The DOI matches its Crossref record, with a small difference in title or year; 52 of the 52 references it cites were found in a registry or an index; none of the 38 sources its claims cite is checked for support yet.
Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization: A Randomized Study
Open accessAbstract
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).
Overview
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.
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Claims the paper makes
25 Not checked yet · 20 Own result · 15 Own method · 10 Own interpretation · 3 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no differences between groups in measured physical activity at any time point.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the study was powered to fi nd a difference in the rate of hospitalization at 12 months, which was not found.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We also found that a higher percentage of patients in the intervention group had improved their QoL based on the minimal clinically important difference (Table 4).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Attendance at PR visits anytime in the fi rst 12 months after discharge tended to be higher in the intervention group (53% vs. 43%; P = 0.056).”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, as the study evolved, we observed that the rate of readmission decreased”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, the absolute risk reduction showed consistency over time (roughly 10% reduction of hospitalizations).”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“First, at the time this study was launched, the rate of 12-month readmission was about 50% in our preliminary data (Table 1), consistent with previously published data (41).”
What the sources say
- Not checked yetcites [41] Bucknall, 2012, Glasgow Supported Self-management Trial (GSuST) for patients with moderate to severe COPD: randomised controlled trial, BMJ source
plain- Asserted: passes — The authors put it forward as true.
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- It may state two separate claims as one. 22
- Probably not a substantial claim. 15
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
- Rests on an assumption: Greater pulmonary rehabilitation attendance in the intervention group did not account for the reduction in COPD hospitalizations.
- Also stated in: § Discussion · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“There were no differences in the rate of hospitalizations between HealthPartners Regions Hospital and the Mayo Clinic.”
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
plaindirectn = 10 ·- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § Results · plain
In the paper
“and most of the time reluctant to participate in research (29)”
What the sources say
- Not checked yetcites [29] Benzo, 2015, Implementation of physical activity programs after COPD hospitalizations: lessons from a randomized study, Chron Respir Dis source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Effective prevention strategies need to be comprehensive and directed at more than COPD alone.”
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Greater pulmonary rehabilitation attendance in the intervention group did not account for the reduction in COPD hospitalizations.
None of the sources cited for this claim have been checked yet.
In the paper
“patients whose health status improves have less likelihood of exacerbation, hospitalization, or dying during a 2-year follow-up (39, 40).”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § Outcomes and Follow-up · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Because there were very few missing values and results from intent-to-treat analyses were similar to the original analyses, no imputations were done.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The minimal clinically important difference accepted for this instrument is 0.5 points (26).”
What the sources say
- Not checked yetcites [26] Jones, 2002, Interpreting thresholds for a clinically significant change in health status in asthma and COPD, Eur Respir J source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Physical activity was measured with a monitor validated in COPD (BodyMedia armband; BodyMedia, Pittsburgh, PA) (27, 28).”
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The overwhelming adherence to health coaching speaks of its feasibility and acceptability.”
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the ripple effect of the lower intensity of calls and less patient support may have translated into less effectiveness.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“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”
What the sources say
- Not checked yetcites [47] Berwick, 2015, Innovations in health care delivery: call for papers for a yearlong series, JAMA source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
- Also stated in: § Conclusions · hedged
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We tested a comprehensive health coaching intervention that included multiple components; we cannot know the exact contributory effect of each component.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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).”
What the sources say
- Not checked yetcites [37] Jones, 2014, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence, Thorax source
boosted- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The sensitivity of these models was evaluated using 1,000 bootstrapped samples.”
plainn = 1,000- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [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 yetcites [13] Borrelli, 2007, Brief motivational interviewing as a clinical strategy to promote asthma medication adherence, J Allergy Clin Immunol source
- Not checked yetcites [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 yetcites [15] Linden, 2010, Motivational interviewing-based health coaching as a chronic care intervention, J Eval Clin Pract source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The missing value rate for the primary outcome was 0.4% (one patient).”
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
What the sources say
- Not checked yetcites [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
hedged- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
What the sources say
- Not checked yetcites [42] Albert, 2011, Azithromycin for prevention of exacerbations of COPD, N Engl J Med source
- Not checked yetcites [43] Rice, 2010, Disease management program for chronic obstructive pulmonary disease: a randomized controlled trial, Am J Respir Crit Care Med source
- Not checked yetcites [44] Feemster, 2014, Penalizing hospitals for chronic obstructive pulmonary disease readmissions, Am J Respir Crit Care Med source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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Probably not a substantial claim.
In the paper
“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.”
What the sources say
- Not checked yetcites [29] Benzo, 2015, Implementation of physical activity programs after COPD hospitalizations: lessons from a randomized study, Chron Respir Dis source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Rests on an assumption: Health coaching is low cost.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“We randomly assigned subjects using an online, computer-generated, simple binomial randomization program to one of the two groups, strati fi ed by center.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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).”
What the sources say
- Not checked yetcites [37] Jones, 2014, Pulmonary rehabilitation following hospitalisation for acute exacerbation of COPD: referrals, uptake and adherence, Thorax source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, there is con fl icting evidence on the effect of posthospitalization PR (48, 49).”
What the sources say
- Not checked yetcites [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 yetcites [49] Seymour, 2010, Outpatient pulmonary rehabilitation following acute exacerbations of COPD, Thorax source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
What the sources say
- Not checked yetcites [52] Woodruff, 2011, Randomized trial of zileuton for treatment of COPD exacerbations requiring hospitalization, COPD source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Wehad minimal missing data”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
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).”
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?
In the citing paper
“this represents a clinically meaningful difference, as even a 3-point difference is considered a MID for confidence in managing health behaviors.34”
From A Multimedia Self-management Intervention to Prepare Cancer Patients and Family Caregivers for Lung Surgery and Postoperative Recovery (2017) · cites this paper as [34]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated major: it would touch a result — a value a result rests on, reported and recomputed p-values on opposite sides of the significance level, two passages that conflict with no sign which is right, or a cited work retracted before this paper was published.
In the paper
“| 6 mo AD | 27.7 | 15.4 | 11.6 | 8 | 0.0315 |”
Reported 11.6 · recomputed 12.3
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| 12 mo AD | 36.0 | 28.4 | 5.2 | | 0.2496 |”
Reported 5.2 · recomputed 7.6
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“| 9 mo AD | 32.7 | 20.6 | 11.4 | | 0.0514 |”
Reported 11.4 · recomputed 12.1
Citations
Cites
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A Reengineered Hospital Discharge Program to Decrease Rehospitalization
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Toward a theory of motivational interviewing
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Azithromycin for prevention of exacerbations of COPD
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Manini, T. M., Everhart, J. E., Patel, K. V., Schoeller, D. A., Colbert, L. H., Visser, M., Tylavsky, F., Bauer, D. C., Goodpaster, B. H., & Harris, T. B. (2006) · JAMA · doi:10.1001/jama.296.2.171 · Cited by 598
Interpreting thresholds for a clinically significant change in health status in asthma and COPD
Jones, P. W. (2002) · European Respiratory Journal · doi:10.1183/09031936.02.00063702 · Cited by 585
A systematic review of randomized trials of disease management programs in heart failure
McAlister, F. A., Lawson, F. M. E., Teo, K. K., & Armstrong, P. W. (2001) · The American Journal of Medicine · doi:10.1016/s0002-9343(00)00743-9 · Cited by 580
An official European Respiratory Society statement on physical activity in COPD
Watz, H., Pitta, F., Rochester, C. L., Garcia-Aymerich, J., ZuWallack, R., Troosters, T., Vaes, A. W., Puhan, M. A., Jehn, M., Polkey, M. I., et al. (2014) · European Respiratory Journal · doi:10.1183/09031936.00046814 · Cited by 526
Kasper, E. K., Gerstenblith, G., Hefter, G. B., Anden, E. V., Brinker, J., Thiemann, D. R., Terrin, M. L., Forman, S. A., & Gottlieb, S. H. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(01)01761-2 · Cited by 429
The effects of health coaching on adult patients with chronic diseases: a systematic review
Kivelä, K., Elo, S., Kyngäs, H., & Kääriäinen, M. (2014) · Patient Education and Counseling · doi:10.1016/j.pec.2014.07.026 · Cited by 402
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Integrative Health Coaching for Patients With Type 2 Diabetes
Wolever, R. Q., Dreusicke, M., Fikkan, J., Hawkins, T. V., Yeung, S., Wakefield, J., Duda, L., Flowers, P., Cook, C., & Skinner, E. (2010) · The Diabetes Educator · doi:10.1177/0145721710371523 · Cited by 317
Disease Management Program for Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial
Rice, K. L., Dewan, N. A., Bloomfield, H. E., Grill, J. P., Schult, T. M., Nelson, D. B., Kumari, S., Thomas, M., Geist, L. J., Beaner, C., et al. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200910-1579oc · Cited by 297
Greening, N. J., Williams, J. E., Hussain, S., Harvey‐Dunstan, T. C., Bankart, M. J., Chaplin, E., Vincent, E. E., Chimera, R., Morgan, M. D., Singh, S. J., et al. (2014) · BMJ · doi:10.1136/bmj.g4315 · Cited by 289
Outpatient pulmonary rehabilitation following acute exacerbations of COPD
Seymour, J. M., Moore, J. E., Jolley, C. J., Ward, K., Creasey, J., Steier, J. S., Yung, B., Man, W. D., Hart, N., Polkey, M. I., et al. (2010) · Thorax · doi:10.1136/thx.2009.124164 · Cited by 285
Roberts, C. M. (2002) · Thorax · doi:10.1136/thorax.57.2.137 · Cited by 253
Coventry, P., Panagioti, M., Scott, C., & Blakemore, A. (2014) · International Journal of Chronic Obstructive Pulmonary Disease · doi:10.2147/copd.s72073 · Cited by 249
Fan, V. S., Curtis, J. R., Tu, S.-P., McDonell, M. B., & Fihn, S. D. (2002) · Chest · doi:10.1378/chest.122.2.429 · Cited by 240
Bucknall, C. E., Miller, G., Lloyd, S. M., Cleland, J., McCluskey, S., Cotton, M., Stevenson, R. D., Cotton, P., & McConnachie, A. (2012) · BMJ · doi:10.1136/bmj.e1060 · Cited by 226
Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease
Almagro, P., Barreiro, B., de Echagüen, A. O., Quintana, S., Rodríguez‐Carballeira, M., Heredia, J. L., & Garau, J. (2005) · Respiration · doi:10.1159/000088092 · Cited by 208
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Jones, S. E., Green, S. A., Clark, A. L., Dickson, M. J., Nolan, A.-M., Moloney, C., Kon, S. S. C., Kamal, F., Godden, J., Howe, C., et al. (2014) · Thorax · doi:10.1136/thoraxjnl-2013-204227 · Cited by 190
Lung function impairment, COPD hospitalisations and subsequent mortality
García‐Aymerich, J., Pons, I. S., Mannino, D. M., Maas, A. K., MILLER, D. P., & Davis, K. J. (2011) · Thorax · doi:10.1136/thx.2010.152876 · Cited by 183
Motivational interviewing‐based health coaching as a chronic care intervention
Linden, A., Butterworth, S. W., & Prochaska, J. O. (2010) · Journal of Evaluation in Clinical Practice · doi:10.1111/j.1365-2753.2009.01300.x · Cited by 174
Improving physical activity in COPD: towards a new paradigm
Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R. A., Vogiatzis, I., Weisman, I., & Kulich, K. (2013) · Respiratory Research · doi:10.1186/1465-9921-14-115 · Cited by 158
Activity Monitoring and Energy Expenditure in COPD Patients: A Validation Study
Patel, S. A., Benzo, R. P., Slivka, W. A., & Sciurba, F. C. (2007) · COPD: Journal of Chronic Obstructive Pulmonary Disease · doi:10.1080/15412550701246658 · Cited by 144
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Gershon, A. S., Campitelli, M. A., Croxford, R., Stanbrook, M. B., To, T., Upshur, R., Stephenson, A. L., & Stukel, T. A. (2014) · JAMA · doi:10.1001/jama.2014.11432 · Cited by 121
Penalizing Hospitals for Chronic Obstructive Pulmonary Disease Readmissions
Feemster, L. C., & Au, D. H. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201308-1541pp · Cited by 117
Walters, J. A., Cameron-Tucker, H., Wills, K. E., Schüz, N., Scott, J. L., Robinson, A., Nelson, M. R., Turner, P. A., Wood-Baker, R. R., & Walters, E. H. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003097 · Cited by 111
Brief motivational interviewing as a clinical strategy to promote asthma medication adherence
Borrelli, B., Riekert, K. A., Weinstein, A. G., & Rathier, L. A. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.08.017 · Cited by 111
Do people with existing chronic conditions benefit from telephone coaching? A rapid review
Dennis, S. M., Harris, M., Lloyd, J., Powell Davies, G., Faruqi, N., & Zwar, N. (2013) · Australian Health Review · doi:10.1071/ah13005 · Cited by 110
Prieto-Centurion, V., Markos, M. A., Ramey, N. I., Gussin, H. A., Nyenhuis, S. M., Joo, M. J., Prasad, B., Bracken, N., DiDomenico, R., Godwin, P. O., et al. (2014) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201308-254oc · Cited by 106
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Meek, P., & Lareau, S. C. (2003) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2003.10.0013 · Cited by 78
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Self-citationOne-year change in health status and subsequent outcomes in COPD
Wilke, S., Jones, P., Müllerová, H., Vestbo, J., Tal‐Singer, R., Franssen, F. M. E., Agustí, A. G. N., Bakke, P. S., Calverley, P. M. A., Coxson, H. O., et al. (2015) · Thorax · doi:10.1136/thoraxjnl-2014-205697 · Cited by 60
Mindfulness and Motivational Interviewing: Two candidate methods for promoting self-management
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“Above all, we tested an intervention aimed primarily at promoting patient activation and mindful communication, two critical and perhaps underrated aspects of care that we firmly believe are at the heart of practicing the art of medicine (53).”
MethodSelf-citationImplementation of physical activity programs after COPD hospitalizations
Benzo, R., Wetzstein, M. M., Neuenfeldt, P., & McEvoy, C. (2014) · Chronic Respiratory Disease · doi:10.1177/1479972314562208 · Cited by 49
Self-citationRandomized Trial of Zileuton for Treatment of COPD Exacerbations Requiring Hospitalization
Woodruff, P. G., Albert, R. K., Bailey, W. C., Casaburi, R. H., Connett, J. E., Cooper, J. A. D., Criner, G. J., Curtis, J. L., Dransfield, M. T., Han, M. K., et al. (2011) · COPD Journal of Chronic Obstructive Pulmonary Disease · doi:10.3109/15412555.2010.540273 · Cited by 39
Self-citationEakin, M. N., Rand, C. S., Borrelli, B., Bilderback, A. L., Hovell, M., & Riekert, K. A. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201404-0618oc · Cited by 38
Gillespie, P., O’Shea, E., Casey, D., Murphy, K., Devane, D., Cooney, A., Mee, L., Kirwan, C., McCarthy, B., Newell, J., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003479 · Cited by 37
Parallel Processes: Using Motivational Interviewing as an Implementation Coaching Strategy
Hettema, J. E., Ernst, D., Williams, J. R., & Miller, K. J. (2013) · The Journal of Behavioral Health Services & Research · doi:10.1007/s11414-013-9381-8 · Cited by 29
Berwick, D. M., Feeley, D., & Loehrer, S. (2015) · JAMA · doi:10.1001/jama.2015.2830 · Cited by 24
Phillips, C. O., Wright, S. M., Kern, D. E., Singa, R. M., Shepperd, S., & Rubin, H. R. (2004) · JAMA · doi:10.1001/jama.291.11.1358 · Cited by 21
Innovations in Health Care Delivery
Berwick, D. M., Bauchner, H., & Fontanarosa, P. (2015) · JAMA · doi:10.1001/jama.2015.9257 · Cited by 12
Interventions to increase physical activity in people with COPD: systematic review
Larson, J. L., Vos, C. M., & Fernandez, D. (2013) · Annual Review of Nursing Research · doi:10.1891/0739-6686.31.297 · Cited by 12 · cited 1×
“There is limited and inconsistent evidence on the effectiveness of interventions for improving physical activity (45, 46).”
Background
Research works printed but not linked: 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
Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary
Agustí, A. G. N., Celli, B. R., Criner, G. J., Halpin, D. M. G., Anzueto, A., Barnes, P. J., Bourbeau, J., Han, M. K., Martínez, F. J., de, M. M., et al. (2023) · European Respiratory Journal · doi:10.1183/13993003.00239-2023 · Cited by 1,467
Global Initiative for Chronic Obstructive Lung Disease 2023 Report: GOLD Executive Summary
Agustí, A. G. N., Celli, B. R., Criner, G. J., Halpin, D. M. G., Anzueto, A., Barnes, P. J., Bourbeau, J., Han, M. K., Martínez, F. J., de, M. M., et al. (2023) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202301-0106pp · Cited by 920
COPD Guidelines: A Review of the 2018 GOLD Report
Mirza, S., Clay, R., Koslow, M., & Scanlon, P. D. (2018) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2018.05.026 · Cited by 456
Lenferink, A., Brusse-Keizer, M., van der Valk, P. D., Frith, P. A., Zwerink, M., Monninkhof, E. M., van der Palen, J., & Effing, T. W. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011682.pub2 · Cited by 328
Facchinetti, G., D’Angelo, D., Piredda, M., Petitti, T., Matarese, M., Oliveti, A., & Marinis, M. G. D. (2019) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2019.103396 · Cited by 208
Metadata
- 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
- 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
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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.
A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
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.
What counts as a claim ›How we measure confidence ›How we check this ›
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