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://clinicaltrials.gov/ct2/show/NCT04479930

BACKGROUND Pulmonary rehabilitation is the most successful intervention to reduce the use of health resources and it promotes a reduction in COPD costs. m-Health systems in COPD aim to improve adherence to maintenance programs after PR by promoting the change in attitude and behaviour necessary for patient involvement in the management of the disease. OBJECTIVE This study aimed to assess the effectivity to promote adherence of an m-health system designed specifically for COPD patients and their needs. METHODS COPD patients from three different hospitals were randomized to a control group (CG) or an intervention group (Happyair group: HG). They developed an 8-week program of rehabilitation and educational sessions about their illness. After completion of the process, only HG performed a comprehensive maintenance program for 10 months, supervised by an m-health system and therapeutic educator. The control group only underwent the scheduled check-ups. Adherence to the program was rated using CAP FISIO questionnaire. Other variables as adherence to physical activity, quality of life or exercise capacity were analysed by Morisky-Green questionnaire, CAT questionnaire and 6MWT, respectively. RESULTS In total, 44 patients were recruited and randomized in CG(n=20) and HG(n=24). 8 patients dropped out for different reasons. CAP FISIO questionnaire results showed an improvement in adherence during follow up period, for HG, observed at 6 and 12 months after pulmonary rehabilitation: 6 months (53.6±5.4; P<0.05) and 12 months (56.1±4; P<0.04) CONCLUSIONS m-health systems designed for COPD patients improve adherence to maintenance programs, as long as they are accompanied by disease awareness and patient involvement in management.

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