C de Jong

Physical activity is increased by a 12-week semiautomated telecoaching programme in patients with COPD: a multicentre randomised controlled trial

Rationale Reduced physical activity (PA) in patients with COPD is associated with a poor prognosis. Increasing PA is a key therapeutic target, but thus far few strategies have been found effective in this patient group. Objectives To investigate the effectiveness of a 12-week semiautomated telecoaching intervention on PA in patients with COPD in a multicentre European randomised controlled trial. Methods 343 patients from six centres, encompassing a wide spectrum of disease severity, were randomly allocated to either a usual care group (UCG) or a telecoaching intervention group (IG) between June and December 2014. This 12-week intervention included an exercise booklet and a step counter providing feedback both directly and via a dedicated smartphone application. The latter provided an individualised daily activity goal (steps) revised weekly and text messages as well as allowing occasional telephone contacts with investigators. PA was measured using accelerometry during 1 week preceding randomisation and during week 12. Secondary outcomes included exercise capacity and health status. Analyses were based on modified intention to treat. Main results Both groups were comparable at baseline in terms of factors influencing PA. At 12 weeks, the intervention yielded a between-group difference of mean, 95% CI (lower limit – upper limit; ll-ul) +1469, 95% CI (971 to 1965) steps/day and +10.4, 95% CI (6.1 to 14.7) min/day moderate PA; favouring the IG (all p≤0.001). The change in 6-min walk distance was significantly different (13.4, 95% CI (3.40 to 23.5) m, p<0.01), favouring the IG. In IG patients, an improvement could be observed in the functional state domain of the clinical COPD questionnaire (p=0.03) compared with UCG. Other health status outcomes did not differ. Conclusions The amount and intensity of PA can be significantly increased in patients with COPD using a 12-week semiautomated telecoaching intervention including a step counter and an application installed on a smartphone. Trial registration number: NCT02158065.

Use of the Control of Allergic Rhinitis and Asthma Test (CARATkids) in children and adolescents; validation in Dutch

Allergic rhinitis and asthma are common and closely related diseases. Recently, a Portuguese questionnaire has been developed ‘The Control of Allergic Rhinitis and Asthma Test’ (CARATkids) that measures disease control of both diseases in children. This study aims to validate the CARATkids in Dutch children and for the first time in adolescents and, in addition, to calculate the minimal clinically important difference (MCID).

Die deutschsprachige Version des Clinical COPD Questionnaires (CCQ) als Outcome-Parameter der Rehabilitation bei COPD

Hintergrund: In den 2013 aktualisierten GOLD-Empfehlungen wurde der CCQ neben dem CAT (COPD Assessment Test) und der MMRC-Dyspnoe-Skala als Symptom-Parameter aufgenommen und ist damit Grundlage der Einteilung in die Gruppen A-D. Bisher liegen aber keine Daten aus Deutschland vor, in wie weit sich der CCQ-Score nach einer dreiwochigen stationaren pneumologischer Rehabilitation bei COPD-Patienten andert und wie anderungssensitiv der CCQ im Vergleich mit dem CAT und der MMRC-Dyspnoe-Skala ist. Methode: Bei 201 konsekutiven COPD-Rehabilitanden (63,5% ♂, GOLD-Schweregrad 2 41,1%, GOLD 3 36%, GOLD 4 22,8%, mittleres Alter 57,4J., FEV1 51%SW) wurden zu Reha-Beginn (T0) und zu Reha-Ende (T1) MMRC, CAT und CCQ erfasst. Zur Abschatzung der Veranderungssensitivitat wurden die Effektstarken (SRM) verglichen. Ergebnisse: Zu T1 finden sich signifikante Verbesserungen aller 3 Scores, wobei die SRM bzgl. CCQ und CAT als mittelgradiger, die bzgl. MMRC als schwacher Effekt zu werten sind. Diskussion: CCQ und CAT verbessern sich am Ende der Rehabilitation mit einer Effektstarke (SRM) von 0,67. Beide weisen somit eine vergleichbare Anderungssensitivitat bzgl. der Rehabilitation auf. Demgegenuber erscheint die Anderungssensitivitat der MMRC-Dyspnoe-Skala deutlich geringer.