A Feasibility and Pilot Randomized Clinical Trial Assessing the Integration of Digital Remote Patient Monitoring Within Pulmonary Rehabilitation
Bibliographic record
Abstract
Abstract Rationale: Chronic respiratory diseases, like chronic obstructive pulmonary disease (COPD), require self-monitoring and disease management, yet traditional methods are hindered by cognitive decline, low health literacy, and symptom underreporting. Pulmonary rehabilitation (PR) improves outcomes but has diminishing long-term effects. Integrating digital remote patient monitoring (DRPM) into PR permits continuous symptom tracking and early exacerbation detection and may facilitate better adherence to disease management behaviours. This study evaluated the feasibility of combining PR with DRPM and will inform future trials assessing clinical efficacy. Methods: Participants in this cluster-randomized trial were assigned to Standard-PR or PR+DRPM, with both groups completing 16 PR sessions over 6 or 8 weeks, then a 12-week post-PR follow-up. Using a Wi-Fi-enabled, Bluetooth-connected device, the PR+DRPM group monitored five resting vital signs daily – blood pressure, heart rate, oxygen saturation, body temperature and weight. Daily adherence was tracked automatically via device connectivity, with missed readings prompting compliance calls. DRPM data were linked to the patient's electronic health record. PR providers monitored the data remotely and contacted participants if readings exceeded pre-set thresholds. Feasibility outcomes included recruitment, retention, adherence, acceptability, adverse events, and staff workload. Secondary outcomes (exercise capacity, quality of life, physical activity and self-efficacy) were analyzed using linear mixed models. Results: The recruitment rate was 94% (n=78, 55% male, mean age = 68.4 ± 11, mean FEV1 = 59.1 ± 22.7). Retention was 77% post-PR and 67% at 12-week follow-up, with similar rates between groups. 94% of PR+DRPM participants attended all PR sessions compared to 86% in Standard-PR. Participants’ adherence to daily vitals monitoring was 90% during PR and 89% at follow-up; 163 compliance calls were made when readings were missed. 100% of participants would recommend DRPM to other patients, and 92% agreed that their health information was kept private. Ten participants reported minor and transient adverse events not related to DRPM. Staff workload increased by ∼45 minutes per participant (attending 496 notifications for abnormal data) over the trial. Secondary outcomes did not differ between the two groups. Conclusion: PR+DRPM is feasible and well-received by participants based on high adherence to daily readings. However, the high number of compliance calls to address missed readings suggests that DRPM may significantly burden staff. Addressing staff workload will be essential in planning a larger trial to examine the efficacy, cost-effectiveness, and scalability of DRPM for sustainable use in managing COPD and other chronic respiratory diseases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".