JMIR Publications

ABSTRACT

Background:

The progression of chronic obstructive pulmonary disease (COPD) leads to increased morbidity and mortality, emphasizing the need for effective self-management. Challenges such as accessibility, cost, and patient engagement hinder self-management efforts, highlighting the need for evidence-based mobile (m)Health interventions.

Objective:

This meta-analysis evaluated randomized control trials (RCTs) on the effectiveness of COPD mHealth self-management programs, focusing on the modified Medical Research Council (mMRC) dyspnea scale, the 6-min walking test (6MWT), and St. George’s Respiratory Questionnaire (SGRQ) score. The study also analyzed the quality-adjusted life years (QALYs) and costs as secondary economic outcomes; exacerbation, hospitalization, and emergency room and clinic visits as clinical outcomes; and self-efficacy as a humanistic outcome.

Methods:

The inclusion criteria covered RCTs involving COPD patients aged ≥18 years, comparing mHealth-based self-management programs to non-mHealth interventions, with outcomes on the mMRC dyspnea scale, 6MWT, and SGRQ score. Exclusion criteria included observational studies, reviews, qualitative research, protocols, and non-English publications. A comprehensive search across PubMed, EMBASE, CINAHL, Web of Science, Cochrane, and Scopus was conducted using predefined keywords and MeSH terms, with the last search completed on September 30, 2024. The risk of bias in included studies was assessed using the Cochrane Risk of Bias 2 tool. Data extraction included study characteristics, interventions, comparators, and outcomes, with meta-analyses conducted for outcomes reported in at least three RCTs using R software (vers. 4.2.2).

Results:

This systematic review included 36 RCTs from diverse geographical regions, encompassing 5606 participants. The meta-analysis showed significant improvements in the mMRC dyspnea scale (mean difference: -0.65, 95% confidence interval (CI) -1.14 to -0.16, p = .02) and 6MWT (mean difference: 25.96 m, 95% CI 10.05 to 41.87 m, p < .01) in the mHealth intervention group compared to controls. However, no significant difference was observed in the SGRQ total score (mean difference: -3.56, 95% CI -7.39 to 0.27, p = .07). Two studies reported economic results, with a possible statistically significant decrease in the mean cost per patient (€3547 vs. €4831; p = .011), but no statistically significant difference in QALYs (0.485 vs. 0.491; p = .731). Eleven studies reported clinical outcomes, showing reductions in hospital admissions, mortality rates, and exacerbation frequencies, and prolongation of the time to first readmission for COPD exacerbation. Self-efficacy as measured by the PRAISE score significantly decreased.

Conclusions:

This review supports the GOLD 2025 recommendations, highlighting mHealth as a supplementary clinical tool requiring patient education, ethical compliance, and informed consent. Further large-scale studies are needed to refine mHealth tools, ensuring accessibility, long-term safety, and effectiveness across diverse populations and outcome domains. Clinical Trial: International Prospective Register for Systematic Reviews (PROSPERO) CRD42020181157; https://www.crd.york.ac.uk/PROSPERO/view/CRD42020181157