Effects of Adherence to an mHealth Tool for Self-Management of COPD Exacerbations

Figures & data

Table 1 Baseline Characteristics of Adherent and Non-Adherent Users of the COPD Exacerbation mHealth Tool (n=38 Patients in Total)

	Adherent Users	Non-Adherent Users	P-value
N (%)	13 (34.2)	25 (65.8)	-
Male, n (%)	5 (38.5)	15 (60.0)	0.31
Age in years, mean (SD)	69.22 (11.16)	68.67 (7.81)	0.86
BMI, mean (SD)	29.84 (4.02)	26.20 (6.21)	0.11
Having a partner, n (%)	10 (76.9)	19 (76.0)	0.95
FEV1 post BD, mean (SD)	1.36 (0.62)	1.57 (0.71)	0.78
CCQ total score, mean (SD)	1.83 (0.94)	2.03 (1.05)	0.56
MRC dyspnea score ≥ 3, n (%)	6 (46.2)	12 (48.0)	0.74
Diagnosis COPD > 5 years, n (%)	7 (53.8)	17 (68.0)	0.49
Currently smoking, n (%)	3 (23.1)	9 (36.0)	0.49
Low educational level, n (%)	6 (46.2)	9 (36.0)	0.67
Short-acting bronchodilators, n (%)	9 (69.2)	16 (64.0)	0.75
Long-acting bronchodilators, n (%)	8 (61.5)	13 (52.0)	0.73
Inhaled corticosteroids, n (%)	3 (23.1)	1 (4)	0.11
Long-acting bronchodilators plus inhaled corticosteroids, n (%)	9 (69.2)	11 (44.0)	0.18
Number of self-reported exacerbations in 12 months prior to study, mean (SD)	3.15 (1.07)	2.96 (1.14)	0.61

Abbreviations: BMI, Body Mass Index; FEV1 post BD, Forced Expiratory Volume in one second post bronchodilator; CCQ, Clinical COPD Questionnaire; MRC, Medical Research Council.

Table 2 Effect of Adherence to the COPD Exacerbation mHealth Tool on Exacerbation-Free Weeks

	Adherent Users	Non-Adherent Users	p-value
N (%)	13 (34.2)	25 (65.8)
Follow-up weeks, mean (SD)	51.1 (5.9)	51.7 (5.2)	0.78
Number of exacerbations per patient per year, mean (SD)	3.4 (1.5)	4.7 (2.1)	0.07
Frequency of mHealth tool use during follow-up, median (range)	26 (3–250)	6 (0–17)	0.002
Number of exacerbation-free weeks, mean (SD)	31.5 (14.5)	33.5 (10.2)	0.63
Number of exacerbation-free weeks as percentage of follow-up length, mean (SD)	60.6 (28.0)	64.5 (19.7)	0.63

Table 3 Self-Management Behavior and Prompt Treatment in Adherent and Non-Adherent Users of the COPD Exacerbation mHealth Tool

	Adherent Users n=13	Non-Adherent Users n=25	OR (CI 95%)	p-value
Number of exacerbations …	44	116	–	–
… in which bronchodilator use was increased, n (%)	36 (81.8)	76 (65.5)	2.51 (0.80–7.86)	0.11
… in which bronchodilator use was increased promptly, n (%)	28 (63.6)	58 (50)	1.76 (0.66–4.70)	0.26
… in which healthcare professional was contacted, n (%)	16 (36.4)	32 (27.6)	1.60 (0.62–4.11)	0.33
… … in which healthcare professional was contacted promptly, n (%)	6 (13.6)	16 (13.8)	1.03 (0.31–3.44)	0.96
… in which a course of prednisolone and/or antibiotics was used, n (%)	19 (43.2)	30 (25.9)	2.36 (0.73–7.59)	0.15
… in which a course of prednisolone and/or antibiotics was used promptly, n (%)	10 (22.7)	12 (10.3)	2.91 (0.65–13.12)	0.16

Table 4 Differences in Scores on Self-Efficacy and Stages of Grief Between Adherent and Non-Adherent Users of the COPD Exacerbation mHealth Tool

	Adherent Users, n=13	Non-Adherent Users, n=25	p-value
Self-efficacy^a, mean (SD)	3.03 (0.43)	2.89 (0.39)	0.34
Denial^b, mean (SD)	2.17 (0.63)	2.33 (0.78)	0.54
Resistance^b, mean (SD)	1.56 (0.64)	1.81 (0.75)	0.32
Sorrow^b, mean (SD)	1.33 (0.33)	1.44 (0.56)	0.53
Acceptance^b, mean (SD)	3.06 (0.79)	2.6 (0.86)	0.12

Notes: ^aSelf-efficacy was measured with an exacerbation-related self-efficacy scale containing 5 questions on a 4-point Likert scale. A higher total score means a higher level of self-efficacy.^bDenial, resistance, sorrow, and acceptance were measured with the Acceptance of Disease and Impairments Questionnaire (ADIQ), which includes 14 questions on a 4-point Likert scale. A higher score on a subdomain means a higher presence of that specific stage of grief.