Telemedicine for patients with COPD: new treatment approaches to improve daily activity behaviour

Obtaining a physically active lifestyle is essential in the treatment of patients with Chronic Obstructive Pulmonary Disease (COPD). Inactivity is thought to be part of a vicious circle of deconditioning, which leads to a reduced quality of life and which may be accelerated by exacerbations (periods of acute worsening of the patient’s condition). The aim of this thesis was to study whether telemedicine can promote daily activity behaviour and support patients with COPD in their self-management of exacerbations. To achieve this goal, a telemonitoring study was performed to gain insight in the daily activity behaviour. Subsequently, an ambulant activity coach was designed that aims to increase awareness and improve the activity level and the distribution of activities during the day. The activity coach was used to investigate its potential to change daily activity behaviour within a 4-week telerehabilitation intervention. A next generation of the activity coach used machine learning to provide motivational cues automatically at the most suitable moment to the patient, which was evaluated in a 3-month intervention. In addition, the activity coach was evaluated as an integrated part of a 9-month telehealth programme, which also included web-based exercising and self-management of exacerbations. Separate from the activity coach, a motivating alternative to conventional exercising was developed: the orange submarine game. The activity coach was able to positively contribute to increasing activity levels: 1) COPD patients significantly changed their activity level on a short-term notice in response to the motivational cues and 2) a higher usage of the activity coach was significantly associated with an improvement in activity levels. So, the self-learning activity coach seems beneficial to increase the activity level and improve the activity balance, although not in all patients. Patients were satisfied with the received care of the telehealth programme and especially the self-management module was highly used. The game was found to be a motivational tool for exercising. In conclusion, the results show that telemedicine has potential to promote an active lifestyle in patients with COPD. For future, decision-support technology should provide highly individualized and persuasive feedback, while gamification strategies could further increase motivation.

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