Effectiveness of a pulmonary rehabilitation (m-PRTM) program using mobile health (mHealth) technologies in people with chronic lung disease.

Abstract

Introduction/Aim: Mobile health (mHealth) pulmonary rehabilitation (PR) is a novel model of care that may help overcome access barriers. Aim: to determine if mHealth PR was equivalent to centre-based PR in improving exercise capacity and health status in people with chronic obstructive pulmonary disease (COPD).   Methods: Single-blinded, multicentre, randomised controlled equivalence trial. Participants were randomised to eight weeks of home-based PR using a smartphone app (m-PR), or centre-based PR (CBPR). Co-primary outcomes, measured at baseline and end-intervention, were change in six-minute walk distance (6MWD) and COPD assessment test (CAT) score, with equivalence margins set at ¬± 25m and ¬± 2 points respectively. Adherence and adverse events (AE) were compared between groups.   Results: 90 participants were randomised (mean¬±SD: age 75¬±7 years, FEV1 57¬±14% predicted), with 38 m-PR and 42 CBPR participants in the intention-to-treat analysis. There was a significant between group difference in CAT scores (mean difference [MD] -4.9 points, 95% confidence interval [CI] -6.8 to -3.0), with upper and lower limits of the CI exceeding equivalence margins, indicating superiority of m-PR. There were no between group differences in 6MWD (MD 13m, 95% CI -3 to 28), however superiority of the m-PR group could not be excluded. Participants had high adherence to both interventions (session adherence: 86% m-PR vs 87% CBPR), with no serious AE.   Conclusion: An mHealth app (m-PRTM) providing PR was safe and resulted in equivalent improvements in exercise capacity and superior improvements in health status in people with COPD. Digitally enabled PR could be an alternative to centre-based PR.