JMIR Publications

ABSTRACT

Background:

Pulmonary rehabilitation improves exercise capacity, dyspnea symptoms, quality of life, and even survival in patients with chronic respiratory disease. Unfortunately, center-based pulmonary rehabilitation programs often face barriers and alternatives to center-based rehabilitation are urgently needed.

Objective:

We aimed to evaluate clinical efficacies of smartphone application-based pulmonary rehabilitation in patients with chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), interstitial lung disease, and bronchiectasis.

Methods:

This randomized controlled trial recruited 90 participants, randomly allocated into intervention (n = 60) and control (n = 30) groups. The intervention group received a 12-week smartphone application-based rehabilitation program, while the control group received standard outpatient care. The primary outcomes were maximal oxygen consumption via cardiopulmonary exercise test and the COPD assessment test (CAT) after 12 weeks period. Based on changes in quality-of-life questionnaire index scores, quality-adjusted life years (QALYs) were calculated, and a cost-utility analysis was conducted. A feasibility trial was also conducted in four community primary healthcare clinics.

Results:

Of the 70 participants (median age 65.0 years) who completed the follow-up visits, the intervention group (n = 43) showed significant improvements compared to the control group in CAT score (median 7.0, interquartile range [IQR, 4.0–15.0] vs. median 10.0, IQR [6.5–18.5], P = 0.039), and International Physical Activity Questionnaire score (median 1488.0, IQR [1250.3–3027.8] vs. median 1164.0, IQR [618.8–2205.0], P = 0.037), but not maximal oxygen consumption. Clinical outcomes showed more prominent improvements among participants who were physically active or compliant to rehabilitation programs. In the user experience survey, around 80% of participants in the intervention group found the application easy to use, and more than 60% reported that it helped improve dyspnea symptoms. The mean total healthcare costs were 495 USD in the control and 523 USD in the intervention group, with no notable difference in the QALY distribution. In the feasibility trial, 24 participants completed follow-up visits, showing a significant reduction in CAT score (median 8.5, IQR [6.0–18.0] to median 5.0, IQR [2.0–7.5], P < 0.001) post-rehabilitation. No participants experienced disease exacerbation or musculoskeletal injury related to the rehabilitation activities.

Conclusions:

The smartphone-based pulmonary rehabilitation program improved clinical outcomes, including quality of life, physical activity, and dyspnea, in patients with chronic respiratory diseases. Although physically active and program-compliant participants showed significant clinical improvements, the fact that less than half of participants demonstrated good compliance warrants more robust strategies to enhance adherence in future programs. This study provided a comprehensive approach to smartphone-based rehabilitation, along with a cost-utility analysis. Additionally, while our study demonstrated the potential for rehabilitation programs for older adults with chronic respiratory diseases to be implemented in primary healthcare settings, further research and development will be necessary to achieve this in practice. Clinical Trial: This study is registered in the ClinicalTrials.gov (NCT05610358, https://clinicaltrials.gov/ct2/show/NCT05610358).