View Abstract

A2512 - Feasibility of Converting Patients to Participants in a Practice-Based Study to Promote Home-Based Physical Activity After a Hospitalization for COPD
Author Block: V. Prieto-Centurion1, D. B. Coultas2, J. J. Luo1, J. Ma1, C. S. Rand3, A. M. Tan1, J. A. Krishnan1; 1University of Illinois at Chicago, Chicago, IL, United States, 2DHSM, VA Portland Health Care System, Portland, OR, United States, 3Johns Hopkins University, Baltimore, MD, United States.
Background: Although pulmonary rehabilitation after hospital discharge improves outcomes in Chronic Obstructive Pulmonary Disease (COPD) patients, its impact is limited due to poor reach and adoption. The study’s objective was to evaluate the feasibility of recruiting recently hospitalized COPD patients into a mobile health-supported home-based physical activity program from routine clinical practice at an urban hospital.
Methods: This 12-week prospective cohort study involves recently discharged (≤4 weeks) patients with COPD exacerbations. Additional eligibility criteria include airflow obstruction by spirometry, inability to attend pulmonary rehabilitation (PR) and no medical contraindications to participation, as determined by the patient’s physician. Patients are enrolled while hospitalized or during outpatient clinic follow-up appointments, attend 5 in-person outpatient study visits (eligibility/baseline visit, and visits on week 1, 2, 4 and 12) and are asked to carry pedometers for physical activity monitoring. To reduce participant burden, visits are scheduled around the time of clinical appointments and participants receive monetary compensation.
Results: Over the first 6 months of recruitment, 81 hospitalized and 13 recently discharged patients were screened; 54 (57% of 94) were approached for enrollment, 44 (87% of 54) were considered eligible for informed consent, and 29 (66% of 44) provided informed consent. Reasons for declining to participate included study burden (e.g., time commitment, n=6) and lack of interest (n=5). Participants who provided informed consent were predominantly African American (93%), women (59%) and had less than high school education (58%). Of the 29 consented subjects, 21 were subsequently excluded for reasons including a change in eligibility status (e.g., change in diagnosis by the participant’s physician, n=4; lack of airflow obstruction on spirometry, n=4; enrollment in PR, n=3; new medical contraindication, n=1), and losses to follow-up (no-show to clinical follow-up appointments, n=3; death, n=1). Thus, over a 6-month period, of 94 patients screened, 87% of approached patients were considered to be initially eligible, 66% of initially eligible patients provided informed consent, and 21 (72%) consented participants subsequently met exclusion criteria with only 8 (28% of 29) participating in the study.
Discussion: There are multiple challenges to enrolling participants in practice-based research involving physical activity promotion following a hospitalization for COPD. The vast majority of patients hospitalized with COPD in this clinical setting were uninterested or ineligible to be enrolled as study participants. Future real-world studies of interventions for COPD patients will require more tailored recruitment strategies, a more flexible enrollment criteria and minimization of study burden on participants.