ABSTRACT
BACKGROUND: Pulmonary rehabilitation (PR) is the standard of care for chronic obstructive pulmonary disease (COPD) management. However, significant barriers limit access and adherence to PR and alternatives are needed. The purpose of this randomized controlled trial is to test the efficacy of a web-based, pedometer-mediated intervention to increase physical activity (PA) for persons with COPD who decline PR or meet U.S. guidelines for referral to PR but have not participated (CAPRI-1). In addition, we will test whether the intervention maintains PA following PR in an exploratory aim (CAPRI-2). METHODS: Participants with COPD (N = 120) will be recruited and randomized 1:1 to a 12-week web-based, pedometer-mediated intervention or usual care (UC) (CAPRI-1). The intervention provides: 1) objective monitoring of walking and iterative feedback, 2) individualized step-count goals, 3) motivational messages and educational content, and 4) an online community. The primary outcome is change in daily step count from baseline to 12 weeks. Secondary outcomes include: (a) exercise capacity; (b) self-reported PA; (c) PA intensity; (d) exercise self-regulatory efficacy, (e) health-related quality of life, (f) dyspnea, (g) depression symptoms, and (h) healthcare utilization. CAPRI-2 will test whether participants (N = 96) assigned to the intervention following PR completion show greater maintenance of daily step count compared to UC at 3, 6, 9, and 12 months. DISCUSSION: If the intervention is efficacious, it may be an alternative for those who cannot attend PR or a maintenance program following completion of conventional PR. We also present adaptations made to the protocol in response to the COVID-19 pandemic.
Subject(s)
COVID-19 , Pulmonary Disease, Chronic Obstructive , Humans , Quality of Life , Pandemics , Exercise , Randomized Controlled Trials as TopicABSTRACT
The COVID-19 pandemic affects many aspects of diabetes care including loss of access to healthcare due to clinic closures or insurance issues, fear of accessing care due to potential COVID exposures, and food/medication insecurity. Little is known about how ER visits for acute diabetic complications change as a result of this pandemic. An observational claims-based study was conducted to evaluate ER visits for DKA and hypoglycemia at the University of Michigan Health System. ER admissions with diagnoses of DKA and hypoglycemia were identified in 2020 and compared to 2017-19 (baseline). Since March 2020 (with the first COVID case identified in Michigan), the numbers of total ER admissions (both COVID and non-COVID related) have consistently remained lower than baseline (Figure 1A). While ER admission numbers for DKA (Figure 1B) and hypoglycemia (Figure 1C) were lower during the first wave of COVID (Mar-May), no consistent pattern has been observed in the second wave of COVID cases (Oct-). In summary, ER admissions for DKA and hypoglycemia decreased as much as 50% during the first, but not the second, waves of COVID cases. Further studies evaluating this complex psycho-social-medical phenomenon is in need.
ABSTRACT
Racism is a pervasive and systemic issue that has profound adverse effects on health.1,2 Racism is associated with poorer mental and physical health outcomes and negative patient experiences in the health care system.3,4 As evidenced by the current coronavirus pandemic, race is a sociopolitical construct that continues to disadvantage Black, Latinx, Indigenous, and other People of Color.5–8 The association between racism and adverse health outcomes has been discussed for decades in the medical literature, including the family medicine literature. [...]in 2016, Dr. J. Nwando Olayiwola, chair of the Department of Family Medicine at Ohio State University, wrote an essay on her experiences taking care of patients as a Black family physician.10 In January 2019, Family Medicine published an entire issue devoted to racism in education and training.11 Dr. Eduardo Medina, a family physician and public health scholar, coauthored a call to action in 2016 for health professionals to dismantle structural racism and support Black lives to achieve health equity. A critical step is to have the expertise of a medical editor for diversity, equity, and inclusion, and we welcome this input from Renee Crichlow, MD, Boston University Department of Family Medicine's vice chair of health equity.