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NCT04093869: INSPIRE-III

Improving Lung Transplant Outcomes With Coping Skills and Physical Activity

Completed NA Results posted Last updated 27 February 2026
What this trial tests

NA trial testing Coping Skills Training combined with Exercise (CSTEX) in Post-Lung Transplantation in 180 participants. Completed in 1 February 2026.

Timeline
6 November 2019
Primary endpoint
21 February 2024
1 February 2026

Quick facts

Lead sponsorDuke University
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingsingle
Primary purposetreatment
Enrollment180
Start date6 November 2019
Primary completion21 February 2024
Estimated completion1 February 2026
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Duke University

Who can join

18 and older, any sex, with Post-Lung Transplantation. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Change in Global Psychological Distress Primary · Baseline to 12 weeks

A composite distress score will assess change from baseline to 12 weeks (post-intervention) and combine the following instruments: General Health Questionnaire, Perceived Stress Scale, Beck Depression Inventory-II, State Trait Anxiety Inventory, and PROMIS Anger. The composite distress score is the average of the participant's rank for change (from baseline to 12 weeks) on each of the 5 scales. A lower rank represents more improvement (decrease in global distress) and higher ranks represent less improvement (or worsening of distress). Scoring is based on the number of participants analyzed; in

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)91± 40
Standard of Care Plus Education (SOC-ED)87± 33
Change in Functional Capacity Secondary · Baseline to 12 weeks

Functional capacity will be measured by distance walked on a standard Six Minute Walk Test (6MWT) at baseline and again post-intervention at 12 weeks. Distance measured in feet. Greater distance represents better functional capacity. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)1451± 332
Standard of Care Plus Education (SOC-ED)1472± 262
Change in Physical Activity Secondary · Baseline to 12 weeks

Daily physical activity (average steps per day) will be assessed via a wrist-worn activity monitor (Actigraph GT9X Link) for 7 consecutive days at baseline and again post-intervention at 12 weeks. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)8037± 3103
Standard of Care Plus Education (SOC-ED)8612± 3161
Change in Sleep Quality Secondary · Baseline to 12 weeks

Sleep quality (average total minutes of sleep per night) will be assessed via the Pittsburgh Sleep Quality Index at baseline and again post-intervention at 12 weeks. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)421± 92
Standard of Care Plus Education (SOC-ED)401± 66
Change in Quality of Life Secondary · Baseline to 12 weeks

Quality of Life will be assessed via the Lung Transplant Quality of Life Survey, which is comprised of 10 scales that measure symptoms, health perceptions, functioning, and well being at baseline and again post-intervention at 12 weeks. The QOL overall score ranges from 1 to 5, with a higher score indicating worse health. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)1.78± 0.49
Standard of Care Plus Education (SOC-ED)1.78± 0.56
Change in Frailty Secondary · Baseline to 12 weeks

Frailty will be measured by performance on the Fried Frailty Index. This assessment includes measures on patient's weight, exhaustion level, physical activity, walking speed, and hand grip strength at baseline and again post-intervention at 12 weeks. Scores range from 0 to 5, with lower scores indicating less frailty. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)0.62± 0.74
Standard of Care Plus Education (SOC-ED)0.52± 0.73
Change in Problem-Focused Coping Secondary · Baseline to 12 weeks

Coping was assessed via the Brief COPE Inventory, which is composed of scales that measure problem-focused coping, emotion-focused coping, and avoidant coping responses at baseline and again post-intervention at 12 weeks. Items are scored on a 4-point Likert scale, with 1 indicating a coping mechanism that the participant has not been doing at all, to 4 indicating a coping mechanism in which the participant has been doing a lot. A higher average score within the problem-focused subscale indicates better coping strategies. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)2.64± 0.79
Standard of Care Plus Education (SOC-ED)2.73± 0.79
Change in Emotion-Focused Coping Secondary · Baseline to 12 weeks

Coping was assessed via the Brief COPE Inventory, which is composed of scales that measure problem-focused coping, emotion-focused coping, and avoidant coping responses at baseline and again post-intervention at 12 weeks. Items are scored on a 4-point Likert scale, with 1 indicating a coping mechanism that the participant has not been doing at all, to 4 indicating a coping mechanism in which the participant has been doing a lot. A higher score within the emotion-focused coping subscale indicates better coping strategies. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)2.26± 0.51
Standard of Care Plus Education (SOC-ED)2.25± 0.49
Change in Avoidant Coping Secondary · Baseline to 12 weeks

Coping was assessed via the Brief COPE Inventory, which is composed of scales that measure problem-focused coping, emotion-focused coping, and avoidant coping responses at baseline and again post-intervention at 12 weeks. Items are scored on a 4-point Likert scale, with 1 indicating a coping mechanism that the participant has not been doing at all, to 4 indicating a coping mechanism in which the participant has been doing a lot. A lower score within the avoidant coping subscale indicates a more useful coping strategy. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)1.45± 0.36
Standard of Care Plus Education (SOC-ED)1.46± 0.34
Change in Self-Efficacy Secondary · Baseline to 12 weeks

Self-efficacy will be assessed via the General Self-Efficacy Scale, which is a 10-item scale that measures emotional distress at baseline and again post-intervention at 12 weeks. Scores range from 10-40 with a higher score indicating better self-efficacy. The change value is calculated as T2 (12 weeks) - T1 (baseline).

GroupValue95% CI
Coping Skills Training Combined With Exercise (CSTEX)33.3± 5.1
Standard of Care Plus Education (SOC-ED)33.1± 4.7

Sponsor's own description

This study evaluates the effectiveness of a coping skills and exercise (CSTEX) intervention among post lung transplant patients aimed to reduce distress and improve functional capacity. Half of the patients will receive CSTEX and half will receive the standard of care plus transplant education (SOC-ED).

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

  1. Telehealth interventions to improve outcomes in lung transplant recipients: Primary results of the INSPIRE-III randomized clinical trial.
    Blumenthal JA, Mabe S, Arthur D, Frankel C, et al · · 2025 · cited 1× · PMID 40180232 · DOI 10.1016/j.healun.2025.03.017

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Primary sources · FDA · ClinicalTrials.gov · EMA · SEC EDGAR · ChEMBL · Wikidata · full sourcing