Smartphone-Based Physical Activity Telecoaching in Chronic Obstructive Pulmonary Disease: Mixed-Methods Study on Patient Experiences and Lessons for Implementation

Abstract

Background: Telecoaching approaches can enhance physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD). However, their effectiveness is likely to be influenced by intervention-specific characteristics.

Objective: This study aimed to assess the acceptability, actual usage, and feasibility of a complex PA telecoaching intervention from both patient and coach perspectives and link these to the effectiveness of the intervention.

Methods: We conducted a mixed-methods study based on the completers of the intervention group (N=159) included in an (effective) 12-week PA telecoaching intervention. This semiautomated telecoaching intervention consisted of a step counter and a smartphone app. Data from a project-tailored questionnaire (quantitative data) were combined with data from patient interviews and a coach focus group (qualitative data) to investigate patient and coach acceptability, actual usage, and feasibility of the intervention. The degree of actual usage of the smartphone and step counter was also derived from app data. Both actual usage and perception of feasibility were linked to objectively measured change in PA.

Results: The intervention was well accepted and perceived as feasible by all coaches present in the focus group as well by patients, with 89.3% (142/159) of patients indicating that they enjoyed taking part. Only a minority of patients (8.2%; 13/159) reported that they found it difficult to use the smartphone. Actual usage of the step counter was excellent, with patients wearing it for a median (25th-75th percentiles) of 6.3 (5.8-6.8) days per week, which did not change over time (P=.98). The smartphone interface was used less frequently and actual usage of all daily tasks decreased significantly over time (P<.001). Patients needing more contact time had a smaller increase in PA, with mean (SD) of +193 (SD 2375) steps per day, +907 (SD 2306) steps per day, and +1489 (SD 2310) steps per day in high, medium, and low contact time groups, respectively; P for-trend=.01. The overall actual usage of the different components of the intervention was not associated with change in step count in the total group (P=.63).

Conclusions: The 12-week semiautomated PA telecoaching intervention was well accepted and feasible for patients with COPD and their coaches. The actual usage of the step counter was excellent, whereas actual usage of the smartphone tasks was lower and decreased over time. Patients who required more contact experienced less PA benefits.

Trial registration: ClinicalTrials.gov NCT02158065; https://ichgcp.net/clinical-trials-registry/NCT02158065 (Archived by WebCite at http://www.webcitation.org/73bsaudy9).

Keywords: COPD; outcome and process assessment (health care); patient adherence; patient satisfaction; physical activity; smartphone; telemedicine.

Conflict of interest statement

Conflicts of Interest: None declared.

©Matthias Loeckx, Roberto A Rabinovich, Heleen Demeyer, Zafeiris Louvaris, Rebecca Tanner, Noah Rubio, Anja Frei, Corina De Jong, Elena Gimeno-Santos, Fernanda M Rodrigues, Sara C Buttery, Nicholas S Hopkinson, Gilbert Büsching, Alexandra Strassmann, Ignasi Serra, Ioannis Vogiatzis, Judith Garcia-Aymerich, Michael I Polkey, Thierry Troosters. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 21.12.2018.

Figures

Figure 1

Overview of the intervention; 1=sending of “steps data” to smartphone (through Bluetooth); 2=data sent to central database; 3=coach is able to access database; 4=coach is able to manually adjust goals, 5=accessing & closing the different tasks on the smartphone app (automated messages); i.e., (from left to right); morning goal, send activity in the evening, daily feedback (from Monday to Saturday) and weekly feedback (only on Sunday) tasks.

Figure 2

Division (into 3 groups) of patients based on total duration and number of contacts between patients and coach. Min=minutes; #=number of contacts; n=number of patients in each group.

Figure 3

Boxplots depicting the usefulness score (0-10 Likert scale) of the different parts of the intervention from the patients’ perspective. “app” between brackets represents messages displayed on the smartphone app.

Figure 4

Contact time throughout the intervention (only including centers with more than 20 patients). The black bars represent the mean contact time (in min per week) per patient from the first 10 patients that were recruited in each center. White bars represent the mean contact time (in min per week) per patient from the patients that were recruited at a later stage. P value indicates difference between the total cumulated contact time over the 12 weeks between patients recruited in early stage versus later stage.

Figure 5

Change in physical activity (PA; mean [SE]) across groups of patients according to total contact time; adjusted for age, baseline functional exercise capacity, baseline forced expiratory volume in 1 second, baseline symptom score and number of acute exacerbations in the previous 12 months. P value (P for trend) indicates difference in intervention effect between patients divided based on total contact time, after adjusting for the covariates. Data are based on Actigraph measurements and include 140 patients. Unadjusted scores were mean(SD) +1489 (SD 2310) steps per day, +907 (SD 2306) steps per day and +193 (SD 2375) steps per day in low, medium and high contact time groups, respectively.

Figure 6

Change in physical activity (PA; mean [SE] across groups of patients according to overall actual usage score; adjusted for age, baseline functional exercise capacity, baseline forced expiratory volume in 1 second, baseline symptom score and number of acute exacerbations in the previous 12 months. P value (P for trend) indicates difference in intervention effect between patients divided based on the total actual usage score, after adjusting for the covariates. Data are based on Actigraph measurements and include 140 patients. Unadjusted scores were mean(SD) +777 (SD 2767) steps per day, +1159 (SD 2720) steps per day and +679 (SD 2075) steps per day in low, medium and high actual usage groups, respectively.