An Integrated, Multimodal, Digital Health Solution for Chronic Obstructive Pulmonary Disease: Prospective Observational Pilot Study

Abstract

Background Chronic obstructive pulmonary disease (COPD) affects millions of Americans and has a high economic impact partially due to frequent emergency room visits and hospitalizations. Advances in digital health have made it possible to collect data remotely from multiple devices to assist in managing chronic diseases such as COPD. Objective In this pilot study, we evaluated the ability of patients with COPD to use the Wellinks mHealth platform to collect information from multiple modalities important to the management of COPD. We also assessed patient satisfaction and engagement with the platform. Methods A single-site, observational, prospective pilot study (N=19) was conducted using the Wellinks platform in adults with COPD. All patients were aged over 30 years at screening, owned an iPhone, and were currently undergoing a treatment regimen that included nebulized therapy. Enrolled patients received a study kit consisting of the Flyp nebulizer, Smart One spirometer, the Nonin pulse oximeter, plus the Wellinks mHealth app, and training for all devices. For 8 weeks, participants were to enter daily symptoms and medication use manually; spirometry, nebulizer, and pulse oximeter data were automatically recorded. Data were sent to the attending physician in a monthly report. Patient satisfaction was measured via a 5-point scale and the Net Promoter Score (NPS) captured in interviews at the end of the observation period. Results Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV1% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV1/forced vital capacity of 65%. COPD severity, as assessed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification, was mild in 2 patients, moderate in 6, and severe/very severe in 11; 9 patients were on home oxygen. During this 8-week study, average use of the spirometer was 2.5 times/week, and the pulse oximeter 4.2 times/week. Medication use was manually documented 9.0 times/week, nebulizer use 1.9 times/week, and symptoms recorded 1.2 times/week on average. The correlation coefficients of home to office measurements for peak flow and FEV1 were high (r=0.94 and 0.96, respectively). Patients found the app valuable (13/16, 81%) and easy to use (15/16, 94%). The NPS was 59. Conclusions This study demonstrates that our cohort of patients with COPD engaged with the Wellinks mHealth platform avidly and consistently over the 8-week period, and that patient satisfaction was high, as indicated by the satisfaction survey and the NPS of 59. In this small, selected sample, patients were both willing to use the technology and capable of doing so successfully regardless of disease severity, age, or gender. The Wellinks mHealth platform was considered useful and valuable by patients, and can assist clinicians in improved, timely decision making for better COPD management.

Study protocol: A comparison of mobile and clinic‐based spirometry for capturing the treatment effect in moderate asthma

“…27,28 The collection of data in the home environment may represent a more accurate reflection of the patients' lived experiences than on-site measurements, 29 aligns with a patient-centric approach to trial design and implementation, 30 and is associated with high patient satisfaction. 31 Finally, eliminating or reducing the need for in-clinic visits removes many barriers to trial entry, potentially increasing the rate of recruitment while improving accessibility, diversity, equity, and inclusion. 32 Before adopting sensor-based DHTs for remote data collection in clinical trials, several considerations must be addressed, including a comparison with reference standard measures 9,16 ; assessments of adherence, usability, and patient/clinical staff satisfaction; and questions of logistics, such as staff training, data transfer, and implementation costs.…”

“…Continuous or daily measurements also allow for a greater understanding of day‐to‐day symptom variability not captured in a pre/post design, which is particularly important for outcomes with known diurnal variability, such as lung function in asthma 27,28 . The collection of data in the home environment may represent a more accurate reflection of the patients' lived experiences than on‐site measurements, 29 aligns with a patient‐centric approach to trial design and implementation, 30 and is associated with high patient satisfaction 31 . Finally, eliminating or reducing the need for in‐clinic visits removes many barriers to trial entry, potentially increasing the rate of recruitment while improving accessibility, diversity, equity, and inclusion 32 .…”

Factors affecting doctor’s recommendation for mobile health services

“…50 In the field of mHealth services, there is a study in which researchers have used NPS to assess the effectiveness and satisfaction of an app in the management of COPD patients. 51 The reason why we chose to use the NPS to assess doctors’ willingness to recommend mHealth services to their patients is, on the one hand, that it is simple and users can respond quickly, as mentioned earlier. Another important reason lies in the way it is calculated.…”

Telemedicine and home monitoring for COPD – a narrative review of recent literature

“…Gelbman et al [23 ▪▪ ] conducted a pilot study on the use of the Wellinks mHealth platform by COPD patients undergoing nebulized therapy. They received a study kit with devices and training and entered daily symptoms and medication use manually, while spirometry, nebulizer, and pulse oximeter data were automatically recorded and sent to the doctor monthly.…”