A Smart Mobile Health Tool Versus a Paper Action Plan to Support Self-Management of Chronic Obstructive Pulmonary Disease Exacerbations: Randomized Controlled Trial

Abstract

BackgroundMany patients with chronic obstructive pulmonary disease (COPD) suffer from exacerbations, a worsening of their respiratory symptoms that warrants medical treatment. Exacerbations are often poorly recognized or managed by patients, leading to increased disease burden and health care costs.ObjectiveThis study aimed to examine the effects of a smart mobile health (mHealth) tool that supports COPD patients in the self-management of exacerbations by providing predictions of early exacerbation onset and timely treatment advice without the interference of health care professionals.MethodsIn a multicenter, 2-arm randomized controlled trial with 12-months follow-up, patients with COPD used the smart mHealth tool (intervention group) or a paper action plan (control group) when they experienced worsening of respiratory symptoms. For our primary outcome exacerbation-free time, expressed as weeks without exacerbation, we used an automated telephone questionnaire system to measure weekly respiratory symptoms and treatment actions. Secondary outcomes were health status, self-efficacy, self-management behavior, health care utilization, and usability. For our analyses, we used negative binomial regression, multilevel logistic regression, and generalized estimating equation regression models.ResultsOf the 87 patients with COPD recruited from primary and secondary care centers, 43 were randomized to the intervention group. We found no statistically significant differences between the intervention group and the control group in exacerbation-free weeks (mean 30.6, SD 13.3 vs mean 28.0, SD 14.8 weeks, respectively; rate ratio 1.21; 95% CI 0.77-1.91) or in health status, self-efficacy, self-management behavior, and health care utilization. Patients using the mHealth tool valued it as a more supportive tool than patients using the paper action plan. Patients considered the usability of the mHealth tool as good.ConclusionsThis study did not show beneficial effects of a smart mHealth tool on exacerbation-free time, health status, self-efficacy, self-management behavior, and health care utilization in patients with COPD compared with the use of a paper action plan. Participants were positive about the supportive function and the usability of the mHealth tool. mHealth may be a valuable alternative for COPD patients who prefer a digital tool instead of a paper action plan.Trial RegistrationClinicalTrials.gov NCT02553096; https://clinicaltrials.gov/ct2/show/NCT02553096.

The effects of nurse‐driven self‐management programs on chronic obstructive pulmonary disease: A systematic review and meta‐analysis

“…When gender distribution was analysed, 55.6% (1,212) of patients were males. Five studies included patients with stage I‐IV COPD (Aboumatar et al., 2018; Billington et al., 2015; Bischoff et al., 2012; Boer et al., 2019; Kuo et al., 2013). Remaining studies ( N = 7) were confined to COPD patients with stage II‐IV ( N = 2), II‐III ( N = 2), I‐III ( N = 2) or only III COPD ( N = 1) (Table 1).…”

“…The content of SM programs consisted of detailed information on COPD including anatomical structures of respiratory ways and lung, pathophysiology, common symptoms, progress and disease stages ( N = 12), conventional medications ( N = 12), exacerbation management ( N = 12), daily exercises ( N = 9) and breathing retraining ( N = 9). Moreover, seven studies focused on lifestyle changes (Aboumatar et al., 2018; Bischoff et al., 2012; Boer et al., 2019; Bucknall et al., 2012; Chang & Dai, 2019; Jonsdottir et al., 2015; Walters et al., 2013) and seven studies gave training on smoking cessation (Aboumatar et al., 2018; Chang & Dai, 2019; Jolly et al., 2018; Jonsdottir et al., 2015; Kuo et al., 2013; LianHong, Yan, LingYun, Li, & YongMei, 2019; Walters et al., 2013). Moreover, seven studies trained patients about coping with anxiety–stress (Billington et al., 2015; Bischoff et al., 2012; Boer et al., 2019; Bucknall et al., 2012; Jonsdottir et al., 2015; Song et al., 2014; Walters et al., 2013).…”

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

“…The results were favorable in terms of adopting positive habits in self-care and from the patients’ point of view, about the support they received in clinical, social, and therapeutic guidance. Some recent studies, such as by Boer and colleagues [ 47 ], highlighted patients’ perception of the usability and support offered by mHealth systems. However, as in some of the studies reviewed [ 48 ], the therapeutic educator reported an increased workload compared with studies of periodic calls or more time-spaced follow-up.…”

Technology-Enabled Self-Management of Chronic Obstructive Pulmonary Disease With or Without Asynchronous Remote Monitoring: Randomized Controlled Trial

“…Some studies have reported positive results on some quality of life measures and symptoms [ 10 , 33 - 35 ], but many have reported no effects [ 8 , 12 , 36 - 39 ]. With respect to health care utilization, the effects are also mixed, with some reporting reductions in hospitalizations [ 5 , 7 , 33 , 40 - 42 ], length of stay [ 7 , 33 , 40 , 43 ], and ED visits [ 33 , 40 ], but many failing to find significant effects [ 6 , 10 , 34 , 36 - 38 ]. A recent systematic review concluded that the evidence on the effectiveness of remote monitoring is mixed [ 16 ], although some meta-analyses have reported significant reductions in hospitalizations and ED visits [ 17 , 44 ].…”

“…Evidence suggests that action plans can be effective in reducing the effects of exacerbations when they are followed, but few patients follow written action plans [ 45 ]. The integration of action plans within the platform, with patients receiving feedback directly from the device, may improve their use, although a recent study found no additional benefits when action plans were embedded within a self-monitoring mobile app over those provided by a written action plan [ 38 ]. Further developments in trend analyses and predictive analytics of remote monitoring data [ 46 ] may allow for early detection of exacerbations as relative changes in vital signs may be more important than detecting vitals reaching absolute thresholds.…”