Clinical Efficacy of Mobile App–Based, Self-Directed Pulmonary Rehabilitation for Patients With Chronic Obstructive Pulmonary Disease: Systematic Review and Meta-Analysis
Authors: Chung Chiwook , Lee Jong Won , Lee Sei Won , Jo Min-Woo 
Published: January 2024

Abstract

Background
Pulmonary rehabilitation is well known to improve clinical symptoms (including dyspnea), quality of life, and exercise capacity in patients with chronic obstructive pulmonary disease (COPD). However, researchers have reported difficulties in practicing center-based pulmonary rehabilitation. Recently, mobile app–based pulmonary rehabilitation has become available in clinical practice. We investigated the clinical outcomes of mobile app–based pulmonary rehabilitation in patients with COPD.

Objective
The objective of our study was to evaluate the clinical efficacy of mobile app–based pulmonary rehabilitation versus conventional center-based pulmonary rehabilitation for patients with COPD, using a systematic review and meta-analysis.

Methods
A systematic search of the literature published between January 2007 and June 2023 was performed, using the PubMed, Embase, Cochrane, and CINAHL databases to identify relevant randomized controlled trials involving patients with COPD. Pulmonary rehabilitation programs needed to provide an exercise program on a smartphone app. Study outcomes, including exercise capacity, symptom scores, quality of life, and hospitalization, were evaluated. The meta-analysis evaluated mean differences in 6-minute walk test distances (6MWDs), COPD Assessment Test (CAT) scores, modified Medical Research Council (mMRC) dyspnea scale scores, St. George Respiratory Questionnaire (SGRQ) scores, and risk ratios for hospitalization resulting from disease exacerbation.

Results
Of the 1173 screened studies, 10 were included in the systematic review and 9 were included in the meta-analysis. Further, 6 studies were multicenter studies. There were a total of 1050 participants, and most were aged ≥65 years. There were discrepancies in the baseline participant characteristics, smartphone apps, interventions, and study outcomes among the included studies. In the meta-analysis, 5 studies assessed 6MWDs (mean difference 9.52, 95% CI −3.05 to 22.08 m), 6 studies assessed CAT scores (mean difference −1.29, 95% CI −2.39 to −0.20), 3 studies assessed mMRC dyspnea scale scores (mean difference −0.08, 95% CI −0.29 to 0.13), 2 studies assessed SGRQ scores (mean difference −3.62, 95% CI −9.62 to 2.38), and 3 studies assessed hospitalization resulting from disease exacerbation (risk ratio 0.65, 95% CI 0.27-1.53). These clinical parameters generally favored mobile app–based pulmonary rehabilitation; however, a statistically significant difference was noted only for the CAT scores (P=.02).

Conclusions
Despite some discrepancies in the baseline participant characteristics and interventions among studies, mobile app–based pulmonary rehabilitation resulted in favorable exercise capacity, symptom score, quality of life, and hospitalization outcomes when compared with conventional pulmonary rehabilitation. In the meta-analysis, the CAT scores of the mobile app–based pulmonary rehabilitation group were significantly lower than those of the control group (P=.02). In real-world practice, mobile app–based pulmonary rehabilitation can be a useful treatment option when conventional center-based pulmonary rehabilitation is not feasible.