JMIR Publications

ABSTRACT

Background:

Chronic obstructive pulmonary disease (COPD), characterized by dyspnoea, cough, and sputum production, significantly impacts patients' quality of life and functional status. To reduce the burden on both patients and healthcare utilization indicators, it is crucial to explore more effective management strategies. These strategies should include empowering patients to actively manage their condition. Digital health interventions have the potential to positively influence health behaviors and enhance self-efficacy, encouraging greater patient engagement in their care. By fostering self-management skills and improving self-efficacy, these interventions may also mitigate the strain on healthcare services.

Objective:

This systematic review and meta-analysis aims to determine the effectiveness of digital health tools on quality of life, self-efficacy, functional outcomes, healthcare utilization indicators on COPD.

Methods:

A systematic literature review was performed using predefined key search terms in the PubMed, EMBASE, Cochrane, and Web of Science databases up to 26 January 2025, to identify eligible randomized controlled trials (RCTs) involving digital health interventions for COPD patients. Two independent reviewers screened the literature according to the eligibility criteria and extracted data from the included articles. The outcomes assessed were quality of life, self-efficacy, functional outcomes, healthcare utilization indicators.

Results:

This review included 17 studies involving 2,027 participants across 11 countries. In 11 of the trials, healthcare professionals were involved in digital health platforms usage, while 12 trials reported measures to ensure adherence to digital health interventions. Digital health tools designed for COPD patients mainly focused on two key areas: rehabilitation and self-management. The study participants were predominantly older adults. Meta-analysis results indicated that digital health interventions significantly improved quality of life at 3 months on COPD Assessment Test (CAT) (MD -1.65, 95％ CI [-3.17 to -0.14]; P = 0.03), at 6 months on CAT (MD = -2.43, 95% CI: -3.93 to -0.94; P = 0.001) and St. George's Respiratory Questionnaire (SGRQ) (MD = 3.25, 95% CI: 0.69 to 5.81; P = 0.01), at 12 months on the CAT (MD = -2.53, 95% CI: -3.91 to -1.16; P = 0.0003), EuroQol 5 Dimensions (EQ-5D) (MD = 0.04, 95% CI: 0.01 to 0.07; P = 0.02), and EuroQol 5 Dimensions Visual Analogue Scale (MD = 5.88, 95% CI: 0.38 to 11.37; P = 0.04); General Self-Efficacy Scale at 3 months (MD = 1.65, 95% CI: 0.62 to 2.69; P = 0.002) and 6 months (MD = 1.94, 95% CI: 0.83 to 3.05; P = 0.0006); and Modified Medical Research Council Dyspnea Scale over 3 months (MD = -0.23, 95% CI: -0.36 to -0.11; P = 0.0003). However, no significant differences were observed in the 6-meter walk test (6 MWT), emergency department admissions, hospital admissions, emergency department admissions for COPD or hospital admissions for COPD.

Conclusions:

Our research indicated that digital health interventions might offer potential benefits to COPD; however, their clinical effectiveness needs to be confirmed. Further studies employing robust methodologies are needed to evaluate their utility. Additionally, future research should include a greater number of older adult with COPD.