JMIR Publications

ABSTRACT

Background:

Chronic Obstructive Pulmonary Disease (COPD) is highly prevalent and significantly affects the daily functioning of those affected. 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 delivery of self-management interventions for COPD. We developed an mHealth intervention (‘SMART-COPD’), delivered via smartphone application and activity tracker, to help people with COPD maintain (or increase) physical activity after undertaking Pulmonary Rehabilitation (PR).

Objective:

To determine whether it is feasible and acceptable to use the SMART-COPD intervention for self-management of physical activity, and to explore the feasibility of conducting a future Randomised Controlled Trial (RCT) to investigate its effectiveness.

Methods:

We carried out a randomised feasibility study. Thirty participants with COPD were randomly allocated to receive the SMART-COPD Intervention (n=19) or Control (n=11). Participants used SMART-COPD throughout PR (six weeks) and for eight weeks afterwards (‘maintenance’) to set physical activity goals and monitor progress towards them. Questionnaire-based and physical activity-based outcome measures were taken at baseline, end of PR, and end of maintenance. Participants, and healthcare professionals involved in PR delivery, were interviewed about their experiences with the technology.

Results:

Fourteen participants out of 30 (47%) withdrew from the study. Difficulty 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. Use of Fitbit™ to monitor daily step-count was the most favoured aspect of the intervention. Activity tracking and self-report were both found to be problematic as outcome measures for physical activity for the current study. There was dissatisfaction among some Control group members regarding their allocation.

Conclusions:

mHealth shows promise in helping people with COPD self-manage their physical activity levels. Mobile health 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 personalisation, 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 take into account high dropout rates. Clinical Trial: NCT02691104