School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom.
School of Education, The University of Sheffield, Sheffield, United Kingdom.
JMIR Mhealth Uhealth. 2020 Jun 3;8(6):e16203. doi: 10.2196/16203.
Chronic obstructive pulmonary disease (COPD) is highly prevalent and significantly affects the daily functioning of patients. Self-management strategies, including increasing physical activity, can help people with COPD have better health and a better quality of life. Digital mobile health (mHealth) techniques have the potential to aid the delivery of self-management interventions for COPD. We developed an mHealth intervention (Self-Management supported by Assistive, Rehabilitative, and Telehealth technologies-COPD [SMART-COPD]), delivered via a smartphone app and an activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking pulmonary rehabilitation (PR).
This study aimed to determine the feasibility and acceptability of using the SMART-COPD intervention for the self-management of physical activity and to explore the feasibility of conducting a future randomized controlled trial (RCT) to investigate its effectiveness.
We conducted a randomized feasibility study. A total of 30 participants with COPD were randomly allocated to receive the SMART-COPD intervention (n=19) or control (n=11). Participants used SMART-COPD throughout PR and for 8 weeks afterward (ie, maintenance) to set physical activity goals and monitor their progress. Questionnaire-based and physical activity-based outcome measures were taken at baseline, the end of PR, and the end of maintenance. Participants, and health care professionals involved in PR delivery, were interviewed about their experiences with the technology.
Overall, 47% (14/30) of participants withdrew from the study. Difficulty in using the technology was a common reason for withdrawal. Participants who completed the study had better baseline health and more prior experience with digital technology, compared with participants who withdrew. Participants who completed the study were generally positive about the technology and found it easy to use. Some participants felt their health had benefitted from using the technology and that it assisted them in achieving physical activity goals. Activity tracking and self-reporting were both found to be problematic as outcome measures of physical activity for this study. There was dissatisfaction among some control group members regarding their allocation.
mHealth shows promise in helping people with COPD self-manage their physical activity levels. mHealth interventions for COPD self-management may be more acceptable to people with prior experience of using digital technology and may be more beneficial if used at an earlier stage of COPD. Simplicity and usability were more important for engagement with the SMART-COPD intervention than personalization; therefore, the intervention should be simplified for future use. Future evaluation will require consideration of individual factors and their effect on mHealth efficacy and use; within-subject comparison of step count values; and an opportunity for control group participants to use the intervention if an RCT were to be carried out. Sample size calculations for a future evaluation would need to consider the high dropout rates.
慢性阻塞性肺疾病（COPD）的发病率很高，严重影响患者的日常功能。自我管理策略，包括增加身体活动，可以帮助 COPD 患者拥有更好的健康和更高的生活质量。数字移动健康（mHealth）技术有可能辅助 COPD 的自我管理干预措施的实施。我们开发了一种 mHealth 干预措施（通过智能手机应用程序和活动跟踪器来支持自我管理的辅助、康复和远程医疗技术-COPD[SMART-COPD]），以帮助接受肺康复（PR）后的 COPD 患者保持（或增加）身体活动。
本研究旨在确定使用 SMART-COPD 干预措施进行身体活动自我管理的可行性和可接受性，并探索进行未来随机对照试验（RCT）以调查其有效性的可行性。
我们进行了一项随机可行性研究。共 30 名 COPD 患者被随机分配接受 SMART-COPD 干预（n=19）或对照组（n=11）。参与者在 PR 期间和之后的 8 周（即维持期）使用 SMART-COPD 设定身体活动目标并监测进展情况。在基线、PR 结束时和维持结束时进行基于问卷和基于身体活动的结果测量。对参与 PR 交付的患者和医疗保健专业人员进行了关于他们对技术体验的采访。
总体而言，47%（14/30）的参与者退出了研究。使用技术困难是退出研究的常见原因。与退出的参与者相比，完成研究的参与者基线健康状况更好，且有更多的数字技术使用经验。完成研究的参与者对技术总体持积极态度，发现其易于使用。一些参与者认为他们的健康因使用技术而受益，并且技术有助于他们实现身体活动目标。活动跟踪和自我报告都被发现是本研究中身体活动的有问题的结果测量方法。一些对照组的成员对他们的分组感到不满。
mHealth 有望帮助 COPD 患者自我管理身体活动水平。对于具有数字技术使用经验的人，mHealth 干预措施用于 COPD 自我管理可能更具可接受性，如果在 COPD 的早期阶段使用，可能更有益。与个性化相比，参与 SMART-COPD 干预措施的关键是简单性和易用性；因此，未来使用时应简化干预措施。未来的评估需要考虑个人因素及其对 mHealth 疗效和使用的影响；在个体内比较步数值；并且如果进行 RCT，应让对照组的参与者有机会使用该干预措施。未来评估的样本量计算需要考虑高退出率。
