A home-based pulmonary rehabilitation mHealth system to enhance the exercise capacity of patients with COPD: Development and evaluation (Preprint)

Abstract

Patients with Chronic Obstructive Pulmonary Disease (COPD) experience deficits in exercise capacity and physical activity as their disease progresses. Pulmonary rehabilitation (PR) can enhance exercise capacity of patients and it is crucial for patients to maintain a long-term physically active lifestyle.

This study aimed to develop a home-based rehabilitation mHealth system incorporating Behavior Change Techniques (BCTs) for COPD patients, and evaluate its technology acceptance and feasibility.

Guided by the Medical Research Council (MRC) framework the process of this study is divided into four steps. In the first step the prescription was constructed. The second step is to formulate specific intervention functions based on the Behavior Change Wheel (BCW) theory. Subsequently, in the third step iterative system development was conducted. And in the last step two polit studies were performed, the first is for the improvement of system functions and the second is to validate the acceptance and usability. Primary outcomes were the exercise capacity measured by Six-Minute Walk Test (6MWT). Secondary clinical outcomes included changes in disease specific health status measured by COPD Assessment Test (CAT), measure of breathlessness indicated by mMRC (modified British medical Research Council) and indicators of mental health such as Hospital Anxiety and Depression Scale (HAD). Compliance, technology acceptance, and feasibility of the system were also used as outcome indicators.

Two-stage study was conducted to evaluate the proposed system. A total of 17 patients was enrolled. 12 patients completed the 12-week study. At the end of the first study, the 6MWT showed significant increase over time (P=0.028). Participants reported that this app had a positive effect on promoting exercise at home. The results of the second stage study is the final result of this study. For the clinical outcomes, 6MWT scores showed significant difference (P=.023) over time with an improvement exceeded the Minimal Clinically Important Difference (MCID). Change in respiratory symptom (CAT score) was statistically different (P=.023) with a greater decrease of -3.17 points that exceeded the MCID. The mMRC levels reduced overall and showed significant difference. HAD did not show statistically significant difference in this study but non-inferiority. The overall compliance of this study reached 82.20% (±1.68%).

This study developed a home-based PR mHealth system for COPD patients. The use of BCW in the intervention developing process offers a systematic method for designing a theory-driven intervention. The pilot study in Yinchuan verified the technical acceptance and availability of the system, and demonstrated the benefits of applying mHealth technology and BCT to Home-based PR for COPD patients. The proposed system plays an important auxiliary role in the process of prescribing exercise prescription according to the characteristics of patients. And it provides means and tools for further individuation of exercise prescription in the future.