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

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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://clinicaltrials.gov/ct2/show/NCT03432117 (Archived by WebCite at http://www.webcitation.org/71Yp0P64a)

Related collections

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Widespread application of pulmonary rehabilitation (also known as respiratory rehabilitation) in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function (health-related quality of life, functional and maximal exercise capacity) attributable to the programmes. This review updates the review reported in 2006.

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Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma.

K Kendrick, Andrew T. Smith, S Baxi (2000)

Rapid assessment and monitoring is essential for patients with acute bronchospasm. However, tools for measuring dyspnea or the state of being short of breath are often limited to peak flow, blood gas analysis, and asking patients multiple questions about their breathing at a time when they find speaking difficult. We thus decided to examine a tool called the modified Borg scale (MBS) that had the potential to provide quick, easy, and rapid information about a patient's subjective state of dyspnea. This 0 to 10 rated scale gave our ED patients a device they could use to measure and evaluate their dyspnea. For this reason, we added it to the triage assessment practice and included it in all posttreatment assessment notes on patients with exacerbations of asthma or chronic obstructive pulmonary disease (COPD) who were seen in the emergency department and urgent care clinic. (1) Can patients with acute bronchospastic asthma or COPD adequately communicate their level of dyspnea using the MBS? (2) Does subjective improvement in the patient's dyspnea using the MBS correlate with improvements in pulmonary functions as measured by the peak flow meter and cutaneous oxygen saturation (Sao(2))? Routine and triage assessment of subjective dyspnea using the MBS was instituted at a hospital emergency department serving adult veterans. Concurrently, the MBS was added to our standardized treatment protocol for management of patients with bronchospasm. ED and urgent care records were reviewed to collect baseline and postrespiratory treatment data on peak expiratory flow rates (PEFR), MBS scores, and Sao(2) percentages. Four hundred male veterans aged 24 to 87 years presented with a chief complaint of dyspnea. The assessing physician identified 102 of these patients as having acute bronchospasm; 42 were diagnosed with asthma, and 60 were diagnosed with COPD. All study patients with acute bronchospasm were able to use the MBS to rate their perception of severity of dyspnea. As the peak flow measurements increased, the MBS scores of difficulty breathing decreased. For the asthma groups, the mean MBS score decreased from 5.1 at triage baseline to 2.4 after treatment. This finding indicated that a significant correlation existed between the change in MBS scores and the change in PEFR from pretreatment to posttreatment scores (r = -.31, P <.05). As the peak flow increased, the MBS scores decreased. Sao(2) only slightly improved in the asthma group compared with the COPD group. For patients with COPD, the mean MBS score decreased from 6.0 at triage baseline to 3.0 after treatment. This finding indicated that a significant correlation also existed between the change in MBS scores and the change in PEFR from pretreatment to posttreatment scores (r = -.42, P <.001). Cutaneous oxygen saturation also improved in the COPD group after treatment. The modality of treatment ordered by the physician was metered dose inhaler or nebulizer. These treatment modalities had no effect on the aforementioned results in the asthma or COPD group. The MBS is a valid and reliable assessment tool for dyspnea. This study demonstrated that it correlated well with other clinical parameters and could be useful when assessing and monitoring outcomes in patients with acute bronchospasm. Patients who used the MBS rated it with a high degree of satisfaction on ease of use and found that the language in this scale adequately expressed their dyspnea. The ED triage and primary care nursing staff rated the MBS as highly satisfactory, stating that it was quick and easy to use. Respiratory assessment in the triage notes and nursing notes were streamlined to consistently include 3 respiratory measures: PEFR, MBS, and Sao(2). Long respiratory narratives were found to be unnecessary in many cases. In addition, the MBS helped to include an important element of subjective assessment when evaluating the severity of dyspnea.

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Author and article information

Contributors

Kichul Shin:

Department of Internal MedicineSeoul Metropolitan Government-Seoul National University Boramae Medical Center20 boramae Ro 5-gil Dongjak-guSeoul,Republic Of Korea82 2 870 320482 2 870 3866kideb1@gmail.com

ORCID: http://orcid.org/0000-0002-6749-7598

Journal

Journal ID (nlm-ta): JMIR Mhealth Uhealth

Journal ID (iso-abbrev): JMIR Mhealth Uhealth

Journal ID (publisher-id): JMU

Title: JMIR mHealth and uHealth

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2291-5222

Publication date Collection: August 2018

Publication date (Electronic): 24 August 2018

Volume: 6

Issue: 8

Electronic Location Identifier: e10502

Affiliations

[1] ¹ LifeSemantics Corp Seoul Republic Of Korea

[2] ² Seoul Metropolitan Government-Seoul National University Boramae Medical Center Seoul Republic Of Korea

[3] ³ Department of Internal Medicine Seoul Metropolitan Government-Seoul National University Boramae Medical Center Seoul Republic Of Korea

[4] ⁴ Division of Pulmonology Hanyang University College of Medicine Gyeonggi-do Republic Of Korea

[5] ⁵ Department of Internal Medicine Kyung Hee University School of Medicine Seoul Republic Of Korea

[6] ⁶ Department of Internal Medicine Yonsei University Wonju College of Medicine Gangwon-do Republic Of Korea

Author notes

Corresponding Author: Kichul Shin kideb1@ 123456gmail.com

Author information

Hee Kwon http://orcid.org/0000-0001-9910-1888

Sungin Lee http://orcid.org/0000-0002-4260-2160

Eun Ji Jung http://orcid.org/0000-0002-9987-0529

SangHee Kim http://orcid.org/0000-0002-8496-6317

Jung-Kyu Lee http://orcid.org/0000-0001-5060-7255

Deog Kyeom Kim http://orcid.org/0000-0001-9379-8098

Tae-Hyung Kim http://orcid.org/0000-0002-3863-7854

Seung Hyeun Lee http://orcid.org/0000-0002-7666-313X

Myoung Kyu Lee http://orcid.org/0000-0002-2450-4882

Seungjae Song http://orcid.org/0000-0002-6963-9123

Kichul Shin http://orcid.org/0000-0002-6749-7598

Article

Publisher ID: v6i8e10502

DOI: 10.2196/10502

PMC ID: 6128957

PubMed ID: 30143475

SO-VID: ebd095b3-7282-48c7-a2b8-f772fd0b07cc

Copyright © ©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.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

History

Date received : 26 March 2018

Date revision requested : 22 April 2018

Date revision received : 17 June 2018

Date accepted : 26 July 2018

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