Gelbman Brian D, Reed Carol R
Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical Center, New York, NY, United States.
Wellinks (Convexity Scientific, Inc), New Haven, CT, United States.
JMIR Form Res. 2022 Mar 17;6(3):e34758. doi: 10.2196/34758.
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.
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.
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.
Average age of the patients was 79.6 (range 65-95) years. Participants (10 female; 9 male) had an average FEV% (forced expiratory volume in 1 second as % of predicted for the patient) of 56.2% of predicted (range 23%-113%) and FEV/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 FEV 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.
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.
慢性阻塞性肺疾病（COPD）影响着数百万美国人，且具有很高的经济影响，部分原因是频繁的急诊室就诊和住院治疗。数字健康的进步使得从多个设备远程收集数据成为可能，有助于管理诸如COPD等慢性疾病。
在这项试点研究中，我们评估了COPD患者使用Wellinks移动健康平台从对COPD管理重要的多种模式收集信息的能力。我们还评估了患者对该平台的满意度和参与度。
在患有COPD的成年人中使用Wellinks平台进行了一项单中心、观察性、前瞻性试点研究（N = 19）。所有患者在筛查时年龄超过30岁，拥有一部iPhone，并且目前正在接受包括雾化治疗在内的治疗方案。入选患者收到一套研究工具包，包括Flyp雾化器、Smart One肺量计、Nonin脉搏血氧仪以及Wellinks移动健康应用程序，并接受了所有设备的培训。在8周时间里，参与者需手动输入每日症状和用药情况；肺量计、雾化器和脉搏血氧仪的数据会自动记录。数据会在月度报告中发送给主治医生。通过5分制量表测量患者满意度，并在观察期结束时通过访谈获取净推荐值（NPS）。
患者的平均年龄为79.6岁（范围65 - 95岁）。参与者（10名女性；9名男性）的平均第1秒用力呼气量（FEV%，即患者的第1秒用力呼气量占预测值的百分比）为预测值的56.2%（范围23% - 113%），FEV/用力肺活量为65%。根据慢性阻塞性肺疾病全球倡议（GOLD）分类评估，COPD严重程度为轻度的患者有2例，中度的有6例，重度/极重度的有11例；9名患者在家中吸氧。在这项为期8周的研究中，肺量计的平均使用频率为每周2.5次，脉搏血氧仪为每周4.2次。用药情况每周手动记录9.0次，雾化器使用每周1.9次，症状记录平均每周1.2次。家庭测量与办公室测量的峰值流量和FEV的相关系数很高（分别为r = 0.94和0.96）。患者认为该应用程序有价值（13/16，81%）且易于使用（15/16，94%）。净推荐值为59。
本研究表明，我们的COPD患者队列在8周时间内积极且持续地参与了Wellinks移动健康平台，并且如满意度调查和净推荐值59所示，患者满意度很高。在这个小的、经过挑选的样本中，患者无论疾病严重程度、年龄或性别，都愿意使用该技术并且能够成功使用。患者认为Wellinks移动健康平台有用且有价值，并且可以帮助临床医生做出更好的、及时的决策，以改善COPD的管理。
