Mobile health pulmonary rehabilitation for people with chronic obstructive pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of disease burden and mortality worldwide. Pulmonary rehabilitation (PR) is strongly recommended as an essential intervention that improves exercise capacity and health-related quality of life in people with COPD. However, significant barriers to access, uptake and completion of the program persist, underscoring the vital need to explore alternative, effective models of PR. Mobile health (mHealth), presents a novel mode of delivering PR that could help overcome some barriers to PR. To date, no randomised controlled trial has rigorously evaluated an mHealth PR program that included all essential components of PR. Chapter 1 is a literature review that establishes the background for this thesis. The aims of the studies presented in Chapter 2, 3 and 4 were i) to determine if mHealth PR was equivalent to centre-based PR for improvements in exercise capacity and health status in people with COPD (Chapter 2); ii) to characterise the engagement behaviour and evaluate the adherence of people with COPD to the multiple components within an mHealth PR app (Chapter 3); and iii) to determine the resource usage costs and carbon footprint of delivering an mHealth PR program to people with COPD (Chapter 4). The main findings were: i) mHealth PR could be a clinically effective option for people with COPD with at least adequate technology skills but should contain all essential and desirable components of PR (Chapter 2); ii) people with COPD can engage and adhere highly to multiple components within an mHealth PR app (Chapter 3); and iii) mHealth PR programs could be implemented into clinical practice to optimise savings in resource usage costs and GHG emissions (Chapter 4). A summary of the main findings of this thesis and the limitations, clinical implications and suggestions for future research are discussed in Chapter 5.