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Hayden Kirton
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Hayden Kirton   My Press Releases

The life of a internet program.

Published on 9/6/2014
For additional information  Click Here

The life of a internet program.

A pedometer-based walking program supported by Internet-based instruction and support can improve health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD), according to a new study presented at the 2014 American Thoracic Society International Conference.

"Low levels of physical activity among individuals with COPD can contribute to impaired quality of life and have been linked to higher risk of exacerbations, hospitalizations, and death. However, getting patients to change behavior and stick to an exercise program can be difficult," said lead author Marilyn Moy, MD of the Department of Veterans Affairs, VA Boston Healthcare System and Assistant Professor of Medicine at Harvard Medical School. "In our study, supporting an exercise program with online resources that provided instruction, individualized goals and timely feedback, COPD-specific education, and support improved HRQOL and daily step count in COPD patients compared with those who were given a pedometer alone ."

The study involved 238 Veterans with COPD who were recruited nationally and 45% of whom lived in rural areas. Participants were randomized to either the pedometer-based exercise program with access to the support website or to the group using a pedometer alone. HRQOL at baseline and four-month follow-up was measured with the St. George's Respiratory Questionnaire (SGRQ). Daily step count to assess engagement in physical activity was a secondary outcome.

A significantly greater proportion of persons in the intervention group than in the control group had at least a 4-unit improvement in SGRQ-TS (53% vs. 39% respectively, P=0.05), the minimum clinically important difference. There was no significant between-group difference in 4-month SGRQ-TS (2.3 units, P=0.14). For domain scores, the intervention group had a significantly lower (reflecting better HRQL) mean than control group by 4.6 units for Symptoms (P=0.046) and by 3.3 units for Impact (P=0.049). Compared to control group, participants in the intervention group walked 779 more steps per day at 4 months (P=0.005).

"This Internet-based intervention significantly improved HRQOL and daily step count in our patients with COPD," said Dr. Moy. "The results are exciting because patients can walk more to make themselves feel better and potentially change the disease course. The potential for this safe and accessible home-based intervention to sustain exercise in persons with COPD, to complement existing pulmonary rehabilitation programs, and to be integrated into COPD self-management programs merits further study."

Dr. Moy and her colleagues are launching a study funded by VA Rehabilitation R&D which will look at whether this intervention impacts 6 minute walk test distance and risk of exacerbations and hospitalizations in persons with COPD.

As the Internet is growing it is increasingly changing how we do everyday tasks. Tasks that were once done mostly through personal interaction, such as banking, shopping, or communication, can now be done onlineā€”a seemingly simpler and better alternative. However, this new online explosion can leave some users behind.

This paper will explore the following topics. What everyday tasks conducted on the Internet make life simpler for sighted users? Have these tasks also become easier for users who have a visual impairment (defined here as someone who is blind or has low vision)? As we increasingly move to the Internet for everyday tasks, what impact does this have on users who are visually impaired; are we creating new barriers or opening up new avenues by moving the world online? What features of Web sites seem to make sites easier to navigate for users with normal vision but complicate the site for users who are visually impaired, and which features make a site easier for users who are visually impaired but complicate it for sighted users?

Research Gathering

To expound on these topics, I conducted a series of interviews with seven users who are visually impaired and seven users with normal vision. I asked them the following questions:

  1. What everyday tasks do you now depend on the Internet for?
  2. For each task you identified in question 1, please answer the following three questions:
    • How did you complete this task before the Internet?
    • Is that task easier or harder because of the Internet?
    • How or why?
  3. What tasks can you no longer do because of the Internet?
  4. What task have you tried in the past to do on the Internet but gave up after becoming frustrating because it was too hard?

I also based this paper on usability tests and focus groups with IBM's Home Page Reader (a Web browser for users who are visually impaired). Much of my firsthand experience with users navigating the Web came from my weeks of working with athletes surfing the Web at the 2000 Sydney Paralympics Games.

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