Health Services Research
Objective : To determine whether collaborative tele-rehabilitation and pharmacological pain management improve function and pain, and reduce hospital and post-acute care facility use.
The Collaborative Care to Preserve Performance in Cancer (COPE) study was a 3-arm randomized trial conducted between March 2013 and follow up concluded October 2016.
Setting : Three large medical centers within a single health system and collectively comprising a NCI-designated comprehensive cancer center
Participants (or Animals, Specimens, Cadavers) : Participants (N=516) were low-level community or household ambulators with Stage IIIC or IV solid or hematologic cancers.
Interventions : Participants were randomly assigned to: 1) control, 2) tele-rehabilitation, and 3) tele-rehabilitation + pharmacological pain management. All underwent automated function and pain monitoring with data reporting to their care teams. Participants in Arms 2 and 3 received 6 months of centralized tele-rehabilitation provided by a physical therapist-physician team. Those in Arm 3 also received nurse-coordinated pharmacological pain management.
Main Outcome Measure(s) : Blinded assessment at baseline and months 3 and 6 for function (Activity Measure for Post Acute Care [AM-PAC]), pain interference and average intensity (BPI), and quality of life (EQ-5D-3L). Hospitalizations and discharges to post-acute care facilities were recorded.
Compared with the control group, the tele-rehabilitation Arm 2 group had improved function (1.3; 95% confidence interval [CI] 0.08 to 2.35; P=0.03) and quality of life (0.04; 95% CI 0.004 to 0.07; P=0.01), while both tele-rehabilitation Arm 2 and 3 groups had reduced pain interference (respectively, -0.4; 95% CI -0.78 to -0.09; P=0.01, and -0.4; 95% CI -0.79 to -0.10; P=0.01), and average intensity (respectively, -0.4; 95% CI -0.78 to -0.07; P=0.02, and -0.5; 95% CI -0.84 to -0.11; P=0.006). Tele-rehabilitation was associated with higher odds of home discharge in Arms 2 (OR 4.3; 95% CI 1.3 to 14.3; P=0.02) and 3 (OR 3.8; 95% CI 1.1 to 12.4; P=0.03) and shorter hospitalizations in Arm 2 (difference -3.9 days; 95% CI -2.4 to -4.6; P=0.01).
Collaborative tele-rehabilitation modestly improved function and pain, while decreasing hospital lengths of stay and requirement for post-acute care, but was not enhanced with pharmacological pain management.