A self-management program (SMP) for chronic obstructive pulmonary disease (COPD) delivered in a group/community-based format was deemed feasible and acceptable by both patients and clinicians, according to research findings in BMJ Open Respiratory Research.
Researchers who successfully developed and delivered an individual COPD self-management program — the Self-Management Programme of Activity, Coping and Education (SPACE) — adapted the program for delivery as a group intervention. The current study assessed the feasibility, acceptability, and clinical effectiveness of this program. The researchers also assessed whether group-based delivery of the program with sustained support improved patient outcomes post-intervention compared with those of patients in a control group.
Participants with an established diagnosis of COPD were randomly assigned to a control group (usual care) or the intervention group. Participants in the control group continued with their usual check-ups, with no additional care provided. Patients in the intervention group received a SPACE for COPD manual and attended the SPACE for COPD group-based SMP, usually within 1 month of their appointment. The program was delivered to groups with up to 10 participants in 6 sessions, each 2 hours long, during a 5-month period.
The primary outcome was health status at 6 months as measured by the COPD Assessment Test (CAT). Qualitative focus groups were conducted after the intervention to understand participants’ experiences, and health care professionals were also invited to participate in a meeting to discuss the program’s feasibility and acceptability.
A total of 193 participants (mean [SD] age, 70.1 [8.2] years; 54.4% male; 90.7% White) were randomly assigned to the intervention (n=97) and control (n=96) groups from March 2015 to October 2016. The final analysis of primary outcome was based on 65% (n=52) of the intervention group and 93% (n=70) of the control group.
No significant difference was observed at 6 months between the 2 groups in the total CAT score (mean difference, 1.70; 95% CI, -0.53 to 3.94; P =.135). After the total CAT score at 9 months was added to the model, no significant difference was observed between the groups (mean difference, 0.511; 95% CI, -1.28 to 2.30; P =.575).
The mean difference in patient activation measure score was significant at 6 months in favor of the intervention group (mean difference -5.66; 95% CI, -10.03 to -1.29; P =.011), which remained at 9 months (mean difference, -6.70; 95% CI, -10.85 to -2.56; P =.002).
At 6 months, the mean difference in Bristol COPD Knowledge Questionnaire score was significant in favor of the intervention group (mean difference -2.53; 95% CI, -4.59 to -0.47; P =.016), which was sustained at 9 months in both groups but was not significantly different between the 2 groups (mean difference, -1.88; 95% CI, -4.16 to .40; P =.106).
Mean differences in the patient fatigue level (mean difference, -0.42; 95% CI, -0.81 to -0.03, P =.035) and mastery (mean difference, -0.44; 95% CI, -0.78 to -0.09; P =.015) domains of the Chronic Respiratory Questionnaire were significant at 6 months, and this difference was sustained in the mastery domain at 9 months (mean difference, -0.44; 95% CI, -0.78 to -0.10; P =.011).
The venues, locations, and session length were generally well received by group members. Some health care professionals thought that group-based COPD could be a good intervention at the time of diagnosis. Also, some health care providers stated that the intervention taught them to allow patients to talk more and seek their own answers.
For some participants, the distance to the group venues was a problem and caused withdrawal from the study, and some patients disliked group formats. In addition, the study was conducted before the beginning of the COVID-19 pandemic, which limited in-person, group-based interventions.
“The SPACE for COPD group-based SMP offers patients a choice which may be more convenient for those who may still be working and unable to commit to traditional pulmonary rehabilitation, or for those struggling to travel and are only able to travel in the local area,” stated the researchers. “The nature of the model also allows for patients to access specialist teams for a longer period of time but also encourages the group to meet outside of the scheduled sessions, creating in effect a local COPD community with shared interests.”
Bourne C, Houchen-Wolloff L, Patel P, Bankart J, Singh S. Self-management programme of activity coping and education—SPACE for COPD(C)—in primary care: a pragmatic randomised trial. BMJ Open Respir Res. 2022;9(1):e001443. doi:10.1136/bmjresp-2022-001443