A feasibility study of an autonomy-supportive intervention in remote pulmonary rehabilitation for older adults with chronic obstructive pulmonary disease

BACKGROUND: Chronic obstructive pulmonary disease (COPD) constitutes a substantial global health burden, particularly amongst older adults. Remote pulmonary rehabilitation (PR) represents an innovative model of delivering PR. However, low adherence rates in remote PR remain a considerable challenge. The development of a customised information framework (CIF) characterised by autonomy support-referred to as an autonomy-supportive CIF-and its application in remote PR, may offer a promising solution. OBJECTIVE: To evaluate the feasibility of implementing an autonomy-supportive CIF within remote PR, and to assess its impact on adherence and autonomy support amongst older adults with COPD. METHODS: A 24-week randomised controlled trial was conducted, enrolling 92 older adults diagnosed with COPD. Participants in the intervention group (n = 46) received a 12-week remote PR intervention based on an autonomy-supportive CIF. The control group (n = 46) received standard remote PR, which included exercise and breathing training, dietary and medication guidance, and disease education. Data were collected at baseline, week 12, and week 24. RESULTS: Both groups demonstrated significant improvements in autonomy support following the intervention (P < .001), with the intervention group exhibiting significantly greater improvements (P < .001). Adherence was effectively maintained in the intervention group (P = .549), while a significant decline was observed in the control group (P < .001). The intervention group also exhibited significant improvements in perceived information relevance, perceived information strength, autonomy needs, and autonomous motivation. CONCLUSION: An autonomy-supportive CIF intervention effectively enhanced autonomy support and maintained adherence in remote PR amongst older adults with COPD.