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

Abstract

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

Efficacy of Web-Based Supportive Interventions in Quality of Life in COPD Patients, a Systematic Review and Meta-Analysis

“…All the studies except the study of Wang et al (47.5%) [ 54 ] had a higher proportion of males than females in the study sample. Regarding COPD severity, five studies [ 55 , 56 , 57 , 58 , 59 ] included mild to very severe patients and four studies [ 53 , 54 , 60 , 61 ] included moderate to very severe patients. All studies included clinically stable patients, with the exception of Wang et al [ 54 ] and Jiménez-Reguera et al [ 61 ], which included patients after discharge.…”

“…For this purpose, the same intervention was carried out in both face-to-face and online modalities. Two studies were based on a telerehabilitation program [ 53 , 60 ], another in a self-management program [ 55 ], and the last one was based on tele-education and symptom and mood telemonitoring [ 61 ].…”

“…Only one study [ 57 ] excluded educational content. Education in self-management skills and tele-communication with healthcare professionals were excluded by Jiménez-Reguera et al [ 61 ]. in three of the studies [ 53 , 55 , 60 ].…”

“…Most of the studies conducted an intervention over one year [ 54 , 55 , 57 , 59 ]. One study conducted an intervention of 10 months [ 61 ] and 4 studies conducted an intervention of less than 4 months [ 53 , 56 , 58 , 60 ].…”

Long-term Exercise After Pulmonary Rehabilitation (LEAP): a pilot randomised controlled trial of Tai Chi in COPD

“…We also observed a decrease in exercise time in both TC and GW during the second 12 weeks compared to the first 12 weeks, suggesting that long-term sustained behaviour change is also a challenge for mind–body exercise interventions. Diaries, phone calls, pedometers and a web-based app have been previously used to improve adherence [ 33 , 34 ]. Our data suggest that continued TC classes may be important.…”