| Chronic Obstructive Pulmonary Disease(COPD),one of the most prevalent chronic diseases in China,is a complex respiratory disease characterized by progressive development of airflow limitation.Even with appropriate medical care,people with COPD experience symptoms and functional exercise capacity challenges on a daily basis,and therefore,they must engage in pulmonary rehabilitation(PR),to maintain their physical,quality of life and mental health.PR is a comprehensive non-drug intervention meant to foster self-management among people with COPD and physical exercise training is an important part of it.However,PR has not been widely used in China for its limitations,such as inadequate health delivery systems and insufficient resources.Besides,center-based PR have showed benefits in the short term but only a few studies reported sustained increase in physical.Unfortunately,how to produce and maintain such behavioral change remains a challenge.Thus,patients with COPD need a more convenient and accessible option to learn from PR and achieve better health-related outcomes.This study aimed to propose a home-based PR method delivered via mHealth technology,which could overcome the limitation of time and space factors and provide continuous physical exercise training for COPD patients at home,so as to promote patients to change their physical behavior.The main contents of this study include:(1)Firstly,we transformed the content of clinical guidelines or booklets into exercise prescriptions that can be delivered to patients at home via mHealth system.Our design of exercise prescription structure laid a foundation for the personalized customization.And then a group of behavior change technologies should be identified as the theoretical guidance for our intervention components design according to the steps of behavior change wheel method.Based on these premises we designed an intervention consisting of motivational interviews,exercise prescription designed for home-based exercise training of COPD patients,supervision/management,feedback and other support components.Finally,combining the COPD closed-loop care pathway approach proposed by our research team with the aforementioned intervention,a home-based PR pathway was constructed.(2)To achieve the goal of improving patients’ physical capability and physical activity,we designed and developed a system according to the home-based PR care pathway after two versions of iterative development,which combined a personalized patient’s app,a website and an app for healthcare professionals,and portable devices..(3)Furthermore,a 12-weeks pilot study was conducted to investigate the feasibility,acceptability,and clinical effectiveness of the intervention delivered by our system.As a result,a sample of 12 patients who completed the intervention period and after 12 weeks of training,their physical capability was significantly improved(p=0.023),disease symptoms were significantly relieved(p=0.031),and the quality of life and mental state also tended to improve.The levels of compliance remained at a high level throughout the experimental period(82.20%±1.68%)and decreased moderately and non-significantly(p=.986)at later stages.And the method and system were affirmed in the technical acceptance questionnaire(49.3/55 points)and semi-structured interviews.At the same time,through the case analysis of 4 patients,we further explored and summarized the intervention mechanism in practice,which emphasized the importance of continuous intervention.This study provided methods and technical support for popularizing sports rehabilitation and promoting patient behavior changes,and confirmed its effectiveness and usability through application evaluation. |
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