Taking Charge After Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Feasibility Trial of a Psychologically Informed Self-Management Intervention

International Journal of Chronic Obstructive Pulmonary Disease Dovepress open access to scientific and medical research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ on 06-Jun-2023 For personal use only. Open Access Full Text Article ORIGINAL RESEARCH Taking Charge After Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Randomized Controlled Feasibility Trial of a Psychologically Informed Self-Management Intervention William MM Levack 1 , Mark Weatherall 1 , Harry K McNaughton 2 , Amanda A McNaughton Anna Hobman 1 , Bernadette Jones 1 , Tristram R Ingham 1 , James Fingleton 3 1 3 2 , Department of Medicine, University of Otago, Wellington, New Zealand; 2Medical Research Institute of New Zealand, Wellington, New Zealand; Te Whatu Ora Capital, Coast and Hutt Valley, Wellington, New Zealand Correspondence: William MM Levack, Department of Medicine, University of Otago Wellington, PO Box 7343, Wellington, 6242, New Zealand, Tel +64 21 918 627, Email Purpose: Few interventions improve outcomes for people with Chronic Obstructive Pulmonary Disease (COPD), particularly higher risk groups such as those admitted to hospital with an acute exacerbation of COPD (AECOPD). The aim of the study was to test the feasibility and acceptability of a modified version of the Take Charge program in people after AECOPD and to determine the potential to improve self-reported limitations, health-related quality of life and reduce future hospitalizations. Patients and Methods: A prospective, parallel group randomized trial with blinded endpoint assessment. Participants had been discharged from hospital with a diagnosis of AECOPD and were randomized to receive either a single 60–90 minute session of “Take Charge for COPD” from a trained facilitator in their own home or usual care. Take Charge is a “talking therapy” that encourages a sense of purpose, autonomy, mastery, and connectedness with others. The primary outcome was the rate of moderate or severe episodes of AECOPD in the subsequent 12 months. Results: Fifty-six people were randomized (study target 60): predominantly European (71%), female (61%), older (mean [SD] age 70 [11] years), and non-smokers (89%). Charlson Comorbidity Index mean (SD) score was 2.3 (1.6) indicating mild to moderate comorbidity severity. There were 85 moderate or severe AECOPD episodes in the 12 months after the index admission for the Take Charge participants and 84 episodes in the control group (relative rate 0.93; 95% confidence interval (CI) 0.69 to 1.26). COPD Clinical Questionnaire (CCQ) scores were significantly lower (better) in the Take Charge group (mean difference −1.26; 95% CI −2.06 to −0.45). Conclusion: The Take Charge intervention proved feasible with a population of people recently discharged from hospital with AECOPD. The direction of change in the primary outcome and some secondary outcomes suggest that an adequately powered study is justified. Keywords: COPD, self-management, Take Charge, randomized controlled trial Introduction Chronic Obstructive Pulmonary Disease (COPD) is an important world-wide cause of death, disability and reduced quality of life.1 Acute exacerbations of COPD (AECOPD) are a common reason for hospital admission and predict both recurrent hospital admission and death: 18–39% of patients admitted with AECOPD are readmitted within 3 months,2 while up to 73% may be readmitted within one year.3,4 The only interventions shown to reduce mortality and disease progression from COPD are smoking cessation and vaccination against influenza and pneumococcus,5 although selected International Journal of Chronic Obstructive Pulmonary Disease 2023:18 317–325 Received: 24 October 2022 Accepted: 15 February 2023 Published: 15 March 2023 317 © 2023 Levack et al. This work is published and licensed by Dove Medical Press Limited. 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For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Levack et al Dovepress patients with severe COPD may also gain improved life expectancy from oxygen therapy, lung volume reduction surgery or lung transplantation.5,6 There is high-quality evidence that pulmonary rehabilitation produces moderately large and clinically significant improvements in health-related quality of life (HRQoL) and exercise capacity for people with COPD.7–9 Early pulmonary rehabilitation may also reduce readmission rates after AECOPD.8 However, availability and uptake of pulmonary rehabilitation is low. Less than 2% of people with COPD have access to pulmonary rehabilitation globally,10 including in New Zealand,11,12 the country of origin for this study. In addition to pulmonary rehabilitation, self-management interventions for COPD that include an exacerbation action plan have been associated with improve ments in HRQoL and lower probability of respiratory-related hospital admissions.13 However, alternative or additional effective strategies to manage AECOPD are urgently required. Previously, we and others have advocated for investigations of psychological interventions for COPD.14 Indeed, we have hypothesized that the positive benefits of pulmonary rehabilitation may not solely, or even primarily, arise from a physiological response to exercise.14 Psychological interventions that emphasise self-determination, autonomy, and hope may be crucial for helping people with COPD regain control of their health and wellbeing, particularly after an episode of AECOPD. “Take Charge” is one such intervention. Although originally tested and shown to be effective as an intervention for people with stroke,15,16 Take Charge is not stroke-specific and is easily adapted for other health conditions. The aim of the study was to test the feasibility and acceptability of a modified version of the Take Charge program in people after AECOPD and to determine the potential to improve self-reported limitations, health-related quality of life and reduce future hospitalizations. We undertook a randomized feasibility study to adapt and test such an intervention, known to be effective for people following acute stroke, in AECOPD, and to collect baseline and outcome data to plan a larger effectiveness study. Materials and Methods Study Design This was a prospective, parallel group randomized trial with blinded endpoint assessment with one active and one control intervention, conducted between 1 December 2017 and 30 November 2019. The study was conducted according to the Declaration of Hel (...truncated)