Figures
- Figure 1–
Consolidated Standards of Reporting Trials flow diagram of participation. MRC: Medical Research Council; COPD: chronic obstructive pulmonary disease; PR: pulmonary rehabilitation; SPACE: Self-Management Programme of Activity, Coping and Education.
- Figure 2–
Change in outcome measures from baseline to 6 weeks and baseline to 6 months. Data are presented as mean and whiskers represent 95% confidence intervals. SPACE: Self-Management Programme of Activity, Coping and Education; MID: minimal important difference; CRQ-SR: self-reported Chronic Respiratory Questionnaire; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walking test; BCKQ: Bristol COPD Knowledge Questionnaire; ns: nonsignificant. *: p<0.05; **: p<0.01.
Tables
- Table 1– Baseline characteristics and demographics
SPACE Usual care Patients 89 95 Age years 69±8.0 69±10.1 Males/females 54/35 47/48 FEV1 L 1.45±0.57 1.45±0.55 FEV1 % predicted 56.04±16.76 59.60±17.42 GOLD stage I/II/III/IV 7/51/22/9 8/60/20/7 GOLD 2011 classification A/B/C/D 33/25/15/16 41/27/9/18 BMI kg·m−2 28.05±5.6 27.09±4.9 Under respiratory consultant 6 7 MRC dyspnoea grade 2/3/4/5 48/24/13/4 50/22/14/9 Oxygen LTOT/ambulatory/both/none 0/1/0 3/0/1 Smoking history Current/ex-/never-smokers 18/67/4 21/68/6 Exposure pack-years 43±31.7 36±22.4 Comorbidities Hypertension 32 37 Type II diabetes 13 8 Heart failure 2 1 Arthritis 35 34 Other 49 48 Number of comorbidities 0/1/2/3/≥4 17/31/24/12/5 16/39/30/8/2 Medication SABA 71 87 LABA 5 3 LABA + ICS 45 63 LAMA 42 46 Time since diagnosis years 7±6.7 6±6.2 Number of exacerbations in previous 6 months 0/1/2/3/4/≥5 46/31/7/3/1/1 45/33/10/5/1/1 Age on leaving education years 15±1.2 16±1.7 Ethnicity White British 87 93 Irish 1 2 Indian 1 0 Lives with Alone 19 21 Spouse 54 58 Family 11 8 Other 5 8 Data are presented as n or mean±sd. SPACE: Self-Management Programme of Activity, Coping and Education; FEV1: forced expiratory volume in 1 s; GOLD: Global Initiative for Chronic Obstructive Lung Disease; BMI: body mass index; MRC: Medical Research Council; LTOT: long-term oxygen therapy; SABA: short-acting β-agonist; LABA: long-acting β-agonist; ICS: inhaled corticosteroid; LAMA: long-acting muscarinic antagonist.
- Table 2– Baseline, and change at 6 weeks and 6 months for all outcomes
SPACE Usual care Between-group difference in change at 6 weeks Between-group difference in change at 6 months Baseline Change at 6 weeks Change at 6 months Baseline Change at 6 weeks Change at 6 months CRQ-SR score Dyspnoea 3.31±1.07 0.71 (0.45–1.00) 0.66 (0.39–0.93) 2.95±1.17 0.42 (0.20–0.65) 0.49 (0.18–0.78) 0.29 (−0.12–0.56) (p = 0.049) 0.17 (−0.29–0.52) (p = 0.17) Fatigue 3.93±1.23 0.49 (0.24–0.66) 0.19 (−0.08–0.47) 3.80±1.32 0.01 (−0.21–0.22) −0.10 (−0.28–0.08) 0.48 (0.08–0.66) (p = 0.013) 0.29 (−0.12–0.53) (p = 0.06) Emotion 4.86±1.27 0.34 (0.11–0.57) 0.16 (−0.14–0.46) 4.83±1.22 −0.07 (−0.27–0.11) −0.19 (−0.39–0.01) 0.41 (0.08–0.62) (p = 0.011) 0.35 (−0.08–0.6) (p = 0.09) Mastery 5.25±1.32 0.15 (−0.06–0.37) 0.04 (−0.22–0.30) 5.14±1.40 −0.11 (−0.35–0.13) −0.23 (−0.47–0.20) 0.26 (−0.05–0.54) (p = 0.10) 0.27 (−0.14–0.56) (p = 0.09) ISWT m 343.0±150.0 9.4 (−5.0–24.0) 10.2 (−7.1–27.5) 353.0±161.8 −6.7 (−17.9–4.5) −5.7 (−17.5–6.0) 16.1 (−1.7–34.0) (p = 0.017) 15.9 (−4.8–36.7) (p = 0.50) ESWT s 260.3±179.4 209.7 (122.3–297.1) 233.5 (136.0–331.0) 262.8±166.6 92.1 (32.8–151.4) 49.9 (−4.5–104.4) 117.6 (16.8–218.5) (p = 0.006) 183.6 (72.8–294.4) (p = 0.003) HADS score Anxiety 5.98±3.94 −0.73 (−1.28– −1.17) −0.31 (−1.06–0.45) 6.91±4.06 0.12 (−0.38–0.62) 0.09 (−0.45–0.63) −0.85 (−1.58– −1.00) (p = 0.04) −0.40 (−1.30–0.50) (p = 0.04) Depression 5.32±3.22 −0.50 (−1.03–0.03) −0.19 (−0.87–0.49) 5.06±3.10 0.22 (−0.30–0.75) 0.47 (−0.02–0.95) −0.72 (−1.47–0.03) (p = 0.10) −0.66 (−1.47–0.15) (p = 0.27) Anxiety among those with baseline ≥8# 10.50±2.11 −1.00 (−2.30–0.30) −1.14 (−2.47–0.19) 10.67±2.47 −0.39 (−1.07–0.29) −0.52 (−1.31–0.28) −0.61 (−1.91–0.70) (p = 0.35) −0.62 (−2.04–0.80) (p = 0.38) Depression among those with baseline ≥8¶ 9.44±1.38 −0.89 (−2.25–0.47) −1.44 (−2.65– −0.23) 9.94±1.77 −0.69 (−2.39–1.01) 0.31 (−1.25–1.88) −0.20 (−2.28–1.87) (p = 0.84) −1.76 (−3.63–0.12) (p = 0.06) BCKQ score 34.41±7.60 2.79 (0.97–4.60) 3.21 (1.24–5.19) 32.99±9.37 0.44 (−1.02–1.90) 0.88 (−0.68–2.45) 2.35 (0.07–4.62) (p = 0.04) 2.33 (−0.12–4.78) (p = 0.04) PRAISE score 46.00±7.03 0.90 (−0.34–2.15) 1.26 (−0.12–2.65) 45.17±8.15 −1.08 (−2.67–0.51) −0.21 (−1.78–1.36) 1.98 (−0.09–4.05) (p = 0.32) 1.47 (−0.65–3.60) (p = 0.21) Data are presented as mean±sd or mean (95% CI), unless otherwise stated. SPACE: Self-Management Programme of Activity, Coping and Education; CRQ-SR: self-reported Chronic Respiratory Questionnaire; ISWT: incremental shuttle walk test; ESWT: endurance shuttle walking test; HADS: Hospital Anxiety and Depression Scale; BCKQ: Bristol COPD Knowledge Questionnaire; PRAISE: Pulmonary Rehabilitation Index of Self-Efficacy. #: n = 55; ¶: n = 34.
- Table 3– Proportion of patients achieving the minimal important difference in various outcomes
SPACE Usual care Between-group p-value 6 weeks CRQ-SR Dyspnoea 63 45 0.187 Fatigue 47 33 0.085 Emotion 32 25 0.317 Mastery 35 29 0.468 HADS Anxiety 33 20 0.242 Depression 28 20 0.195 ISWT 20 10 0.073 ESWT 35 17 0.011 6 months CRQ-SR Dyspnoea 56 44 0.143 Fatigue 46 25 0.010 Emotion 31 26 0.533 Mastery 34 23 0.129 HADS Anxiety 28 27 0.847 Depression 25 18 0.286 ISWT 20 10 0.116 ESWT 42 16 0.001 Data are presented as % unless otherwise stated. Minimal important differences: self-reported Chronic Respiratory Questionnaire (CRQ-SR) dyspnoea, fatigue, emotion and mastery domains, 0.5 points; Hospital Anxiety and Depression Scale, −1.5 points; incremental shuttle walk test (ISWT), 48 m; endurance shuttle walk test (ESWT), 186 s. SPACE: Self-Management Programme of Activity, Coping and Education.
- Table 4– Patients who had access to other pulmonary interventions during the 6-month study period
SPACE Usual care Smoking cessation support 3 0 Self-reported successful cessation 2 0 Pulmonary rehabilitation 0 0 Supplementary oxygen assessment 6 2 Change in oxygen prescription 1 0 Respiratory physiotherapy 0 0 NIV assessment 0 0 CPAP assessment 1 0 Change in CPAP treatment 0 0 Nebuliser assessment 0 1 Data are presented as n. SPACE: Self-Management Programme of Activity, Coping and Education; NIV: noninvasive ventilation; CPAP: continuous positive airway pressure.
- Table 5– Healthcare utilisation
SPACE Usual care OR (95% CI) 12 months preceding randomisation Respiratory admissions 4 5 0.865 (0.225–3.327) Nonrespiratory admissions 6 11 0.590 (0.209–1.664) 6 months post-randomisation Antibiotic course 82 70 1.199 (0.774–1.856) Respiratory GP visits 78 73 1.153 (0.749–1.775) Respiratory GP home visits 1 7 0.154 (0.019–1.279) Respiratory nurse visits 48 53 0.978 (0.601–1.590) Respiratory specialist nurse home visits 10 26 0.415 (0.189–0.910)* Respiratory emergency department visits 1 2 0.540 (0.048–6.058) Respiratory admissions 2 5 0.432 (0.082–2.283) All cause admissions 17 26 0.706 (0.359–1.389) Data are presented as n unless otherwise stated. GP: general practitioner. *: p<0.05.
Disclosures
Files in this Data Supplement:
Supplementary material
Please note: supplementary material is not edited by the Editorial Office, and is uploaded as it has been supplied by the author.
Files in this Data Supplement:
- Online supplement 1 - SPACE manual contents
- Online supplement 2 - Manual structure
- Online supplement 3 - Telephone schedule
