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Nurs Outlook. 2018 Sep;66(5):455-463. doi: 10.1016/j.outlook.2018.05.005. Epub 2018 Jul 12.

Applying the pragmatic-explanatory continuum indicator summary to the implementation of a physical activity coaching trial in chronic obstructive pulmonary disease.

Author information

1
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Electronic address: huong.q2.nguyen@kp.org.
2
Harvard Medical School, VA Boston Healthcare System, Pulmonary and Critical Care Section, Boston, MA.
3
University of Washington, Seattle, Puget Sound VA Health System, Seattle, WA.
4
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
5
Kaiser Permanente Southern California, San Diego, CA.

Abstract

BACKGROUND:

Observational studies show that physical inactivity is associated with worse outcomes in chronic obstructive pulmonary disease (COPD). Despite practice guidelines recommending regular physical activity (PA), there are no large-scale experimental studies to confirm that patients at high risk for COPD exacerbations can increase their PA and consequently, have improved outcomes.

PURPOSE:

The purpose of this case study is to describe the use of a widely accepted pragmatic trials framework for the design and implementation of a pragmatic clinical trial (PCT) of PA coaching for COPD in a real-world setting.

METHOD:

The aim of the trial was to determine the effectiveness of a 12-month PA coaching intervention (Walk On!) compared to standard care for 2,707 patients at high risk for COPD exacerbations from a large integrated health care system. The descriptions of our implementation experiences are anchored within the pragmatic-explanatory continuum indicator summary (PRECIS-2) framework.

DISCUSSION:

Facilitators of PCT implementation include early and ongoing engagement and support of multiple stakeholders including patients, health system leaders, administrators, physician champions, and frontline clinicians, an organizational/setting that prioritizes positive lifestyle behaviors, and a flexible intervention that allows for individualization. Pragmatic challenges include reliance on electronic data that are not complete or available in real-time for patient identification, timing of outreach may not synchronize with patients' readiness for change, and high turnover of clinical staff drawn from the existing workforce.

DISCUSSION:

PRECIS-2 is a useful guide for organizing decisions about study designs and implementation approaches to help diverse stakeholders recognize the compromises between internal and external validity with those decisions.

KEYWORDS:

COPD; PRECIS-2; Physical activity; Pragmatic trials

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