Development and Preliminary Evaluation of the Effects of an mHealth Web-Based Platform (HappyAir) on Adherence to a Maintenance Program After Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial

Begoña Jiménez-Reguera, Eva Maroto López, Shane Fitch, Lourdes Juarros, Marta Sánchez Cortés, Juan Luis Rodríguez Hermosa, Myriam Calle Rubio, María Teresa Hernández Criado, Marta López, Santiago Angulo-Díaz-Parreño, Aitor Martín-Pintado-Zugasti, Jordi Vilaró, Begoña Jiménez-Reguera, Eva Maroto López, Shane Fitch, Lourdes Juarros, Marta Sánchez Cortés, Juan Luis Rodríguez Hermosa, Myriam Calle Rubio, María Teresa Hernández Criado, Marta López, Santiago Angulo-Díaz-Parreño, Aitor Martín-Pintado-Zugasti, Jordi Vilaró

Abstract

Background: Pulmonary rehabilitation is one of the main interventions to reduce the use of health resources, and it promotes a reduction in chronic obstructive pulmonary disease (COPD) costs. mHealth systems in COPD aim to improve adherence to maintenance programs after pulmonary rehabilitation by promoting the change in attitude and behavior necessary for patient involvement in the management of the disease.

Objective: This study aimed to assess the effects of an integrated care plan based on an mHealth web-based platform (HappyAir) on adherence to a 1-year maintenance program applied after pulmonary rehabilitation in COPD patients.

Methods: COPD patients from three hospitals were randomized to a control group or an intervention group (HappyAir group). Patients from both groups received an 8-week program of pulmonary rehabilitation and educational sessions about their illness. After completion of the process, only the HappyAir group completed an integrated care plan for 10 months, supervised by an mHealth system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using a respiratory physiotherapy adherence self-report (CAP FISIO) questionnaire. Other variables analyzed were adherence to physical activity (Morisky-Green Test), quality of life (Chronic Obstructive Pulmonary Disease Assessment Test, St. George's Respiratory Questionnaire, and EuroQOL-5D), exercise capacity (6-Minute Walk Test), and lung function.

Results: In total, 44 patients were recruited and randomized in the control group (n=24) and HappyAir group (n=20). Eight patients dropped out for various reasons. The CAP FISIO questionnaire results showed an improvement in adherence during follow-up period for the HappyAir group, which was statistically different compared with the control group at 12 months (56.1 [SD 4.0] vs 44.0 [SD 13.6]; P=.004) after pulmonary rehabilitation.

Conclusions: mHealth systems designed for COPD patients improve adherence to maintenance programs as long as they are accompanied by disease awareness and patient involvement in management.

Trial registration: ClinicalTrials.gov NCT04479930; https://ichgcp.net/clinical-trials-registry/NCT04479930.

Keywords: COPD; adherence; chronic obstructive pulmonary disease; mHealth; pulmonary rehabilitation.

Conflict of interest statement

Conflicts of Interest: This study was financed by the Board of Lovexair Foundation (HappyAir in intellectual property of the Lovexair Foundation); SF is its president. EM is an employee of the Lovexair Foundation.

©Begoña Jiménez-Reguera, Eva Maroto López, Shane Fitch, Lourdes Juarros, Marta Sánchez Cortés, Juan Luis Rodríguez Hermosa, Myriam Calle Rubio, María Teresa Hernández Criado, Marta López, Santiago Angulo-Díaz-Parreño, Aitor Martín-Pintado-Zugasti, Jordi Vilaró. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 31.07.2020.

Figures

Figure 1
Figure 1
Intervention and control group process and follow-up.
Figure 2
Figure 2
Distribution of patients Consolidated Standards of Reporting Trials flow diagram.
Figure 3
Figure 3
Adherence to HappyAir program: total dimension of CAP questionnaire.
Figure 4
Figure 4
Percentage of patients adherent to physical activity: Morisky Green questionnaire.
Figure 5
Figure 5
Relationship between mood state and physical activity.
Figure 6
Figure 6
Quality of life: Chronic Obstructive Pulmonary Disease Assessment Test questionnaire.

References

    1. Celli BR, MacNee W, ATS/ERS Task Force Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respir J. 2004 Jun;23(6):932–946. doi: 10.1183/09031936.04.00014304.
    1. Fau LF. [The IBERPOC project: an epidemiological study of COPD in Spain. Scientific Committee of the IBERPOC study] Arch Bronconeumol. 1997 Jun;33(6):293–299.
    1. Alcázar-Navarrete B, Trigueros JA, Riesco JA, Campuzano A, Pérez J. Geographic variations of the prevalence and distribution of COPD phenotypes in Spain: the ESPIRAL-ES study. Int J Chron Obstruct Pulmon Dis. 2018;13:1115–1124. doi: 10.2147/COPD.S158031. doi: 10.2147/COPD.S158031.
    1. Miravitlles M. Guía de Práctica Clínica para el Diagnóstico y Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Crónica (EPOC)—Guía Española de la EPOC (GesEPOC) Arch Bronconeumol. 2012 Jan;48:2–58. doi: 10.1016/S0300-2896(12)70035-2.
    1. Mantoani LC, Rubio N, McKinstry B, MacNee W, Rabinovich RA. Interventions to modify physical activity in patients with COPD: a systematic review. Eur Respir J. 2016 Jul;48(1):69–81. doi: 10.1183/13993003.01744-2015.
    1. Miravitlles M, Soler-Cataluña JJ, Calle M, Molina J, Almagro P, Antonio Quintano J, Antonio Riesco J, Antonio Trigueros J, Piñera P, Simón A, Rodríguez-Hermosa JL, Marco E, López D, Coll R, Coll-Fernández R, Ángel Lobo M, Díez J, Soriano JB, Ancochea J. Spanish Guideline for COPD (GesEPOC). Update 2014. Arch Bronconeumol (English Edition) 2014;50:1–16. doi: 10.1016/s1579-2129(14)70070-9.
    1. Pleguezuelos E, Miravitlles M. Pulmonary rehabilitation… yes but no. Arch Bronconeumol. 2019 Dec;55(12):617–618. doi: 10.1016/j.arbres.2019.07.018.
    1. Global Strategy for Prevention, Diagnosis and Management of COPD. [2020-07-02]. .
    1. Nishiyama O, Taniguchi H, Kondoh Y, Kimura T, Ogawa T, Watanabe F, Arizono S. Factors in maintaining long-term improvements in health-related quality of life after pulmonary rehabilitation for COPD. Qual Life Res. 2005 Dec;14(10):2315–2321. doi: 10.1007/s11136-005-7710-y.
    1. Heerema-Poelman A, Stuive I, Wempe JB. Adherence to a maintenance exercise program 1 year after pulmonary rehabilitation: what are the predictors of dropout? J Cardiopulm Rehabil Prev. 2013;33(6):419–426. doi: 10.1097/HCR.0b013e3182a5274a.
    1. Beauchamp MK, Francella S, Romano JM, Goldstein RS, Brooks D. A novel approach to long-term respiratory care: results of a community-based post-rehabilitation maintenance program in COPD. Respir Med. 2013 Aug;107(8):1210–1216. doi: 10.1016/j.rmed.2013.04.014.
    1. Rubeis G, Schochow M, Steger F. Patient autonomy and quality of care in telehealthcare. Sci Eng Ethics. 2018 Feb;24(1):93–107. doi: 10.1007/s11948-017-9885-3.
    1. Criner RN, Han MK. COPD care in the 21st century: a public health priority. Respir Care. 2018 Apr 24;63(5):591–600. doi: 10.4187/respcare.06276.
    1. Pedone C, Lelli D. Systematic review of telemonitoring in COPD: an update. Pneumonol Alergol Pol. 2015;83(6):476–484. doi: 10.5603/PiAP.2015.0077.
    1. Bolton CE, Waters CS, Peirce S, Elwyn G. Insufficient evidence of benefit: a systematic review of home telemonitoring for COPD. J Eval Clin Pract. 2011 Dec;17(6):1216–1222. doi: 10.1111/j.1365-2753.2010.01536.x.
    1. McCabe C, McCann M, Brady AM. Computer and mobile technology interventions for self-management in chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2017 Dec 23;5:CD011425. doi: 10.1002/14651858.CD011425.pub2.
    1. Korpershoek YJG, Vervoort SCJM, Trappenburg JCA, Schuurmans MJ. Perceptions of patients with chronic obstructive pulmonary disease and their health care providers towards using mHealth for self-management of exacerbations: a qualitative study. BMC Health Serv Res. 2018 Oct 04;18(1):757. doi: 10.1186/s12913-018-3545-4.
    1. Güell Rous MR, Díaz Lobato S, Rodríguez Trigo G, Morante Vélez F, San Miguel M, Cejudo P, Ortega Ruiz F, Muñoz A, Galdiz Iturri JB, García A, Servera E, Sociedad Española de Neumología y Cirugía Torácica (SEPAR) Pulmonary rehabilitation. Sociedad Española de Neumología y Cirugía Torácica (SEPAR) Arch Bronconeumol. 2014 Aug;50(8):332–344. doi: 10.1016/j.arbres.2014.02.014.
    1. Cebrià IIM, Del CNT, Cañas N, Martínez M, Froilán C, Vilaró-Casamitjana J. Physiotherapy adherence and perception in patients with cystic fibrosis: a descriptive study. Eur Respir J (suppl 59) 2015;46 doi: 10.1183/13993003.congress-2015.pa2793.
    1. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986 Jan;24(1):67–74.
    1. Rodríguez Chamorro MA, García-Jiménez E, Amariles P, Rodríguez Chamorro A, Faus MJ. [Review of the test used for measuring therapeutic compliance in clinical practice] Aten Primaria. 2008 Aug;40(8):413–418. doi: 10.1157/13125407.
    1. Jones PW, Harding G, Berry P, Wiklund I, Chen W, Kline LN. Development and first validation of the COPD Assessment Test. Eur Respir J. 2009 Sep;34(3):648–654. doi: 10.1183/09031936.00102509.
    1. Ferrer M, Alonso J, Prieto L, Plaza V, Monsó E, Marrades R, Aguar MC, Khalaf A, Antó JM. Validity and reliability of the St George's Respiratory Questionnaire after adaptation to a different language and culture: the Spanish example. Eur Respir J. 1996 Jun;9(6):1160–1166. doi: 10.1183/09031936.96.09061160.
    1. Güell R, Casan P, Sangenís M, Morante F, Belda J, Guyatt GH. Quality of life in patients with chronic respiratory disease: the Spanish version of the Chronic Respiratory Questionnaire (CRQ) Eur Respir J. 1998 Jan;11(1):55–60. doi: 10.1183/09031936.98.11010055.
    1. EuroQol Group EuroQol—a new facility for the measurement of health-related quality of life. Health Policy. 1990 Dec;16(3):199–208.
    1. Güell R, Perpiñá M. Calidad de vida relacionada con la salud en neumología. Arch Bronconeumol. 1997 May;33(5):257–258. doi: 10.1016/s0300-2896(15)30619-0.
    1. Singh SJ, Puhan MA, Andrianopoulos V, Hernandes NA, Mitchell KE, Hill CJ, Lee AL, Camillo CA, Troosters T, Spruit MA, Carlin BW, Wanger J, Pepin V, Saey D, Pitta F, Kaminsky DA, McCormack MC, MacIntyre N, Culver BH, Sciurba FC, Revill SM, Delafosse V, Holland AE. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur Respir J. 2014 Dec;44(6):1447–1478. doi: 10.1183/09031936.00150414.
    1. Moullec G, Ninot G. An integrated programme after pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: effect on emotional and functional dimensions of quality of life. Clin Rehabil. 2010 Feb;24(2):122–136. doi: 10.1177/0269215509346088.
    1. Jolly K, Sidhu MS, Hewitt CA, Coventry PA, Daley A, Jordan R, Heneghan C, Singh S, Ives N, Adab P, Jowett S, Varghese J, Nunan D, Ahmed K, Dowson L, Fitzmaurice D. Self management of patients with mild COPD in primary care: randomised controlled trial. BMJ. 2018 Jun 13;361:k2241. doi: 10.1136/bmj.k2241.
    1. Spencer LM, Alison JA, McKeough ZJ. Do supervised weekly exercise programs maintain functional exercise capacity and quality of life, twelve months after pulmonary rehabilitation in COPD? BMC Pulm Med. 2007 May 16;7:7. doi: 10.1186/1471-2466-7-7.
    1. Arnold E, Bruton A, Ellis-Hill C. Adherence to pulmonary rehabilitation: a qualitative study. Respir Med. 2006 Oct;100(10):1716–1723. doi: 10.1016/j.rmed.2006.02.007.
    1. Lilholt PH, Witt UF, Ehlers L, Hejlesen OK. Telehealthcare for patients suffering from chronic obstructive pulmonary disease: effects on health-related quality of life: results from the Danish 'TeleCare North' cluster-randomised trial. BMJ Open. 2017 May 09;7(5):e014587. doi: 10.1136/bmjopen-2016-014587.
    1. Trappenburg JCA, Niesink A, de Weert-van Oene GH, van der Zeijden H, van Snippenburg R, Peters A, Lammers JJ, Schrijvers AJP. Effects of telemonitoring in patients with chronic obstructive pulmonary disease. Telemed J E Health. 2008 Mar;14(2):138–146. doi: 10.1089/tmj.2007.0037.
    1. Eckerstorfer LV, Tanzer NK, Vogrincic-Haselbacher C, Kedia G, Brohmer H, Dinslaken I, Corcoran K. Key elements of mhealth interventions to successfully increase physical activity: meta-regression. JMIR Mhealth Uhealth. 2018 Nov 12;6(11):e10076. doi: 10.2196/10076.
    1. Ding H, Fatehi F, Maiorana A, Bashi N, Hu W, Edwards I. Digital health for COPD care: the current state of play. J Thorac Dis. 2019 Oct;11(Suppl 17):S2210–S2220. doi: 10.21037/jtd.2019.10.17. doi: 10.21037/jtd.2019.10.17.
    1. Slevin P, Kessie T, Cullen J, Butler MW, Donnelly SC, Caulfield B. A qualitative study of chronic obstructive pulmonary disease patient perceptions of the barriers and facilitators to adopting digital health technology. Digit Health. 2019;5:2055207619871729. doi: 10.1177/2055207619871729.
    1. Gorst SL, Armitage C, Hawley M, Coates E. Exploring patient beliefs and perceptions about sustained use of telehealth. Int J Integr Care. 2013 Nov 20;13(7):1–2. doi: 10.5334/ijic.1393.
    1. Dobson R, Herbst P, Candy S, Brott T, Garrett J, Humphrey G, Reeve J, Tawhai M, Taylor D, Warren J, Whittaker R. Understanding end-user perspectives of mobile pulmonary rehabilitation (mPR): cross-sectional survey and interviews. JMIR Form Res. 2019 Dec 20;3(4):e15466. doi: 10.2196/15466.
    1. Gordon N, Crouch E. Digital information technology use and patient preferences for internet-based health education modalities: cross-sectional survey study of middle-aged and older adults with chronic health conditions. JMIR Aging. 2019 Apr 04;2(1):e12243. doi: 10.2196/12243.
    1. Sobnath DD, Philip N, Kayyali R, Nabhani-Gebara S, Pierscionek B, Vaes AW, Spruit MA, Kaimakamis E. Features of a mobile support app for patients with chronic obstructive pulmonary disease: literature review and current applications. JMIR Mhealth Uhealth. 2017 Feb 20;5(2):e17. doi: 10.2196/mhealth.4951.
    1. Almagro P, Castro A. Helping COPD patients change health behavior in order to improve their quality of life. Int J Chron Obstruct Pulmon Dis. 2013;8:335–345. doi: 10.2147/COPD.S34211. doi: 10.2147/COPD.S34211.
    1. Direito A, Carraça E, Rawstorn J, Whittaker R, Maddison R. mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Ann Behav Med. 2017 Apr;51(2):226–239. doi: 10.1007/s12160-016-9846-0.
    1. Global recommendations on physical activity for health. World Health Organization. [2020-07-06].
    1. Haskell WL, Lee I, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007 Aug;39(8):1423–1434. doi: 10.1249/mss.0b013e3180616b27.
    1. Fahy BF. Pulmonary rehabilitation for chronic obstructive pulmonary disease: a scientific and political agenda. Respir Care. 2004 Jan;49(1):28–36.
    1. Liacos A, Burge AT, Cox NS, Holland AE. Promoting physical activity using the internet: is it feasible and acceptable for patients with chronic obstructive pulmonary disease and bronchiectasis? J Aging Phys Act. 2018 Jul 01;26(3):372–381. doi: 10.1123/japa.2017-0123.
    1. Boer L, Bischoff E, van der Heijden M, Lucas P, Akkermans R, Vercoulen J, Heijdra Y, Assendelft W, Schermer T. A smart mobile health tool versus a paper action plan to support self-management of chronic obstructive pulmonary disease exacerbations: randomized controlled trial. JMIR Mhealth Uhealth. 2019 Oct 09;7(10):e14408. doi: 10.2196/14408.
    1. Brunton L, Bower P, Sanders C. The contradictions of telehealth user experience in chronic obstructive pulmonary disease (COPD): a qualitative meta-synthesis. PLoS One. 2015 Oct;10(10):e0139561. doi: 10.1371/journal.pone.0139561.
    1. Troosters T, Gosselink R, Decramer M. Short- and long-term effects of outpatient rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Am J Med. 2000 Aug 15;109(3):207–212. doi: 10.1016/s0002-9343(00)00472-1.
    1. Lewis KE, Annandale JA, Warm DL, Rees SE, Hurlin C, Blyth H, Syed Y, Lewis L. Does home telemonitoring after pulmonary rehabilitation reduce healthcare use in optimized COPD? A pilot randomized trial. J COPD. 2010 Feb;7(1):44–50. doi: 10.3109/15412550903499555.
    1. Hardinge M, Rutter H, Velardo C, Shah SA, Williams V, Tarassenko L, Farmer A. Using a mobile health application to support self-management in chronic obstructive pulmonary disease: a six-month cohort study. BMC Med Inform Decis Mak. 2015 Jun 18;15:46. doi: 10.1186/s12911-015-0171-5.
    1. Román M, Larraz C, Gómez A, Ripoll J, Mir I, Miranda EZ, Macho A, Thomas V, Esteva M. Efficacy of pulmonary rehabilitation in patients with moderate chronic obstructive pulmonary disease: a randomized controlled trial. BMC Fam Pract. 2013 Feb 11;14:21. doi: 10.1186/1471-2296-14-21.
    1. Kwon H, Lee S, Jung EJ, Kim S, Lee J, Kim DK, Kim T, Lee SH, Lee MK, Song S, Shin K. An mHealth management platform for patients with chronic obstructive pulmonary disease (efil breath): randomized controlled trial. JMIR Mhealth Uhealth. 2018 Aug 24;6(8):e10502. doi: 10.2196/10502.
    1. Busby AK, Reese RL, Simon SR. Pulmonary rehabilitation maintenance interventions: a systematic review. Am J Health Behav. 2014 May;38(3):321–330. doi: 10.5993/AJHB.38.3.1.

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner