An mHealth Management Platform for Patients with Chronic Obstructive Pulmonary Disease (efil breath): Randomized Controlled Trial

Hee Kwon, Sungin Lee, Eun Ji Jung, SangHee Kim, Jung-Kyu Lee, Deog Kyeom Kim, Tae-Hyung Kim, Seung Hyeun Lee, Myoung Kyu Lee, Seungjae Song, Kichul Shin, Hee Kwon, Sungin Lee, Eun Ji Jung, SangHee Kim, Jung-Kyu Lee, Deog Kyeom Kim, Tae-Hyung Kim, Seung Hyeun Lee, Myoung Kyu Lee, Seungjae Song, Kichul Shin

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is one of the major morbidities in public health, and the use of mHealth technology for rehabilitation of patients with COPD can help increase physical activity and ameliorate respiratory symptoms.

Objective: This study aimed to develop a comprehensive rehabilitation management platform to improve physical activity and quality of life in patients with COPD.

Methods: The study comprised the following 2 stages: (1) a pilot stage in which a prototype app was developed; and (2) a fully-fledged platform development stage in which 2 apps and 1 COPD patient monitoring website were developed. We conducted a randomized clinical trial to investigate the efficacy of the apps developed in the second stage of the study. In addition, two 12-week exercise regimens (fixed and fixed-interactive) were tested for the trial. The clinical parameters of the respiratory function and patient global assessment (PGA) of the app were obtained and analyzed. Notably, Android was the chosen operating system for apps.

Results: We developed 2 COPD rehabilitation apps and 1 patient monitoring website. For the clinical trial, 85 patients were randomized into the following 3 groups: 57 were allocated to the 2 intervention groups and 28 to the control group. After 6 weeks, the COPD assessment test scores were significantly reduced in the fixed group (P=.01), and signs of improvement were witnessed in the fixed-interactive group. In addition, the PGA score was moderate or high in all aspects of the user experience of the apps in both intervention groups.

Conclusions: A well-designed mobile rehabilitation app for monitoring and managing patients with COPD can supplement or replace traditional center-based rehabilitation programs and achieve improved patient health outcomes.

Trial registration: ClinicalTrials.gov NCT03432117; https://ichgcp.net/clinical-trials-registry/NCT03432117 (Archived by WebCite at http://www.webcitation.org/71Yp0P64a).

Keywords: chronic obstructive pulmonary disease; mHealth; mobile phone; physical activity; quality of life; rehabilitation.

Conflict of interest statement

Conflicts of Interest: None declared.

©Hee Kwon, Sungin Lee, Eun Ji Jung, SangHee Kim, Jung-Kyu Lee, Deog Kyeom Kim, Tae-Hyung Kim, Seung Hyeun Lee, Myoung Kyu Lee, Seungjae Song, Kichul Shin. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.08.2018.

Figures

Figure 1
Figure 1
Study design. COPD: Chronic obstructive pulmonary disease; SMG-SNU: Seoul Metropolitan Government-Seoul National University.
Figure 2
Figure 2
Usability evaluation results (Stage 1).
Figure 3
Figure 3
Architecture of the home-based mobile COPD care service. PR: pulmonary rehabilitation; SpO2: blood oxygen saturation.
Figure 4
Figure 4
Fixed and interactive exercise regimens.
Figure 5
Figure 5
Walking exercise regimens: (1) fixed regimen and (2) interactive regimen.
Figure 6
Figure 6
Patient pulmonary rehabilitation record.
Figure 7
Figure 7
Study groups. IC: informed consent; a: Participants used fixed-regimen app; b: Participants used interactive-regimen app.
Figure 8
Figure 8
Respiratory function parameter changes and the patient global assessment of trial participants. PGA: patient global assessment; CAT: COPD assessment test; 6MWT: 6-minute walk test; mMRC: modified Medical Research Council; V1: baseline; V2: 6 weeks; V3: 12 weeks.

References

    1. Murray CJ, Lopez AD. Evidence-based health policy--lessons from the Global Burden of Disease Study. Science. 1996 Nov 01;274(5288):740–3.
    1. Yoo KH, Kim YS, Sheen SS, Park JH, Hwang YI, Kim S, Yoon HI, Lim SC, Park JY, Park SJ, Seo KH, Kim KU, Oh Y, Lee NY, Kim JS, Oh KW, Kim YT, Park I, Lee S, Kim SK, Kim YK, Han SK. Prevalence of chronic obstructive pulmonary disease in Korea: the fourth Korean National Health and Nutrition Examination Survey, 2008. Respirology. 2011 May;16(4):659–65. doi: 10.1111/j.1440-1843.2011.01951.x.
    1. Korean statistical information service (KOSIS) Chronic obstructive pulmonary disease : ≥40 years, by sex. [2018-08-15]. Statistical Annual Report (2009/2010)
    1. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WD, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van DPJ, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van MMPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM, ATS/ EFOPR. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med. 2013 Oct 15;188(8):e13–64. doi: 10.1164/rccm.201309-1634ST.
    1. Ries AL, Bauldoff GS, Carlin BW, Casaburi R, Emery CF, Mahler DA, Make B, Rochester CL, Zuwallack R, Herrerias C. Pulmonary Rehabilitation: Joint ACCP/AACVPR Evidence-Based Clinical Practice Guidelines. Chest. 2007 May;131(5 Suppl):4S–42S. doi: 10.1378/chest.06-2418.
    1. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2015 Feb 23;(2):CD003793. doi: 10.1002/14651858.CD003793.pub3.
    1. Keating A, Lee A, Holland AE. What prevents people with chronic obstructive pulmonary disease from attending pulmonary rehabilitation? A systematic review. Chron Respir Dis. 2011;8(2):89–99. doi: 10.1177/1479972310393756.
    1. Donaire-Gonzalez D, Gimeno-Santos E, Balcells E, Rodríguez DA, Farrero E, de BJ, Benet M, Ferrer A, Barberà JA, Gea J, Rodriguez-Roisin R, Antó JM, Garcia-Aymerich J. Physical activity in COPD patients: patterns and bouts. Eur Respir J. 2013 Oct;42(4):993–1002. doi: 10.1183/09031936.00101512.
    1. Hernandes NA, Teixeira DDC, Probst VS, Brunetto AF, Ramos EMC, Pitta F. Profile of the level of physical activity in the daily lives of patients with COPD in Brazil. J Bras Pneumol. 2009 Oct;35(10):949–56.
    1. Maltais F, Bourbeau J, Shapiro S, Lacasse Y, Perrault H, Baltzan M, Hernandez P, Rouleau M, Julien M, Parenteau S, Paradis B, Levy RD, Camp P, Lecours R, Audet R, Hutton B, Penrod JR, Picard D, Bernard S, Chronic OPDAORHNFDRESDQ. Effects of home-based pulmonary rehabilitation in patients with chronic obstructive pulmonary disease: a randomized trial. Ann Intern Med. 2008 Dec 16;149(12):869–78.
    1. Strijbos JH, Postma DS, van AR, Gimeno F, Koëter GH. A comparison between an outpatient hospital-based pulmonary rehabilitation program and a home-care pulmonary rehabilitation program in patients with COPD. A follow-up of 18 months. Chest. 1996 Feb;109(2):366–72.
    1. Fernández AM, Pascual J, Ferrando C, Arnal A, Vergara I, Sevila V. Home-based pulmonary rehabilitation in very severe COPD: is it safe and useful? J Cardiopulm Rehabil Prev. 2009;29(5):325–31. doi: 10.1097/HCR.0b013e3181ac7b9d.
    1. Holland AE, Mahal A, Hill CJ, Lee AL, Burge AT, Cox NS, Moore R, Nicolson C, O'Halloran P, Lahham A, Gillies R, McDonald CF. Home-based rehabilitation for COPD using minimal resources: a randomised, controlled equivalence trial. Thorax. 2017 Dec;72(1):57–65. doi: 10.1136/thoraxjnl-2016-208514.
    1. Lahham A, McDonald CF, Mahal A, Lee AL, Hill CJ, Burge AT, Cox NS, Moore R, Nicolson C, O'Halloran P, Gillies R, Holland AE. Home-based pulmonary rehabilitation for people with COPD: A qualitative study reporting the patient perspective. Chron Respir Dis. 2018 May;15(2):123–130. doi: 10.1177/1479972317729050.
    1. Wong S, Meng Y, Loprinzi P, Hongu N. Smart applications to track and record physical activity: implications for obesity treatment. Smart Homecare Technology and TeleHealth. 2014 Jul 31;:77–91. doi: 10.2147/SHTT.S41484.
    1. Ketel C. Potentials of internet-based patient engagement and education programs to reduce hospital readmissions: a spotlight on need in heart failure. Nurs Clin North Am. 2015 Jun;50(2):283–91. doi: 10.1016/j.cnur.2015.02.003.
    1. Riley WT, Rivera DE, Atienza AA, Nilsen W, Allison SM, Mermelstein R. Health behavior models in the age of mobile interventions: are our theories up to the task? Transl Behav Med. 2011 Mar;1(1):53–71. doi: 10.1007/s13142-011-0021-7.
    1. Delbaere K, Valenzuela T, Woodbury A, Davies T, Yeong J, Steffens D, Miles L, Pickett L, Zijlstra GAR, Clemson L, Close JCT, Howard K, Lord SR. Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the Standing Tall randomised controlled trial. BMJ Open. 2015 Oct 22;5(10):e009173. doi: 10.1136/bmjopen-2015-009173.
    1. Liu W, Wang C, Lin H, Lin S, Lee K, Lo Y, Hung S, Chang Y, Chung KF, Kuo H. Efficacy of a cell phone-based exercise programme for COPD. Eur Respir J. 2008 Sep;32(3):651–9. doi: 10.1183/09031936.00104407.
    1. Nguyen HQ, Gill DP, Wolpin S, Steele BG, Benditt JO. Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD. Int J Chron Obstruct Pulmon Dis. 2009;4:301–13.
    1. Güell MR, de LP, Gáldiz JB, Montemayor T, Rodríguez GJM, Gorostiza A, Ortega F, Bellón JM, Guyatt G. [Home vs hospital-based pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a Spanish multicenter trial] Arch Bronconeumol. 2008 Oct;44(10):512–8.
    1. Horton EJ, Mitchell KE, Johnson-Warrington V, Apps LD, Sewell L, Morgan M, Taylor RS, Singh SJ. Comparison of a structured home-based rehabilitation programme with conventional supervised pulmonary rehabilitation: a randomised non-inferiority trial. Thorax. 2018 Dec;73(1):29–36. doi: 10.1136/thoraxjnl-2016-208506.
    1. Verwey R, van DWS, Spreeuwenberg M, Tange H, van DWT, de WL. A pilot study of a tool to stimulate physical activity in patients with COPD or type 2 diabetes in primary care. J Telemed Telecare. 2014 Jan;20(1):29–34. doi: 10.1177/1357633X13519057.
    1. Knight E, Stuckey MI, Prapavessis H, Petrella RJ. Public health guidelines for physical activity: is there an app for that? A review of android and apple app stores. JMIR Mhealth Uhealth. 2015;3(2):e43. doi: 10.2196/mhealth.4003.
    1. American College of Sports Medicine . ACSM's Guidelines for Exercise Testing and Prescription. Philadelphia: Lippincott Williams & Wilkins; 2013. Mar 04,
    1. Kitsiou S, Thomas M, Marai G, Maglaveras N, Kondos G, Arena R. editors. Development of an innovative mHealth platform for remote physical activity monitoring and health coaching of cardiac rehabilitation patients. Biomedical & Health Informatics (BHI); 2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI); Feb. 16-19, 2017; Orlando, Florida, USA. 2017.
    1. Wise RA, Brown CD. Minimal clinically important differences in the six-minute walk test and the incremental shuttle walking test. COPD. 2005 Mar;2(1):125–9.
    1. Laviolette L, Bourbeau J, Bernard S, Lacasse Y, Pepin V, Breton M, Baltzan M, Rouleau M, Maltais F. Assessing the impact of pulmonary rehabilitation on functional status in COPD. Thorax. 2008 Feb;63(2):115–21. doi: 10.1136/thx.2006.076844.
    1. The Korean Academy of Tuberculosis and Respiratory Diseases. Consensus document on pulmonary rehabilitation in Korea 2015 .
    1. Gordon Nf. Breathing Disorders Complete Exercise Guide. Champaign, Illinois: Human Kinetics Publishers; 1993. Breathing Disorders: Your Complete Exercise Guide.
    1. Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. J Emerg Nurs. 2000 Jun;26(3):216–22.
    1. Huang W, Wu M, Chen H, Hsu J, TOLD Group Features of COPD patients by comparing CAT with mMRC: a retrospective, cross-sectional study. NPJ Prim Care Respir Med. 2015 Nov 05;25:15063. doi: 10.1038/npjpcrm.2015.63.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera