{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:05:00Z","timestamp":1784901900652,"version":"3.55.0"},"reference-count":83,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Ligue Pulmonaire Vaudoise","award":["NA"],"award-info":[{"award-number":["NA"]}]},{"name":"Fondation Givel","award":["NA"],"award-info":[{"award-number":["NA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,15]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Self-management is a key component of effective chronic obstructive pulmonary disease (COPD) management and is mainly promoted through pulmonary rehabilitation (PR) programmes. However, less than 2% of patients participate in PR programmes. Among those who do, approximately 40% fail to complete the programme. The reasons for this are multifactorial and include dyspnoea, reduced exercise tolerance, lack of motivation and inadequate transportation and infrastructure to access PR centres. In this context, self-management digital health interventions emerge as a promising approach to support the development of self-management competencies, contribute to changing and maintaining behaviours and prevent a downward spiral of deconditioning in this population. The aim of this study is to evaluate the feasibility, acceptability and preliminary effects of a theory-based self-management digital intervention (Respir\u2019air BPCO) designed to promote physical activity in patients with COPD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This pilot randomised controlled trial will enrol 20 patients with COPD who are being followed at a Swiss pulmonary centre. Participants will be randomised using Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage stratification (1:1) at the end of the in-person PR programme into either an experimental group receiving a mobile app-based self-management intervention aimed at promoting physical activity or a control group receiving only usual care. Data will be collected at three time points: immediately after completion of the PR programme (T0), 3\u2009months post-PR (T1) and 6\u2009months post-PR (T2). The study will assess trial methodological feasibility, including recruitment duration, consent rate, retention rate, acceptance of the allocated group and data completeness. Intervention feasibility will be evaluated through intervention fidelity, the number and type of technical problems reported by patients, and patients\u2019 and\/or researchers\u2019 observations regarding the intervention design, content and use to inform future refinements. Intervention acceptability will be assessed using mobile app usage data and the Treatment Acceptability and Preferences questionnaire. In addition, preliminary effects will be evaluated through daily step count (pedometer), self-management (Self-Care in Chronic Obstructive Pulmonary Disease Inventory), motivational regulation of physical activity (Behavioural Regulation in Exercise Questionnaire-3), quality of life (St. George's Respiratory Questionnaire and EuroQol 5-Dimensions-5 Levels), severity of dyspnea (Modified Medical Research Council Dyspnea Scale) and the number of exacerbations and hospitalisations. Analyses will include descriptive statistics and estimation-based comparative analyses using generalised linear mixed-effects models under the intention-to-treat principle, which accommodate missing data under standard assumptions, with reporting of effect sizes and CIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The study protocol has been approved by the Ethics Commission of the Canton of Vaud (registration no.: 2025-01697). Results will be published in international peer-reviewed journals and presented at national and international conferences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07262229\">NCT07262229<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-116719","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:20:25Z","timestamp":1784899225000},"page":"e116719","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Self-management digital intervention to promote physical activity in people living with chronic obstructive pulmonary disease: a pilot randomised controlled trial study protocol"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07262229","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07262229","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-7361","authenticated-orcid":false,"given":"Ricardo","family":"Salgado","sequence":"first","affiliation":[{"name":"La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland"},{"name":"ICBAS - Abel Salazar Biomedical Sciences Institute, Porto University, Porto, Portugal"},{"name":"RISE-Health, Nursing School of Porto (ESEP), Porto, Portugal"},{"name":"Bureau d\u2019Echanges des Savoirs pour des praTiques Exemplaires de Soins (BEST), Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8814-2043","authenticated-orcid":false,"given":"Michael","family":"Amiguet","sequence":"additional","affiliation":[{"name":"Unisant\u00e9, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patr\u00edcio","family":"Costa","sequence":"additional","affiliation":[{"name":"Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippe","family":"Delmas","sequence":"additional","affiliation":[{"name":"La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6631-776X","authenticated-orcid":false,"given":"Jos\u00e9 Miguel","family":"Padilha","sequence":"additional","affiliation":[{"name":"RISE-Health, Nursing School of Porto (ESEP), Porto, Portugal"},{"name":"Nursing School, University of Porto, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"2026072406201430000_16.7.e116719.1","unstructured":"WHO . Chronic obstructive pulmonary disease (COPD). 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/chronic-obstructive-pulmonary-disease-(copd)"},{"key":"2026072406201430000_16.7.e116719.2","unstructured":"Global Initiative for Chronic Obstructive Lung Disease . GOLD report. GIGOLD; 2026. Available: https:\/\/goldcopd.org\/2026-gold-report-and-pocket-guide\/"},{"key":"2026072406201430000_16.7.e116719.3","unstructured":"OFSP O f\u00e9d\u00e9ral de la sant\u00e9 publique . Affections respiratoires chroniques. 2018. Available: https:\/\/www.bag.admin.ch\/bag\/fr\/home\/krankheiten\/krankheiten-im-ueberblick\/chronische-atemwegserkrankungen.html"},{"key":"2026072406201430000_16.7.e116719.4","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/S2213-2600(21)00511-7","article-title":"Global, regional, and national prevalence of, and risk factors for, chronic obstructive pulmonary disease (COPD) in 2019: a systematic review and modelling analysis","volume":"10","author":"Adeloye","year":"2022","journal-title":"Lancet Respir Med"},{"key":"2026072406201430000_16.7.e116719.5","doi-asserted-by":"publisher","DOI":"10.2147\/COPD.S146390"},{"key":"2026072406201430000_16.7.e116719.6","doi-asserted-by":"crossref","first-page":"905","DOI":"10.2147\/COPD.S192280","article-title":"To live a life with COPD - the consequences of symptom burden","volume":"14","author":"Johansson","year":"2019","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2026072406201430000_16.7.e116719.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2025.03.029"},{"key":"2026072406201430000_16.7.e116719.8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2023-016686"},{"key":"2026072406201430000_16.7.e116719.9","doi-asserted-by":"crossref","unstructured":"Holland AE , Corso SD , editors . In: Pulmonary Rehabilitation. Sheffield, United Kingdom: European Respiratory Society, 2021. Available: https:\/\/doi.org\/10.1183\/2312508X.erm9321","DOI":"10.1183\/2312508X.erm9321"},{"key":"2026072406201430000_16.7.e116719.10","doi-asserted-by":"crossref","unstructured":"Schrijver J , Lenferink A , Brusse-Keizer M , et al . Self\u2010management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022. doi:10.1002\/14651858.CD002990.pub4","DOI":"10.1002\/14651858.CD002990.pub4"},{"key":"2026072406201430000_16.7.e116719.11","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1111\/jnu.12385","article-title":"A Systematic Review and Integration of Concept Analyses of Self\u2010Care and Related Concepts","volume":"50","author":"Matarese","year":"2018","journal-title":"J Nursing Scholarship"},{"key":"2026072406201430000_16.7.e116719.12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/inr.12366","article-title":"Nursing clinical practice changes to improve self\u2010management in chronic obstructive pulmonary disease","volume":"65","author":"Padilha","year":"2018","journal-title":"Int Nurs Rev"},{"key":"2026072406201430000_16.7.e116719.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1547-5069.2011.01404.x"},{"key":"2026072406201430000_16.7.e116719.14","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/ANS.0000000000000237","article-title":"Integrating Symptoms Into the Middle-Range Theory of Self-Care of Chronic Illness","volume":"42","author":"Riegel","year":"2019","journal-title":"Adv Nurs Sci"},{"key":"2026072406201430000_16.7.e116719.15","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00025-2016"},{"key":"2026072406201430000_16.7.e116719.16","doi-asserted-by":"crossref","unstructured":"Salgado R , Fernandes H , Goumo\u00ebns V , et al . Effectiveness of self-management digital interventions in improving health-related outcomes in patients with chronic obstructive pulmonary disease: an umbrella review. Pulmonology 2026. doi:10.1080\/25310429.2026.2684901","DOI":"10.1080\/25310429.2026.2684901"},{"key":"2026072406201430000_16.7.e116719.17","doi-asserted-by":"crossref","unstructured":"Lenferink A , Brusse-Keizer M , van der Valk PD , et al . Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017;2017. doi:10.1002\/14651858.CD011682.pub2","DOI":"10.1002\/14651858.CD011682.pub2"},{"key":"2026072406201430000_16.7.e116719.18","first-page":"126","article-title":"Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research","volume":"100","author":"Caspersen","year":"1985","journal-title":"Public Health Rep Wash DC"},{"key":"2026072406201430000_16.7.e116719.19","unstructured":"WHO . Physical activity. 2022. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/physical-activity"},{"key":"2026072406201430000_16.7.e116719.20","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1111\/nuf.12296","article-title":"How is exercise different from physical activity? A concept analysis","volume":"54","author":"Dasso","year":"2019","journal-title":"Nurs Forum"},{"key":"2026072406201430000_16.7.e116719.21","doi-asserted-by":"publisher","DOI":"10.1097\/00005768-200106001-00005"},{"key":"2026072406201430000_16.7.e116719.22","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00046814"},{"key":"2026072406201430000_16.7.e116719.23","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1080\/15412555.2021.1922371","article-title":"Barriers toward Physical Activity in COPD: A Quantitative Cross-Sectional, Questionnaire-Based Study","volume":"18","author":"Sritharan","year":"2021","journal-title":"COPD"},{"key":"2026072406201430000_16.7.e116719.24","doi-asserted-by":"crossref","DOI":"10.1186\/s12890-022-02099-4","article-title":"Physical activity and chronic obstructive pulmonary disease: a scoping review","volume":"22","author":"Xiang","year":"2022","journal-title":"BMC Pulm Med"},{"key":"2026072406201430000_16.7.e116719.25","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1177\/1084822321990376","article-title":"Maintaining Effects of Pulmonary Rehabilitation at Home in Chronic Obstructive Pulmonary Disease: A Systematic Literature Review","volume":"33","author":"Pinto","year":"2021","journal-title":"Home Health Care Manag Pract"},{"key":"2026072406201430000_16.7.e116719.26","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-204763"},{"key":"2026072406201430000_16.7.e116719.27","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2014.12.004"},{"key":"2026072406201430000_16.7.e116719.28","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201701-0218PP"},{"key":"2026072406201430000_16.7.e116719.29","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2014.922066"},{"key":"2026072406201430000_16.7.e116719.30","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201805-332OC"},{"key":"2026072406201430000_16.7.e116719.31","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2013-204227"},{"key":"2026072406201430000_16.7.e116719.32","doi-asserted-by":"crossref","unstructured":"Levack WM , Watson J , Hay-Smith EJC , et al . Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: a qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers. Cochrane Database Syst Rev 2018.:CD013195. doi:10.1002\/14651858.CD013195","DOI":"10.1002\/14651858.CD013195"},{"key":"2026072406201430000_16.7.e116719.33","doi-asserted-by":"crossref","DOI":"10.33194\/rper.2024.36144","article-title":"Perceived barriers and criteria for referral to pulmonary rehabilitation used in primary health care by general practitioners","volume":"7","author":"Silva","year":"2024","journal-title":"Rev Port Enf Reab"},{"key":"2026072406201430000_16.7.e116719.34","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2421"},{"key":"2026072406201430000_16.7.e116719.35","doi-asserted-by":"crossref","DOI":"10.1136\/bmjresp-2019-000500","article-title":"Longevity of pulmonary rehabilitation benefit for chronic obstructive pulmonary disease\u2014health care utilisation in the subsequent 2 years","volume":"6","author":"Walsh","year":"2019","journal-title":"BMJ Open Resp Res"},{"key":"2026072406201430000_16.7.e116719.36","article-title":"Digital interventions for the management of chronic obstructive pulmonary disease","volume":"4","author":"Janjua","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026072406201430000_16.7.e116719.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2016.01.001"},{"key":"2026072406201430000_16.7.e116719.38","doi-asserted-by":"crossref","DOI":"10.2196\/27759","article-title":"Web Portals for Patients With Chronic Diseases: Scoping Review of the Functional Features and Theoretical Frameworks of Telerehabilitation Platforms","volume":"24","author":"Morimoto","year":"2022","journal-title":"J Med Internet Res"},{"key":"2026072406201430000_16.7.e116719.39","doi-asserted-by":"crossref","unstructured":"Pinnock H , Poberezhets V , Drummond D , eds. Digital Respiratory Healthcare [Internet]. Sheffield, United Kingdom: European Respiratory Society, 2023. Available: http:\/\/erspublications.com\/lookup\/doi\/10.1183\/2312508X.erm10223","DOI":"10.1183\/2312508X.erm10223"},{"key":"2026072406201430000_16.7.e116719.40","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(22)01273-9"},{"key":"2026072406201430000_16.7.e116719.41","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1590\/S0103-21002012000800010","article-title":"Analysis of use of technological support and information content by patients with chronic obstructive pulmonary disease","volume":"25","author":"Padilha","year":"2012","journal-title":"Acta paul enferm"},{"key":"2026072406201430000_16.7.e116719.42","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1089\/tmj.2013.0249","article-title":"Home Telehealth for Chronic Disease Management: Selected Findings of a Narrative Synthesis","volume":"20","author":"Jones","year":"2014","journal-title":"Telemed E-Health"},{"key":"2026072406201430000_16.7.e116719.43","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.40591","article-title":"Assessment of an Interactive Digital Health\u2013Based Self-management Program to Reduce Hospitalizations Among Patients With Multiple Chronic Diseases","volume":"4","author":"Lear","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026072406201430000_16.7.e116719.44","doi-asserted-by":"crossref","unstructured":"McCabe C , McCann M , Brady AM . Computer and mobile technology interventions for self-management in chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017;2020. doi:10.1002\/14651858.CD011425.pub2","DOI":"10.1002\/14651858.CD011425.pub2"},{"key":"2026072406201430000_16.7.e116719.45","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013682","article-title":"Interactive web-based pulmonary rehabilitation programme: a randomised controlled feasibility trial","volume":"7","author":"Chaplin","year":"2017","journal-title":"BMJ Open"},{"key":"2026072406201430000_16.7.e116719.46","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1093\/tbm\/ibac070","article-title":"Older adults can use technology: why healthcare professionals must overcome ageism in digital health","volume":"12","author":"Mace","year":"2022","journal-title":"Transl Behav Med"},{"key":"2026072406201430000_16.7.e116719.47","doi-asserted-by":"crossref","first-page":"2802","DOI":"10.1111\/jan.15693","article-title":"Effectiveness of internet\u2010based self\u2010management interventions on pulmonary function in patients with chronic obstructive pulmonary disease: A systematic review and meta\u2010analysis","volume":"79","author":"Liu","year":"2023","journal-title":"J Adv Nurs"},{"key":"2026072406201430000_16.7.e116719.48","doi-asserted-by":"crossref","DOI":"10.1038\/s41533-020-0167-1","article-title":"Are COPD self-management mobile applications effective? A systematic review and meta-analysis","volume":"30","author":"Shaw","year":"2020","journal-title":"NPJ Prim Care Respir Med"},{"key":"2026072406201430000_16.7.e116719.49","doi-asserted-by":"crossref","first-page":"106947","DOI":"10.1016\/j.rmed.2022.106947","article-title":"Efficacy of self-management mobile applications for patients with breathlessness: Systematic review and quality assessment of publicly available applications","volume":"201","author":"Sunjaya","year":"2022","journal-title":"Respir Med"},{"key":"2026072406201430000_16.7.e116719.50","doi-asserted-by":"crossref","DOI":"10.2196\/24602","article-title":"Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis","volume":"23","author":"Song","year":"2021","journal-title":"J Med Internet Res"},{"key":"2026072406201430000_16.7.e116719.51","article-title":"Telerehabilitation for chronic respiratory disease","volume":"1","author":"Cox","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026072406201430000_16.7.e116719.52","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.n2061","article-title":"A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance","volume":"374","author":"Skivington","year":"2021","journal-title":"BMJ"},{"key":"2026072406201430000_16.7.e116719.53","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03668-w"},{"key":"2026072406201430000_16.7.e116719.54","unstructured":"GHOL . Le programme de r\u00e9habilitation respiratoire \u00e0 Rolle, 2022. Available: https:\/\/www.ghol.ch\/jcms\/fr\/navigation\/actualites-evenements\/offre-de-soins\/le-programme-de-rehabilitation-respiratoire-en-physiotherapie-a-l-hopital-de-rolle-p_141088.html"},{"key":"2026072406201430000_16.7.e116719.55","doi-asserted-by":"crossref","first-page":"100623","DOI":"10.1016\/j.ijnsa.2026.100623","article-title":"Development of a theory-based self-management digital intervention to promote physical activity in people living with chronic obstructive pulmonary disease: Respir\u2019air BPCO","volume":"11","author":"Salgado","year":"2026","journal-title":"Int J Nurs Stud Adv"},{"key":"2026072406201430000_16.7.e116719.56","doi-asserted-by":"crossref","unstructured":"Ryan RM , Deci EL , eds. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. Guilford Press, 2017. Available: https:\/\/www.google.com\/books\/edition\/Self_Determination_Theory\/th5rDwAAQBAJ?hl=en&gbpv=1&dq=inauthor:%22Richard+M.+Ryan%22","DOI":"10.1521\/978.14625\/28806"},{"key":"2026072406201430000_16.7.e116719.57","doi-asserted-by":"publisher","DOI":"10.3310\/hta19880"},{"key":"2026072406201430000_16.7.e116719.58","doi-asserted-by":"crossref","unstructured":"Marques MM , Hagger MS , Teixeira P . Classification of techniques used in self-determination theory-based interventions in health contexts: an expert consensus study. 2019. doi:10.31234\/osf.io\/z9wqu","DOI":"10.31234\/osf.io\/z9wqu"},{"key":"2026072406201430000_16.7.e116719.59","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.11124\/JBIES-24-00195","article-title":"Effectiveness of self-management digital interventions for improving health-related outcomes in patients with chronic obstructive pulmonary disease: an umbrella review protocol","volume":"23","author":"Salgado","year":"2025","journal-title":"JBI Evid Synth"},{"key":"2026072406201430000_16.7.e116719.60","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1111\/aogs.13309","article-title":"A simplified guide to randomized controlled trials","volume":"97","author":"Bhide","year":"2018","journal-title":"Acta Obstet Gynecol Scand"},{"key":"2026072406201430000_16.7.e116719.61","doi-asserted-by":"crossref","unstructured":"Sidani S , Braden CJ . Nursing and Health Interventions: Design, Evaluation, and Implementation. 1st edn. Wiley, 2021. Available: https:\/\/onlinelibrary.wiley.com\/doi\/book\/10.1002\/9781119610113","DOI":"10.1002\/9781119610113"},{"key":"2026072406201430000_16.7.e116719.62","doi-asserted-by":"crossref","DOI":"10.1186\/s40814-016-0077-8","article-title":"Feasibility and acceptability of a nursing intervention with family caregiver on self-care among heart failure patients: a randomized pilot trial","volume":"2","author":"Cossette","year":"2016","journal-title":"Pilot Feasibility Stud"},{"key":"2026072406201430000_16.7.e116719.63","unstructured":"Paradis V . \u00c9Valuation D\u2019une Intervention Infirmi\u00e8re Motivationnelle Selon Les Stades De Changement (MSSC) sur des comportements d\u2019auto-soins chez des patients insuffisants cardiaques. Universit\u00e9 de Montr\u00e9al; 2009. Available: https:\/\/umontreal.scholaris.ca\/server\/api\/core\/bitstreams\/874bfb3e-0719-4722-94e3-a5ff58162f43\/content"},{"key":"2026072406201430000_16.7.e116719.64","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1111\/j.1741-6787.2006.00060.x","article-title":"Eliciting patient treatment preferences: A strategy to integrate evidence-based and patient-centered care","volume":"3","author":"Sidani","year":"2006","journal-title":"Worldviews Evid Based Nurs"},{"key":"2026072406201430000_16.7.e116719.65","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20329"},{"key":"2026072406201430000_16.7.e116719.66","unstructured":"YAMAX . YAMAX | pedometer | power walker series | power walker ex ex-510. 2023. Available: http:\/\/www.yamax-yamasa.com\/pw\/ex_510.html"},{"key":"2026072406201430000_16.7.e116719.67","doi-asserted-by":"publisher","DOI":"10.1177\/1479972315619574"},{"key":"2026072406201430000_16.7.e116719.68","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1177\/0163278719856660","article-title":"The Self-Care in Chronic Obstructive Pulmonary Disease Inventory: Development and Psychometric Evaluation","volume":"43","author":"Matarese","year":"2020","journal-title":"Eval Health Prof"},{"key":"2026072406201430000_16.7.e116719.69","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4733.2005.04054.x"},{"key":"2026072406201430000_16.7.e116719.70","doi-asserted-by":"publisher","DOI":"10.1123\/jsep.26.2.191"},{"key":"2026072406201430000_16.7.e116719.71","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1111\/j.1751-9861.2006.tb00021.x","article-title":"\u201cIt\u2019s Who I Am \u2026 Really!\u2019 The Importance of Integrated Regulation in Exercise Contexts1","volume":"11","author":"Wilson","year":"2006","journal-title":"J Appl Biobehavioral Res"},{"key":"2026072406201430000_16.7.e116719.72","first-page":"480","article-title":"French\u2010Canadian Version of the Chronic Respiratory and of the St George\u2032s Respiratory Questionnaires: An Assessment of their Psychometric Properties in Patients with Chronic Obstructive Pulmonary Disease","volume":"11","author":"Bourbeau","year":"2004","journal-title":"Can Respir J"},{"key":"2026072406201430000_16.7.e116719.73","unstructured":"EuroQol Group . EQ-5D-5L. EuroQol. 2009 Available: https:\/\/euroqol.org\/information-and-support\/euroqol-instruments\/eq-5d-5l\/"},{"key":"2026072406201430000_16.7.e116719.74","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.01.00044901"},{"key":"2026072406201430000_16.7.e116719.75","doi-asserted-by":"publisher","DOI":"10.1007\/s40273-019-00876-4"},{"key":"2026072406201430000_16.7.e116719.76","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2015-207782"},{"key":"2026072406201430000_16.7.e116719.77","doi-asserted-by":"publisher","DOI":"10.1378\/chest.93.3.580"},{"key":"2026072406201430000_16.7.e116719.78","unstructured":"Soci\u00e9t\u00e9 de Pneumologie de Langue Fran\u00e7aise . Recommandations de la Soci\u00e9t\u00e9 de Pneumologie de Langue Fran\u00e7aise sur la prise en charge de la BPCO (mise \u00e0 jour 2009). Rev Mal Respir 2010. Available: https:\/\/aquirespi.fr\/_pages\/bpco\/doc\/splf.pdf"},{"key":"2026072406201430000_16.7.e116719.79","doi-asserted-by":"crossref","unstructured":"Eldridge SM , Chan CL , Campbell MJ , et al . CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016.:i5239. doi:10.1136\/bmj.i5239","DOI":"10.1136\/bmj.i5239"},{"key":"2026072406201430000_16.7.e116719.80","doi-asserted-by":"publisher","DOI":"10.1177\/0962280215588241"},{"key":"2026072406201430000_16.7.e116719.81","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-013096","article-title":"To condition or not condition? Analysing \u201cchange\u201d in longitudinal randomised controlled trials","volume":"6","author":"Coffman","year":"2016","journal-title":"BMJ Open"},{"key":"2026072406201430000_16.7.e116719.82","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3639"},{"key":"2026072406201430000_16.7.e116719.83","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2026-116719","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:20:34Z","timestamp":1784899234000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2026-116719"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":83,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjopen-2026-116719"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2026-116719","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}