Acceptability of a web-based self-management programme: ‘SPACE for COPD©’, for individuals hospitalised with an acute exacerbation of Chronic Obstructive Pulmonary Disease: a feasibility study (Preprint)

BACKGROUND Hospital admissions due to acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD) are costly to the individual and health services. Pulmonary Rehabilitation (PR) is known to reduce hospital readmissions when delivered after hospitalisation but uptake and completion of PR following hospitalisation remains poor (<10% of those eligible in UK audit data). A web-based platform of the SPACE for COPD© self-management programme has previously shown promising results in stable COPD but has not been tested in an acute population. OBJECTIVE The primary aim of this study was to assess the feasibility and acceptability of the web-based programme as a bridge to outpatient PR for individuals hospitalised with an AECOPD. METHODS A non-randomised feasibility study for patients with confirmed AECOPD, deemed web-literate was conducted. All patients were consented during their hospitalisation and received access to the website following discharge (via tablet), in addition to usual care. The programme aims to facilitate patients to better understand and manage their condition through education and home-based exercises. Participants were asked to complete the Bristol COPD Knowledge Questionnaire (BCKQ) at baseline and then at home via post at 6-months. 14 participants were also interviewed (n=8 Completers; n= 6 Non-Completers) regarding their participation in the trial and experiences of the web-based programme. Interviews were analysed using thematic analysis. The primary outcome was feasibility of the intervention/ trial (recruitment figures and completion of the BCKQ). Secondary outcomes were: acceptability of the intervention/ trial (qualitative interviews), intervention engagement (web usage statistics), and uptake to outpatient PR at 6-months. RESULTS 2080 patients were screened for eligibility of which 100 patients [mean (SD)71.2 (9.3) years, N(%) 55 (55) male, mean (SD) FEV1/FVC ratio 0.46 (0.14), mean (SD) 50.2 (31.0) pack years, current smokers N (%) 35 (35)] were recruited (4.8% of those screened). The main reason for ineligibility was lack of web-literacy (70%); defined as either not having an email address or not using a computer/ laptop/ smart device ever/ regularly (≤ once a week). N=18 patients (18%) had completed the web programme by 6-months, with others still registered on the programme: N= 27 (27%) and over half not registering: N= 55 (55%). There was a change in BCKQ scores at 6-months of 7.8 points (SD 10.2). Qualitative interviews identified 3 main themes: preparing for, engagement with and benefits of the study/ programme. Of those accepting a referral to PR on discharge (57%), 19% had completed the programme at 6-months. CONCLUSIONS Based on the challenges to recruit, retain and engage participants in the web-based self-management programme, it is not a feasible approach to roll out widely. It appears that the COPD population may not be equipped and ready for digital self-management interventions following an AECOPD. This is particularly important given the drive towards digital interventions post-COVID. This work acknowledges that this is a challenging time for patients with AECOPD to engage with exercise and self-management education. However, for patients able to engage with such an intervention, the completion of PR was double previous audit estimates from the UK, disease knowledge improved and was of value to patients. CLINICALTRIAL Isrctn: 13081008