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Cited by 176Chronic Obstructive Pulmonary Disease (COPD) ResearchAsthma and respiratory diseasesSmoking Behavior and Cessation

Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study

Open access
Benzo, Roberto, Vickers, Kristin, Novotny, Paul J., Tucker, Sharon, Hoult, Johanna, Neuenfeldt, Pamela, Connett, John, Lorig, Kate +1 more·2016·American Journal of Respiratory and Critical Care Medicine
DOI 10.1164/rccm.201512-2503ocPMC PMC5027231
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Abstract

Rationale: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. Objectives: To determine the effect of comprehensive health coaching on the rate of COPD readmissions. Methods: A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing–based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. Measurements and Main Results: We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01–0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15–0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20–0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30–1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point. Conclusions: Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).

AI snapshot

Written from the paper’s full text.

TL;DR

In a randomized trial of 215 patients hospitalized for COPD exacerbation, motivational-interviewing-based health coaching plus a written action plan and brief exercise advice reduced COPD-related rehospitalization at 1, 3, and 6 months but not at 12 months. Disease-specific quality of life improved at 6 and 12 months, while measured physical activity did not differ between groups.

Key findings

  • COPD-related rehospitalization absolute risk reductions were 7.5% at 1 month (P = 0.01), 11.0% at 3 months (P = 0.02), 11.6% at 6 months (P = 0.03), 11.4% at 9 months (P = 0.05), and 5.4% at 12 months (P = 0.24); the corresponding odds ratios were 0.09 (95% CI, 0.01–0.77) at 1 month, 0.37 (95% CI, 0.15–0.91) at 3 months, 0.43 (95% CI, 0.20–0.94) at 6 months, and 0.60 (95% CI, 0.30–1.20) at 12 months.
  • Number needed to treat to prevent one hospitalization was 13 at 1 month, 9 at 3 months, and 8 at 6 months; for every 10 patients treated, there were 3 fewer hospital days at 1 month, 4 fewer at 3 months, and 8 fewer at 6 months.
  • Disease-specific quality of life improved significantly in the health coaching group at 6 and 12 months on the Chronic Respiratory Disease Questionnaire emotional and physical scores (P < 0.05), with NNT of 6–7 for clinically meaningful improvement at 6 months.
  • There were no differences between groups in measured physical activity at any time point; confirmed exacerbations were greater in the control group than the intervention group over 12 months (mean [SD], 1.15 [1.5] vs. 0.8 [1.5]; P = 0.03).

Methods

  • Multisite randomized trial conducted September 2010 to August 2014 at Mayo Clinic and HealthPartners Regions Hospital; 215 patients admitted for a COPD exacerbation, older than 40 years, with more than 10 pack-years smoking, English-speaking, and telephone access were randomized at hospital discharge, stratified by center.
  • Intervention was motivational-interviewing-based health coaching plus a written action plan for exacerbations (prednisone 40 mg orally and a generic antibiotic for 5 days) and brief exercise advice; control received guideline-based usual care, with both groups referred for conventional pulmonary rehabilitation.
  • Primary outcome was rate of COPD-related rehospitalization over 1 year; secondary outcomes included disease-specific quality of life (CRQ) and measured physical activity at 6 and 12 months. Analyses used chi-square tests and logistic models adjusted for age, FEV1, mMRC score, and prior hospitalizations, with bootstrap sensitivity analyses.

Limitations

  • The paper states the study was powered to detect a difference in hospitalization at 12 months, which was not found; the authors believe intermediate time-point differences are robust but cannot know the exact contributory effect of each intervention component.
  • The paper notes the intervention did not increase measured physical activity, and possible reasons for the lack of 12-month effect include decreasing secular readmission rates and reduced intervention intensity after Month 3.
  • Evident from the text: participants and coaches were not blinded, although outcome assessors and adjudicating pulmonologists were blinded; the intervention was multicomponent, and the two-site U.S. sample may limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1164/rccm.201512-2503oc

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 38 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § Effect on Disease-Speci fi c Quality of Life

    About six or seven patients needed to be treated for one patient to achieve a meaningful improvement in quality of life at 6 months in both physical and emotional summary CRQ scores.

    “our analysis of the percentage of patients who had clinically signi fi cant improvement showed that about six or seven patients needed to be treated (NNT = 6 -7) (Table 4) for one patient to achieve a meaningful improvement in QoL at 6 months in both physical (dyspnea and fatigue domains) and emotional (emotion and mastery domains) summary CRQ scores.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Abstract

    There were no differences between groups in measured physical activity at any time point.

    “There were no differences between groups in measured physical activity at any time point.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Limitations

    No difference in the rate of hospitalization at 12 months was found.

    “the study was powered to fi nd a difference in the rate of hospitalization at 12 months, which was not found.”
    Quote in the paperSubstantial claim
  • Findingown data
    § Results

    There was no difference between groups in use of an antibiotic-prednisone combination at 3, 6, or 9 months after discharge.

    “There was no difference between groups in the use of an antibioticprednisone combination (written action plan) at 3, 6, or 9 months after discharge (when the intervention was signi fi cant in decreasing hospitalizations).”
    Quote in the paperNot a substantial claim
  • Findingown data
    § Abstract

    Disease-specific quality of life improved significantly in the health coaching group compared with control at 6 and 12 months, based on CRQ emotional and physical scores.

    “Disease-speci fi c quality of life improved signi fi cantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) ( P , 0.05).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 22
  • Classified as probably not a substantial claim. 15

  • May combine two claims.

    Findingown data
    § Results

    Health coaching significantly reduced COPD-related hospitalizations at 1, 3, and 6 months after hospital discharge, but not at 12 months.

    “The health coaching intervention had a signi fi cant effect on the main outcome (rates of COPD hospitalization at 1, 3, and 6 months post -hospital discharge), but this effect faded at 12 months (Table 2).”
    • Also stated in: § Discussion · plain
      “we found that a comprehensive health coaching intervention that included MI-based intervention delivered via telephone, a written action plan for exacerbations, and an exercise prescription decreased COPDrelated hospitalizations at 1, 3, and 6 months after hospital discharge, but not at 1 year after discharge.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Greater pulmonary rehabilitation attendance in the intervention group did not account for the reduction in COPD hospitalizations.

  • May combine two claims.

    Findingown data
    § Abstract

    The odds ratios for COPD hospitalization in the intervention arm compared with control were 0.09 at 1 month, 0.37 at 3 months, 0.43 at 6 months, and 0.60 at 1 year.

    “The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% con fi dence interval [CI], 0.01 -0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15 -0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20 -0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30 -1.20) at 1 year postdischarge.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § Outcomes and Follow-up

    There were no differences in the rate of hospitalizations between HealthPartners Regions Hospital and the Mayo Clinic.

    “There were no differences in the rate of hospitalizations between HealthPartners Regions Hospital and the Mayo Clinic.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § Results

    Days in hospital after discharge were fewer in the intervention group than control at 1, 3, and 6 months.

    “We also found that days in the hospital after discharge were fewer in the intervention group.”
    • Also stated in: § Results · plain
      “For every 10 patients treated, there were 3 fewer hospital days at 1 month (mean length of stay in a COPD hospitalization at 1 month, 0.3 vs. 0.0; P = 0.015), 4 fewer hospital days at 3 months (mean length of stay in a COPD hospitalization at 3 months, 0.8 vs. 0.4; P = 0.027), and 8 fewer hospital days at 6 months (mean length of stay in a COPD hospitalization at 6 months, 1.5 vs. 0.7; P = 0.027).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation
    § Strengths

    The patient population was most of the time reluctant to participate in research.

    “and most of the time reluctant to participate in research (29)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Benzo, 2015, Implementation of physical activity programs after COPD hospitalizations: lessons from a randomized study, Chron Respir Dis source

      Not checked in the free run.

  • May combine two claims.

    Findingnone given
    § Limitations

    The use of antibiotics and prednisone in the intervention group was similar to that in the control group when the intervention showed effectiveness in decreasing rehospitalizations.

    “The use of antibiotics and prednisone in the intervention group was similar to that in the control group when the intervention showed effectiveness in decreasing rehospitalizations”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Statistical Analysis

    Logistic models compared rates between arms after adjusting for age, mMRC score, and FEV1.

    “Logistic models were used to compare these rates between arms after adjusting for the confounding factors of age, modi fi ed Medical Research Council dyspnea scale (mMRC) score, and FEV1.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § What This Study Adds to the

    Effective prevention strategies need to be comprehensive and directed at more than COPD alone.

    “Effective prevention strategies need to be comprehensive and directed at more than COPD alone.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data
    § Results

    Fidelity of the health coaching intervention to motivational interviewing principles was assessed, with global ratings on a 1-5 scale: empathy 3.9, collaboration 4, autonomy/support 4, direction 3.9, and evocation 3.9; a score greater than 3 was required for minimal proficiency.

    “The fi delity of the health coaching intervention to MI principles, as measured by the global ratings of the MI Treatment Integrity (24) tool, were as follows on a 1 -5 scale and expressed as mean (SD): empathy 3.9 (0.5), collaboration 4 (0.6), autonomy/support 4 (0.3), direction 3.9 (0.5), and evocation 3.9 (0.5). A score greater than 3 was required to maintain minimal pro fi ciency.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data
    § Abstract

    Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions.

    “Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Greater pulmonary rehabilitation attendance in the intervention group did not account for the reduction in COPD hospitalizations.

  • May combine two claims.

    Premisecitation
    § Effect on Disease-Speci fi c Quality of Life

    Patients whose health status improves have less likelihood of exacerbation, hospitalization, or dying during a 2-year follow-up.

    “patients whose health status improves have less likelihood of exacerbation, hospitalization, or dying during a 2-year follow-up (39, 40).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [39] Wilke, 2015, One-year change in health status and subsequent outcomes in COPD, Thorax source

      Not checked in the free run.

    • cites [40] Fan, 2002, Using quality of life to predict hospitalization and mortality in patients with obstructive lung diseases, Chest source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data
    § Outcomes and Follow-up

    Research staff and pulmonologists assessing outcomes were blinded to study group allocation.

    “Research staff blinded to study group allocation contacted patients every 3 months to determine whether they had developed symptoms of a COPD exacerbation or were hospitalized.”
    • Also stated in: § Outcomes and Follow-up · plain
      “Per protocol, three pulmonologists blinded to group allocation reviewed discharge summaries and other available information to determine the primary cause of all hospitalizations and classi fi ed them as COPD related (COPD exacerbation or pneumonia), cardiovascular, or other.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data
    § Statistical Analysis

    Intent-to-treat analyses were run, and because missing values were very few and results were similar to the original analyses, no imputations were done.

    “Because there were very few missing values and results from intent-to-treat analyses were similar to the original analyses, no imputations were done.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Baseline and Follow-up Assessments

    The minimal clinically important difference accepted for the Chronic Respiratory Disease Questionnaire is 0.5 points.

    “The minimal clinically important difference accepted for this instrument is 0.5 points (26).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Jones, 2002, Interpreting thresholds for a clinically significant change in health status in asthma and COPD, Eur Respir J source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Baseline and Follow-up Assessments

    Physical activity was measured with a monitor validated in COPD.

    “Physical activity was measured with a monitor validated in COPD (BodyMedia armband; BodyMedia, Pittsburgh, PA) (27, 28).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] Patel, 2007, Activity monitoring and energy expenditure in COPD patients: a validation study, COPD source

      Not checked in the free run.

    • cites [28] Watz, 2014, An official European Respiratory Society statement on physical activity in COPD, Eur Respir J source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data
    § Outcomes and Follow-up

    Reported hospitalizations were compared with electronic medical record or health plan claims data and found to be accurate.

    “To ascertain that recall bias was not an issue in the study, the reported hospitalizations were compared with the electronic medical record or health plan claims data and found to be accurate.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given
    § Effect on Disease-Speci fi c Quality of Life

    The overwhelming adherence to health coaching speaks of its feasibility and acceptability.

    “The overwhelming adherence to health coaching speaks of its feasibility and acceptability.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning
    § Plausible Explanations for the Lack of Effect at 12 Months

    The lower intensity of calls and less patient support may have translated into less effectiveness.

    “the ripple effect of the lower intensity of calls and less patient support may have translated into less effectiveness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation
    § Limitations

    Our results represent the first available randomized evidence of a feasible and possibly effective intervention designed to reduce short-term readmissions of patients with COPD that could be translated to care.

    “Our results represent the fi rst available randomized evidence of a feasible and possibly effective intervention designed to reduce short-term readmissions of patients with COPD that could be translated to care”
    • Also stated in: § Conclusions · hedged
      “This study may represent the fi rst available randomized evidence of a feasible and possibly effective intervention to reduce short-term readmissions for patients with COPD that could be translated to care”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [47] Berwick, 2015, Innovations in health care delivery: call for papers for a yearlong series, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning
    § Limitations

    We tested a comprehensive health coaching intervention that included multiple components; we cannot know the exact contributory effect of each component.

    “We tested a comprehensive health coaching intervention that included multiple components; we cannot know the exact contributory effect of each component.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § Limitations

    Attending PR visits after discharge from a COPD hospitalization is a desirable but not widely feasible intervention for most communities, as published data indicate that only 10% of post-hospital discharge patients complete PR.

    “It is known that attending PR visits after discharge from a COPD hospitalization is a desirable but not widely feasible intervention for most communities, as published data indicate that only 10% of post -hospital discharge patients complete PR (37).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Jones, 2014, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence, Thorax source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Statistical Analysis

    The sensitivity of the logistic models was evaluated using 1,000 bootstrapped samples.

    “The sensitivity of these models was evaluated using 1,000 bootstrapped samples.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § What This Study Adds to the

    One-to-one phone-based health coaching using motivational interviewing skills has been associated with behavior change and improved self-management abilities, self-efficacy, health status, and medication adherence.

    “One-to-one phone-based health coaching using motivational interviewing (MI) skills has been associated with behavior change (12, 13) and improved self-management abilities (14), self-ef fi cacy (15), health status (16, 17), and medication adherence (16).”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [12] Eakin, 2014, Effectiveness of motivational interviewing to reduce Head Start children’s secondhand smoke exposure: a randomized clinical trial, Am J Respir Crit Care Med source

      Not checked in the free run.

    • cites [13] Borrelli, 2007, Brief motivational interviewing as a clinical strategy to promote asthma medication adherence, J Allergy Clin Immunol source

      Not checked in the free run.

    • cites [14] Walters, 2013, Effects of telephone health mentoring in community-recruited chronic obstructive pulmonary disease on self-management capacity, quality of life and psychological morbidity: a randomised controlled trial, BMJ Open source

      Not checked in the free run.

    • cites [15] Linden, 2010, Motivational interviewing-based health coaching as a chronic care intervention, J Eval Clin Pract source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Abstract

    The missing value rate for the primary outcome was 0.4% (one patient).

    “The missing value rate for the primary outcome was 0.4% (one patient).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation
    § Effect on Disease-Speci fi c Quality of Life

    The effect size seen in CRQ is comparable and likely not inferior to the one seen in PR, an established and accepted intervention in COPD.

    “It is plausible that the effect size seen in CRQ is comparable and likely not inferior to the one seen in PR, an established and accepted intervention in COPD (38).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [38] Gillespie, 2013, The cost-effectiveness of a structured education pulmonary rehabilitation programme for chronic obstructive pulmonary disease in primary care: the PRINCE cluster randomised trial, BMJ Open source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation
    § Plausible Explanations for the Lack of Effect at 12 Months

    The decrease in readmission rate was possibly related to increased use of macrolides and written action plans to prevent exacerbations, based on the positive results of two large studies and the implementation of readmission reduction programs at both institutions.

    “possibly related to increased use of macrolides and written action plans to prevent exacerbations, based on the positive results of two large studies (42, 43) and the implementation of readmission reduction programs at both institutions due to the upcoming readmission initiative (44).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [42] Albert, 2011, Azithromycin for prevention of exacerbations of COPD, N Engl J Med source

      Not checked in the free run.

    • cites [43] Rice, 2010, Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial, Am J Respir Crit Care Med source

      Not checked in the free run.

    • cites [44] Feemster, 2014, Penalizing hospitals for chronic obstructive pulmonary disease readmissions, Am J Respir Crit Care Med source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Statistical Analysis

    A sample size of 101 per group was estimated to give 80% power to detect a 20% difference in readmission rates.

    “To reach 80% power, an estimated sample size of 101 for each group was needed to detect a 20% difference (50% control to 30% intervention) between the group readmission rates.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation
    § Results

    In a previous report, individuals who declined the intervention did not differ in age, FEV1 percentage predicted, mMRC score, and age-dyspnea-obstruction index from included subjects, suggesting the recruited population reflected the intended population without bias.

    “In our previous report (29), we compared the age, FEV1 percentage of predicted value, mMRC score, and age -dyspnea -obstruction index of the individuals who declined the intervention with these data for the subjects who were included in the study, and we found no differences, suggesting that the population recruited re fl ected the intended population without bias.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Benzo, 2015, Implementation of physical activity programs after COPD hospitalizations: lessons from a randomized study, Chron Respir Dis source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Discussion

    Health coaching was a simple and trainable intervention with low cost, was feasible, and had a high likelihood of replication.

    “We found health coaching to be a simple and trainable intervention with low cost and that was feasible (not requiring transportation, unlike PR) and had a high likelihood of replication, given the expansive availability of health coaching training programs.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Health coaching is low cost.

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § Randomization and Interventions

    Subjects were randomly assigned using an online, computer-generated, simple binomial randomization program, stratified by center.

    “We randomly assigned subjects using an online, computer-generated, simple binomial randomization program to one of the two groups, strati fi ed by center.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Effect on Disease-Speci fi c Quality of Life

    Pulmonary rehabilitation has been shown to be the best intervention to improve emotions in COPD, but it can be completed by only 10% of patients with COPD after a hospitalization.

    “So far, PR has been shown to be the best intervention to improve emotions in COPD; however, PR can be completed by only 10% of patients with COPD after a hospitalization (37).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [37] Jones, 2014, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence, Thorax source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Limitations

    There is conflicting evidence on the effect of posthospitalization PR.

    “However, there is con fl icting evidence on the effect of posthospitalization PR (48, 49).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [48] Greening, 2014, An early rehabilitation intervention to enhance recovery during hospital admission for an exacerbation of chronic respiratory disease: randomised controlled trial, BMJ source

      Not checked in the free run.

    • cites [49] Seymour, 2010, Outpatient pulmonary rehabilitation following acute exacerbations of COPD, Thorax source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Strengths

    Accruing participants for a study of this population is difficult: the National Institutes of Health COPD Clinical Research Network failed to accrue a sufficient number of participants in a study aimed at decreasing exacerbations that targeted the same population we did in this study (patients hospitalized with a COPD exacerbation).

    “Accruing participants for a study of this population is dif fi cult: the National Institutes of Health COPD Clinical Research Network, a multicenter group of large and highly reputable centers, failed to accrue a suf fi cient number of participants in a study aimed at decreasing exacerbations that targeted the same population we did in this study (patients hospitalized with a COPD exacerbation) (5”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] Woodruff, 2011, Randomized trial of zileuton for treatment of COPD exacerbations requiring hospitalization, COPD source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Limitations

    Mindful attention (not any attention) such as that received in health coaching may matter because health coaching may motivate people to engage in behaviors (e.g., attending PR visits) that translate into improvement of 'hard' outcomes (e.g., hospitalizations).

    “suggesting that mindful attention (not any attention) such as that received in health coaching may matter because health coaching may motivate people to engage in behaviors (e.g., attending PR visits) that translate into improvement of ' hard ' outcomes (e.g., hospitalizations).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Strengths

    We had minimal missing data.

    “Wehad minimal missing data”
    Quote in the paperNot a substantial claim
35 of 35

  • The paper relies on this without support.

    Health coaching is low cost.

    “We found health coaching to be a simple and trainable intervention with low cost and that was feasible (not requiring transportation, unlike PR) and had a high likelihood of replication, given the expansive availability of health coaching training programs.”

  • The paper relies on this without support.

    Greater pulmonary rehabilitation attendance in the intervention group did not account for the reduction in COPD hospitalizations.

    “Attendance at PR visits in the fi rst 3 months after discharge (as part of the patient ' s discharge plan, not research) was greater in the intervention group than in the control group (50% vs. 33%; P = 0.017).”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Six-month absolute risk reduction does not match hospitalization rates

    Major

    The control and intervention hospitalization rates differ by 12.3 percentage points, not the reported 11.6 points. This is an effect-size error for a time point the paper identifies as significant.

    Reported 11.6 · recomputed 12.3

  • Twelve-month absolute risk reduction does not match hospitalization rates

    Minor

    The rates differ by 7.6 percentage points, not the table's 5.2 points. The abstract gives a third value, 5.4%.

    Reported 5.2 · recomputed 7.6

  • Nine-month absolute risk reduction does not match hospitalization rates

    Minor

    The rates differ by 12.1 percentage points, rather than the reported 11.4 points.

    Reported 11.4 · recomputed 12.1

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Lorig, 2006, Living a healthy life with chronic conditions: self-management of heart disease, arthritis, diabetes, asthma, bronchitis, emphysema and others.

Cited by

Sorted by citations

Related

Authors
Benzo, R., Vickers, K., Novotny, P. J., Tucker, S., Hoult, J., Neuenfeldt, P., Connett, J., Lorig, K., & McEvoy, C.
Affiliations
  • Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine
  • Department of Psychology, and
  • Mayo Clinic (US)
  • University of Iowa (US)
  • HealthPartners (US)
  • University of Minnesota (US)
  • Stanford University (US)
Corresponding author
Benzo, Roberto
ORCID
Venue
American Journal of Respiratory and Critical Care Medicine
Publisher
Oxford University Press (OUP)
Published
2016-09
Volume
194
Issue
6
Pages
672-680
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/rccm.201512-2503oc
PMC
PMC5027231
OpenAlex
W2519121194
Semantic Scholar
19fe3a7cf1e93b350c5cdd4b8042bf609ce27ace
Cited by
176
References
52
Citations by year
2026: 8 · 2025: 4 · 2024: 16 · 2023: 18 · 2022: 22 · 2021: 23 · 2020: 24 · 2019: 19 · 2018: 11 · 2017: 27 · 2016: 4
FWCI
18.19
Type
journal article
Language
en
Open access
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
NHLBI (R01 HL09468)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
Keywords
health coaching, chronic obstructive pulmonary disease, hospital readmission, COPD exacerbations, motivational interviewing, action plan, exercise recommendations, disease-specific quality of life, post-discharge care, physical activity, antibiotic use, oral corticosteroids, Chronic Respiratory Questionnaire, dyspnea, fatigue, emotional mastery, patient education, health behavior change
MeSH terms
Mentoring, Aged, Exercise Therapy, Female, Humans, Male, Patient Readmission, Quality of Life, Pulmonary Disease, Chronic Obstructive, Motivational Interviewing

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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