Recruiting patients to a digital self-management study whilst in hospital for a chronic obstructive pulmonary disease exacerbation: A feasibility analysis

Maxine Whelan; Christopher Biggs; Carlos Areia; Elizabeth King; Beth Lawson; Nikki Newhouse; Xiaorong Ding; Carmelo Velardo; Mona Bafadhel; Lionel Tarassenko; Peter Watkinson; David Clifton; Andrew Farmer

doi:10.1177/20552076211020876

Recruiting patients to a digital self-management study whilst in hospital for a chronic obstructive pulmonary disease exacerbation: A feasibility analysis

Digit Health. 2021 May 27:7:20552076211020876. doi: 10.1177/20552076211020876. eCollection 2021 Jan-Dec.

Authors

Maxine Whelan^{1

2}, Christopher Biggs³, Carlos Areia³, Elizabeth King³, Beth Lawson¹, Nikki Newhouse¹, Xiaorong Ding⁴, Carmelo Velardo⁴, Mona Bafadhel⁵, Lionel Tarassenko⁴, Peter Watkinson³, David Clifton^{4

6}, Andrew Farmer¹

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
² Centre for Intelligent Healthcare, Coventry University, Coventry, UK.
³ Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
⁴ Department of Engineering, Institute of Biomedical Engineering, University of Oxford, Oxford, UK.
⁵ Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
⁶ Oxford-Suzhou Centre for Advanced Research, Suzhou, China.

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) are often hospitalised with acute exacerbations (AECOPD) and many patients get readmitted. Intervening with hospitalised patients may be optimal timing to provide support. Our previous work demonstrated use of a digital monitoring and self-management support tool in the community. However, we wanted to explore the feasibility of recruiting patients whilst hospitalised for an AECOPD, and to identify the rate of dropout attrition around admission for AECOPD.

Methods: Patients were recruited to the EDGE2 study between May 2019 and March 2020. Patients were identified by the clinical teams and patients were recruited by members of the clinical research team. Participants were aged 40 years or older, had a diagnosis of COPD and were attending or admitted to hospital for an AECOPD. Participants were given a tablet computer, Bluetooth-linked pulse oximeter and wrist-worn physical activity monitor to use until 6 months post-discharge. Use of the system aimed to support COPD self-management by enabling self-monitoring of vital signs, COPD symptoms, mood and physical activity, and access to multi-media educational resources.

Results: 281 patients were identified and 126 approached. The main referral source was the specialist respiratory nursing and physiotherapist team (49.8% of patients identified). Twenty-six (37.1%) patients were recruited. As of 21 April 2020, 14 (53.8%) participants withdrew and 11 (of 14; 78.6%) participants withdrew within four weeks of discharge. The remaining participants withdrew between one and three months follow-up (1 of 14; 7.1%) and between three and six months follow-up (2 of 14; 14.3%).

Conclusion: A large number of patients were screened to recruit a relatively small sample and a high rate of dropout was observed. It does not appear feasible to recruit patients with COPD to digital interventional studies from the hospital setting when they have the burden of coping with acute illness.

Keywords: COPD; Feasibility; hospital admission; respiratory; self monitoring; wearables.

Grants and funding

WT_/Wellcome Trust/United Kingdom