-4））。参与者必须愿意参加试验的任何一个臂，具有互联网访问权限并且精通网络。 干预措施：随机分配到基于网络的方案的患者通过网站进行锻炼并记录他们的进展情况，以及阅读教育材料。常规 PR 包括每周两次，每次 2 小时的课程（1 小时用于锻炼训练，1 小时用于教育）。 结果：收集了两种方案的招募率、合格性、患者偏好以及失访和完成率。还评估了 PR 评估的标准结果，包括运动能力和生活质量问卷的测量。 结果：在每个组中，耐力穿梭步行测试（WEB：平均变化 189±211.1；PR 课程：平均变化 184.5±247.4 s）和慢性呼吸系统疾病问卷-呼吸困难（CRQ-D；WEB：平均变化 0.7±1.2；PR 课程：平均变化 0.8±1.0）均观察到统计学显著改善（p≤0.01）。然而，两组之间在任何结果上均无显著差异。基于网络的方案的辍学率更高（57%对 23%）。 结论：与传统 PR 相比，交互式网络 PR 方案是可行且可接受的。未来的试验可能围绕选择患者的基于选择的 PR 方案进行，以便对患者护理进行分层。 试验注册号：ISRCTN03142263；结果。
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