Watching an educational video at discharge about the value of pulmonary rehabilitation did not increase rates of participation, referral, or completion among patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD) in a new trial.
Researchers in London designed an educational video as an adjunct to care for patients who were hospitalized for COPD exacerbations. Patients were assigned to receive usual care, defined as a COPD discharge bundle that included written information about pulmonary rehab, or usual care plus the video, which was viewed on a handheld tablet at discharge. Those in the intervention group also received a secure link and password that allowed them to access the video after discharge. Pulmonary rehab uptake within 28 days of discharge was the study's primary outcome. Secondary end points included referral to or completion of pulmonary rehab, and safety end points were readmission and death. In addition, 15 participants in the intervention group were interviewed about their perspectives within a week after the 90-day follow-up period ended. The study results were published March 17 by the American Journal of Respiratory and Critical Care Medicine.
Two hundred patients were recruited for the study between February 2015 and May 2018, and of these, 196 were randomly assigned, 98 to each group. Fifty-one percent of patients were women, and the median FEV1 was 36% of predicted. Overall, participation in pulmonary rehab was 37%, and the difference between the usual care and intervention groups was not significant (41% vs. 34%; P=0.37). No between-group differences were seen in secondary end points or safety end points. Of the 15 patients interviewed, eight did not participate in pulmonary rehab and six completed the program. Six participants did not remember having seen the video. Mortality rates and all-cause readmission rates during the 90-day follow-up period were 2% and 15% in the control group and 1% and 22% in the intervention group, respectively. However, 42 patients in the intervention group and 38 in the control group were lost to follow-up.
The study was done at a single center, and patients were not formally evaluated for cognitive dysfunction, digital literacy, or internet availability, among other limitations. The researchers concluded that the educational video in this trial did not appear to affect rates of referral to or participation in pulmonary rehab after a COPD-related hospitalization. “However, given the intervention is cheap, easily implementable and not associated with any known adverse effects, further studies could be considered to identify potential roles for this education video,” the authors wrote. They noted that the video may be able increase delivery of COPD discharge bundles in some settings.