Internet-Based Dyspnea Self-Management Support for Patients With Chronic Obstructive Pulmonary Disease

Context. People with chronic obstructive pulmonary disease experience dyspnea with activities despite optimal medical management. Objectives. The purpose of this study was to test the efficacy of two 12-month dyspnea self-management programs (DSMPs), Internet-based (eDSMP) and face-to-face (fDSMP), compared with a general health education (GHE) control on the primary outcome of dyspnea with activities. Methods. Participants with chronic obstructive pulmonary disease were randomized to eDSMP (n = 43), fDSMP (n = 41), or GHE (n = 41). The content of the DSMPs were similar and focused on education, skills training, and coaching on dyspnea self-management strategies, including exercise, and only differed in the delivery mode. Dyspnea with activities was measured with the Chronic Respiratory Questionnaire at three, six, and 12 months. Secondary outcomes included exercise behavior and performance, health-related quality of life, self-efficacy for dyspnea management, and perception of support for exercise. The study was registered at Clinicaltrials.gov (NCT00461162). Results. There were no differences in dyspnea with activities across groups over 12 months (P = 0.48). With the exception of arm endurance (P = 0.04), exercise behavior, performance, and health-related quality of life did not differ across groups (P > 0.05). Self-efficacy for managing dyspnea improved for the DSMPs compared with GHE (P = 0.06). DSMP participants perceived high levels of support for initiating and maintaining an exercise program. Conclusion. The DSMPs did not significantly reduce dyspnea with activities compared with attention control. However, the high participant satisfaction with the DSMPs combined with positive changes in other outcomes, including self-efficacy for managing dyspnea and exercise behavior, highlight the need for additional testing of individually tailored technology-enabled interventions to optimize patient engagement and improve clinically relevant outcomes. (c) 2013 U.S. Cancer Pain Relief Committee.