***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: In international and national guidelines patient education is recommended as an integral part of an effective management for both , asthma and COPD , respectively . The evaluation of numerous structured education programs for adult asthmatics revealed an increase of quality of life of the educated patients , reduced morbidity with less asthmatic attacks , a decrease of emergency visits , sick leave days and hospitalizations due to asthma . On the basis of cost/benefit analysis cost effectiveness could be demonstrated for education programs for asthmatics . On the basis of education programs in COPD including self-management , in a r and omized controlled study an improvement of the patient 's ability to react to exacerbations could be shown , thus reducing the morbidity by the disease . Further controlled studies of the effects of patient education on morbidity , mortality and cost effectiveness are necessary to establish the role of structured education programs in the treatment of COPD with sufficient validity Introduction COPD is a leading cause of morbidity and mortality . Self-management interventions are considered important in order to limit the progression of the disease . Computer-tailored interventions could be an effective tool to facilitate self-management . Methods This r and omized controlled trial tested the effectiveness of a web-based , computer-tailored COPD self-management intervention on physical activity and smoking behavior .  Participants were recruited from an online panel and through primary care practice s. Those at risk for or diagnosed with COPD , between 40 and 70 years of age , proficient in Dutch , with access to the Internet , and with basic computer skills ( n=1,325 ) , were r and omly assigned to either the intervention group ( n=662 ) or control group ( n=663 ) . The intervention group received the web-based self-management application , while the control group received no intervention . Participants were not blinded to group assignment . After 6 months , the effect of the intervention was assessed for the primary outcomes , smoking cessation and physical activity , by self-reported 7-day point prevalence abstinence and the International Physical Activity Question naire – Short Form . Results Of the 1,325 participants , 1,071 ( 80.8 % ) completed the 6-month follow-up question naire . No significant treatment effect was found on either outcome . The application however , was used by only 36 % of the participants in the experimental group . Conclusion A possible explanation for the nonsignificant effect on the primary outcomes , smoking cessation and physical activity , could be the low exposure to the application as engagement with the program has been shown to be crucial for the effectiveness of computer-tailored interventions . ( Netherl and s Trial Registry number : NTR3421 . Background Low levels of physical activity are common in patients with chronic obstructive pulmonary disease ( COPD ) , and a sedentary lifestyle is associated with poor outcomes including increased mortality , frequent hospitalizations , and poor health-related quality of life .  Internet-mediated physical activity interventions may increase physical activity and improve health outcomes in persons with COPD . Methods / Design This manuscript describes the design and rationale of a r and omized controlled trial that tests the effectiveness of Taking Healthy Steps , an Internet-mediated walking program for Veterans with COPD .  Taking Healthy Steps includes an uploading pedometer , a website , and an online community .  Eligible and consented patients  wear a pedometer to obtain one week of baseline data and then are r and omized on a 2:1 ratio to Taking Healthy Steps or to a wait list control . The intervention arm receives iterative step-count feedback ; individualized step-count goals , motivational and informational messages , and access to an online community . Wait list controls are notified that they are enrolled , but that their intervention will start in one year ; however , they keep the pedometer and have access to a static webpage . Discussion Participants include 239 Veterans ( mean age 66.7 years , 93.7 % male ) with 155 r and omized to Taking Healthy Steps and 84 to the wait list control arm ; rural-living ( 45.2 % ) ; ever-smokers ( 93.3 % ) ; and current smokers ( 25.1 % ) . Baseline mean St. George ’s Respiratory Question naire Total Score was 46.0 ; 30.5 % reported severe dyspnea ; and the average number of comorbid conditions was 4.9 . Mean baseline daily step counts was 3497 ( + /- 2220).Veterans with COPD can be recruited to participate in an online walking program . We successfully recruited a cohort of older Veterans with a significant level of disability including Veterans who live in rural areas using a remote national recruitment strategy .Trial registration Clinical Trials.gov Computer-tailored printed education can be a promising way of promoting physical activity . The present study tested whether computer-tailored feedback on physical activity is effective and whether there are differences between respondents with low and high motivation to change . Respondents ( n = 487 ) were r and omly assigned to a tailored intervention group or a no information control group .  Physical activity and determinants were measured at baseline and after 3 months . At post-test , the motivated respondents in the control group were more likely not to meet the recommendation for physical activity than to meet it , and motivated respondents in the experimental group were more likely to engage in transport-related activities and showed more improvement over time for the total activity score than respondents in the control group ( beta = 0.24 , P = 0.02 ) . Both groups improved their behaviour over time . No group differences in physical activity were found for the unmotivated respondents . The results showed that the effects of the tailored feedback were restricted to respondents who had a positive motivation to change at baseline . Possible explanations could be that unmotivated respondents were unwilling to read and process the information because they felt ' no need to change ' . Alternatively , one tailored feedback letter may not have been sufficient for this unmotivated group Objective To determine the feasibility and efficacy of a six-month , cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease ( COPD ) following pulmonary rehabilitation . Methods Participants who completed a two-week run-in were r and omly assigned to either MOBILE-Coached  ( n = 9 ) or MOBILE-Self-Monitored  ( n = 8) . All participants met with a nurse to develop an individualized exercise plan , were issued a pedometer and exercise booklet , and instructed to continue to log their daily exercise and symptoms . MOBILE-Coached also received weekly reinforcement text messages on their cell phones ; reports of worsening symptoms were automatically flagged for follow-up . Usability and satisfaction were assessed . Participants completed incremental cycle and six minute walk ( 6MW ) tests , wore an activity monitor for 14 days , and reported their health-related quality of life ( HRQL ) at baseline , three , and six months . Results The sample had a mean age of 68 ±11 and forced expiratory volume in one second 18 % predicted . Participants reported that logging their exercise and symptoms ( FEV1 ) of 40 ± was easy and that keeping track of their exercise helped them remain active . There were no differences between groups over time in maximal workload , 6MW distance , or HRQL ( p > 0.05 ) ; however , MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months ( p = 0.04 ) . Conclusions We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring . The latter finding needs to be interpreted with caution since this was a purely exploratory study . Trial registration Clinical Trials.gov ( NCT00373932 ) Background Distributing a multiple computer-tailored smoking cessation intervention through the Internet has several advantages for both provider and receiver . Most important , a large audience of smokers can be reached while a highly individualized and personal form of feedback can be maintained . However , such a smoking cessation program has yet to be developed and implemented in the Netherl and s. Objective To investigate the effects of a Web-based multiple computer-tailored smoking cessation program on smoking cessation outcomes in a sample of Dutch adult smokers . Methods Smokers were recruited from December 2009 to June 2010 by advertising our study in the mass media and on the Internet . Those interested and motivated to quit smoking within 6 months ( N = 1123 ) were r and omly assigned to either the experimental ( n = 552 ) or control group ( n = 571 ) . Respondents in the experimental group received the fully automated Web-based smoking cessation program , while respondents in the control group received no intervention . After 6 weeks and after 6 months , we assessed the effect of the intervention on self-reported 24-hour point prevalence abstinence , 7-day point prevalence abstinence , and prolonged abstinence using logistic regression analyses . Results Of the 1123 respondents , 449 ( 40.0 % ) completed the 6-week follow-up question naire and 291 ( 25.9 % ) completed the 6-month follow-up question naire . We used a negative scenario to replace missing values . That is , we considered respondents lost to follow-up to still be smoking . The computer-tailored program appeared to have significantly increased 24-hour point prevalence abstinence ( odds ratio [ OR ] 1.85 , 95 % confidence interval [ CI ] 1.30–2.65 ) , 7-day point prevalence abstinence ( OR 2.17 , 95 % CI 1.44–3.27 ) , and prolonged abstinence ( OR 1.99 , 95 % CI 1.28–3.09 ) rates reported after 6 weeks . After 6 months , however , no intervention effects could be identified . Results from complete-case analyses were similar . Conclusions The results presented suggest that the Web-based computer-tailored smoking cessation program had a significant effect on abstinence reported after a 6-week period . At the 6-month follow-up , however , no intervention effects could be identified . This might be explained by the replacement of missing values on the primary outcome measures due to attrition using a negative scenario . While results were similar when using a less conservative scenario ( ie , complete-case analyses ) , the results should still be interpreted with caution . Further research should aim at identifying strategies that will prevent high attrition in the first place and , subsequently , to identify the best strategies for dealing with missing data when studies have high attrition rates . Trial Registration Dutch Trial Register NTR1351 ; http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=1351 ( Archived by WebCite at http://www.webcitation.org/67egSTWrz The objective of this pilot study was to investigate the use of and satisfaction with a  chronic obstructive pulmonary disease ( COPD ) telehealth program applied in both primary and secondary care . The program consisted of four modules : 1 ) activity coach for ambulant activity monitoring and real-time coaching of daily activity behavior , 2 ) web-based exercise program for home exercising , 3 ) self-management of COPD exacerbations via a triage diary on the web portal , including self-treatment of exacerbations , and 4 ) teleconsultation .  Twenty-nine COPD patients were r and omly assigned to either the intervention group ( telehealth program for 9 months ) or the control group ( usual care ) . Page hits on the web portal showed the use of the program , and the Client Satisfaction Question naire showed satisfaction with received care . The telehealth program with decision support showed good satisfaction ( mean 26.4 , maximum score 32 ) . The program was accessed on 86 % of the treatment days , especially the diary . Patient adherence with the exercise scheme was low ( 21 % ) . Health care providers seem to play an important role in patients ’ adherence to telehealth in usual care . Future research should focus on full-scale implementation in daily care and investigating technological advances , like gaming , to increase adherence Inhaled medication is important in the treatment of chronic obstructive pulmonary disease ( COPD ) . In this paper a comparison of the long-term efficacy of three instruction-models is presented . A total of 152 COPD - patients were r and omized into one of four groups : Personal- , video- , group-instruction and a control group . Inhalation technique was assessed by means of checklists , on which essential inhalation manoeuvres were identified . Up to 9 months later , 148 patients returned for follow-up assessment . Prior to instruction 61 % of patients in the control group had a perfect score on essential actions , compared to 62 , 65 and 53 % for those receiving group- , personal- and video-instruction respectively . At follow-up these percentages were 49 , 97 , 75 and 76 % . For group-(35 % ) and video-instruction ( 24 % ) the increase from baseline was significant . Examining the different inhalers under investigation , it is striking , that only 24 % of all patients with a Metered Dose Inhaler ( MDI ) performed all essential checklist items correctly , versus 96 % for those using a Diskhaler . The fact that for the MDI this percentage improved to 90 % post-instruction , shows that time spent on instruction , is time well spent . We conclude that group instruction seems superior to personal counselling , and equally effective or even better than video instruction . Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well Background Regular physical activity ( PA ) is recommended for persons with chronic obstructive pulmonary disease ( COPD ) . Interventions that promote PA and sustain long-term adherence to PA are needed . Objective We examined the effects of an Internet-mediated , pedometer-based walking intervention , called Taking Healthy Steps , at 12 months . Methods Veterans with COPD ( N=239 ) were r and omized in a 2:1 ratio to the 
    Output:
    
Although our review suggests that interventions aim ed at facilitating , supporting , and sustaining self-managment in people with COPD and delivered via smart technology significantly improved HRQoL and levels of activity up to six months compared with interventions given through face-to-face/digital and /or written support , no firm conclusions can be drawn .
This improvement may not be sustained over a long duration .
The only included study that measured outcomes up to 12 months highlighted the need to ensure sustained engagement with the technology over time .
Limited evidence suggests that using computer and mobile technology for self-management for people with COPD is not harmful and may be more beneficial for some people than for others , for example , those with an interest in using technology may derive greater benefit .
The evidence , provided by three studies at high risk of bias , is of poor quality and is insufficient for advising healthcare professionals , service providers , and members of the public with COPD about the health benefits of using smart technology as an effective means of supporting , encouraging , and sustaining self-management .