Effects of umbrella precise intervention on self-management, cognitive function and patient activation in COPD: a randomized controlled trial

To evaluate the effectiveness of a multicomponent umbrella precise intervention on self-management behavior, cognitive function, and patient activation in COPD patients, and to explore the differences across three predefined patient subgroups defined by combined cognitive-activation status. Based on the IMB Model, participants were divided into three subgroups, namely: low cognition-low activation (LC-LA group); low cognition-normal activation (LC-NA group) and normal cognition-low activation (NC-LA group), randomly assigned to intervention or control group. Patients in the intervention group received a 5-week general program (HKGP) delivering COPD education covering exercise, respiratory training, inhalation, oxygen therapy, and cognitive prevention. Two targeted plans were offered: (1) ICTP program for MoCA < 26 (LC-LA and LC-NA group), using a home-based digital system “Liuliu Brain” for 30 min, 3–5 times/week for 12 weeks, to improve cognitive function. (2) MIP program for PAM < 55.1(LC-LA and NC-LA group), consisting of four biweekly 15–20 min motivational interviews from week 6 to 12, focusing on goal-setting and behavioral discrepancy. Controls received routine self-management education and booklets. Self-management, MoCA, patient activation, inhaler adherence and quality of life were measured at baseline, post-intervention and the 6-month follow-up, and the improvement of all results in each subgroup of the intervention group was compared. A total of 66 participants were included. However, 4 participants withdrew during the intervention period due to worsening of their conditions. As a result, 62 participants were finally included, and 30 were allocated to the intervention group and 32 to the control group. The intervention group showed significant improvements in cognitive function (MoCA), self-management, patient activation, inhaler adherence, and quality of life from baseline to post-intervention, all sustained at 6-month follow-up (all P < 0.001). In contrast, the control group exhibited no improvement, with self-management and activation declining over time ( P < 0.001). Repeated-measures ANOVA revealed significant time×group interactions for all primary outcomes except the group main effect for MoCA, with effect sizes (partial η² 0.240 to 0.818). The exploratory results from subgroup analyses may suggest differential responses: patients with low cognition-low activation gained most in self-management and activation; those with normal cognition-low activation had the greatest activation improvement; those with low cognition-normal activation achieved the largest self-management gains initially but declined at the 6-month follow-up. The umbrella precise intervention yielded significant and sustained improvements in self-management, cognition, patient activation, inhaler adherence, and quality of life in COPD. Despite non-significant MoCA group main effect, the significant time×group interaction confirms cognitive benefit over time. Positive effects on self-management and activation were observed. Subgroup analyses revealed differential responsiveness across baseline cognitive-activation profiles, suggesting that tailored strategies may be necessary to optimize treatment outcomes for distinct patient subgroups. Furthermore, further large-scale and longer-term studies are warranted.