Background:Pulmonary rehabilitation improves exercise capacity, dyspnea, quality of life, and survival in patients with chronic respiratory disease. However, center-based pulmonary rehabilitation programs remain unavailable in many health care facilities due to several barriers. To address this, we developed a smartphone app that enabled individuals to perform pulmonary rehabilitation at home. Objective:We aimed to evaluate the efficacy of smartphone app-guided pulmonary rehabilitation in improving exercise capacity in individuals with chronic respiratory diseases. Methods:This was a multicenter prospective, single-blind, randomized controlled trial conducted in 2022. A total of 100 participants with chronic respiratory disease, including chronic obstructive pulmonary disease, asthma, and lung cancer, were recruited, with equal distribution (50:50) between the intervention group and the control group. The intervention group followed a 12-week app-guided rehabilitation program, while the control group received standard outpatient treatment. The primary outcome was the 6-minute walk test distance (6MWD) after the 12-week rehabilitation period. Secondary outcomes included quality of life questionnaires and health care usage. Results:Among the 100 participants included, 88 completed the follow-up visit (41 in the intervention group and 47 in the control group). Their median age was 68.0 years, and 72 (81.8%) were men. Most participants (n=70, 79.5%) had a smoking history, with a median of 40.0 pack-years. Their forced expiratory volume in 1 second was a median of 63.0% (IQR 50.5-71.5). Most participants (n=85, 96.6%) had chronic obstructive pulmonary disease. After the 12-week rehabilitation program, 6MWD was not different between the intervention and control group (median 490.0, IQR 468.8-556.3 vs 485.0, IQR 440.0-527.3 m). Assuming a clinically minimal effective change of 25 meters in 6MWD, only 7 out of 41 participants among the intervention group achieved the minimal clinically important differences after the rehabilitation program. Quality of life questionnaire scores, including the St George's Respiratory Questionnaire and Hospital Anxiety and Depression Scale, did not differ between groups. In addition, none of the participants experienced hospitalization or emergency room visits during the study period. Regarding the service satisfaction questionnaire, more than 3-quarters of the intervention group (34/41) rated their scores as ≥17/20. Conclusions:In this study, smartphone app-guided pulmonary rehabilitation failed to improve exercise capacity and quality of life in patients with chronic respiratory diseases. However, the results indicated that older adults with chronic respiratory conditions can safely use smartphone app-guided pulmonary rehabilitation. Thus, smartphone app-guided pulmonary rehabilitation may be a feasible option for older adults with chronic respiratory disease.

BackgroundPulmonary rehabilitation improves exercise capacity, dyspnea symptoms, quality of life, and even survival in patients with chronic respiratory disease. Center-based pulmonary rehabilitation programs often face barriers, and alternatives to center-based rehabilitation are urgently needed. ObjectiveThis study aimed to evaluate the clinical efficacy of smartphone app–based pulmonary rehabilitation in patients with chronic respiratory diseases, including chronic obstructive pulmonary disease, interstitial lung disease, and bronchiectasis. MethodsThis randomized controlled trial recruited 90 participants, randomly allocated into intervention (n=60) and control (n=30) groups. The intervention group received a 12-week smartphone app–based rehabilitation program, while the control group received standard outpatient care. The primary outcomes were maximal oxygen consumption via cardiopulmonary exercise test and the chronic obstructive pulmonary disease assessment test (CAT) after a 12-week period. Based on changes in quality-of-life questionnaire index scores, quality-adjusted life years were calculated, and a cost-utility analysis was conducted. A feasibility trial was also conducted in 4 community primary health care clinics. ResultsOf the 70 participants (median age 65.5 years) who completed the follow-up visits, 67 were included in the per-protocol analysis. The intervention group (n=43) showed significant improvements compared with the control group (n=24) in CAT score (median 7.0, IQR 4.0-15.0 vs median 10.0, IQR 6.5-18.5; P=.04), and International Physical Activity Questionnaire score (median 1488.0, IQR 1250.3-3027.8 vs median 1164.0, IQR 618.8-2205.0; P=.04), but not maximal oxygen consumption. Clinical outcomes showed more prominent improvements among participants who were physically active or compliant with rehabilitation programs. In the user experience survey, around 80% (35/43) of participants in the intervention group found the app easy to use, and more than 60% (27/43) reported that it helped improve dyspnea symptoms. The mean total health care costs were US $495 in the control and US $523 in the intervention group, with no notable difference in the quality-adjusted life year distribution. In the feasibility trial, 24 participants completed follow-up visits, showing a significant reduction in CAT score (median 8.5, IQR 6.0-18.0 to median 5.0, IQR 2.0-7.5; P<.001) post rehabilitation. No participants experienced disease exacerbation or musculoskeletal injury related to the rehabilitation activities. ConclusionsThe randomized controlled trial demonstrated that a smartphone-based pulmonary rehabilitation program improved clinical outcomes, including quality of life, physical activity, and dyspnea, in patients with chronic respiratory diseases. Although physically active and program-compliant participants showed significant clinical improvements, the fact that less than half of the participants demonstrated good compliance warrants more robust strategies to enhance adherence in future programs. Additionally, our feasibility trial demonstrated the potential for rehabilitation programs for older adults with chronic respiratory diseases to be implemented in primary health care settings. This approach represents a novel, scalable model bridging hospital- and community-based care, demonstrating real-world feasibility for digital rehabilitation in chronic respiratory diseases. Trial RegistrationClinicalTrials.gov NCT05610358; https://clinicaltrials.gov/ct2/show/NCT05610358

Introduction Rehabilitation is well known to improve clinical symptoms and decrease the risk of mortality in patients with chronic respiratory or cardiovascular diseases. We will evaluate the efficacy of smartphone application-based rehabilitation programmes in patients with chronic respiratory or cardiovascular diseases. Methods and analysis This single-centre single-blind randomised controlled trial will recruit a total of 162 participants from Asan Medical Center (81 patients each for pulmonary and cardiac rehabilitation, respectively). Participants will be assigned to the pulmonary or cardiac rehabilitation groups based on their underlying disease. Participants will be allocated randomly into the intervention or control groups at the ratio of 2:1 (54 and 27 patients). The intervention group will be provided with a smartphone application and undergo smartphone application-based rehabilitation for 12 weeks. The control group will receive the usual outpatient medical treatment without rehabilitation. Participants will be evaluated at baseline and at the end of the rehabilitation. The primary outcomes will be exercise capacity, such as maximal oxygen consumption on cardiopulmonary exercise test for both groups, chronic obstructive pulmonary disease assessment test for the pulmonary rehabilitation group, and Health-related Quality of Life Instrument with 8 Items questionnaires for the cardiac rehabilitation group. The secondary outcomes will include quality of life questionnaires, symptom scores, pulmonary function test and limb muscle test. Ethics and dissemination The study protocol was approved by the Institutional Review Board of Asan Medical Center. Written informed consent will be obtained from all participants prior to inclusion. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences. Trial registration number NCT05610358.

Introduction Rehabilitation is well known to improve clinical symptoms and decrease the risk of mortality in patients with chronic respiratory or cardiovascular diseases. We will evaluate the efficacy of smartphone application-based rehabilitation programmes in patients with chronic respiratory or cardiovascular diseases.Methods and analysis This single-centre single-blind randomised controlled trial will recruit a total of 162 participants from Asan Medical Center (81 patients each for pulmonary and cardiac rehabilitation, respectively). Participants will be assigned to the pulmonary or cardiac rehabilitation groups based on their underlying disease. Participants will be allocated randomly into the intervention or control groups at the ratio of 2:1 (54 and 27 patients). The intervention group will be provided with a smartphone application and undergo smartphone application-based rehabilitation for 12 weeks. The control group will receive the usual outpatient medical treatment without rehabilitation. Participants will be evaluated at baseline and at the end of the rehabilitation. The primary outcomes will be exercise capacity, such as maximal oxygen consumption on cardiopulmonary exercise test for both groups, chronic obstructive pulmonary disease assessment test for the pulmonary rehabilitation group, and Health-related Quality of Life Instrument with 8 Items questionnaires for the cardiac rehabilitation group. The secondary outcomes will include quality of life questionnaires, symptom scores, pulmonary function test and limb muscle test.Ethics and dissemination The study protocol was approved by the Institutional Review Board of Asan Medical Center. Written informed consent will be obtained from all participants prior to inclusion. The findings from this study will be disseminated through peer-reviewed scientific journals and conferences.Trial registration number NCT05610358.

Purpose: This study evaluated the effects of nutrition management application in a mobile device on obesity management of patients with breast cancer. Methods: Fifty subjects, who were breast cancer survivors, aged 30 years and older, participated in an obesity management program for four weeks. They were divided randomly into two groups: a control group (n = 25) and a treatment group (n = 25). The treatment group was provided an application for nutrition management and diet consultant, while the control group maintained their ordinary life without any nutrition management. Results: The weight of the treatment group decreased by 0.8 kg, but the change was not significant. In contrast, the waist-hip ratio of the treatment group decreased significantly from 0.75 to 0.71 (p = 0.012). The Nutrition Quotients of the treatment group increased significantly from 61.3 to 69.6 points (p < 0.001), whereas that of the control group decreased significantly from 61.5 to 59.0 (p = 0.002). Conclusion: This mobile nutrition management application for breast cancer patients is effective in managing obesity and dietary habits. These results can be used as basic information to prepare an obesity management program for breast cancer patients.

Background Advances in mobile health (mHealth) have enabled systematic and continuous management of patients with chronic diseases. Objective We developed a smartphone-based mHealth system and aimed to evaluate its effects on health behavior management and risk factor control in stroke patients. Methods With a multifaceted stroke aftercare management system that included exercise, medication, and educational materials, we performed a 12-week single-arm intervention among eligible poststroke patients in the stroke clinic from September to December 2016. The intervention consisted of (1) regular blood pressure (BP), blood glucose, and physical activity measurements; (2) stroke education; (3) an exercise program; (4) a medication program; and (5) feedback on reviewing of records by clinicians. Clinical assessments consisted of the stroke awareness score, Beck Depression Inventory-II (BDI), EuroQol-5 Dimensions (EQ-5D), and BP at visit 1 (baseline), visit 2 (4 weeks), and visit 3 (12 weeks). Temporal differences in the parameters over 12 weeks were investigated with repeated-measures analysis of variance. Changes in medication adherence at visit 1-2 (from visit 1 to visit 2) and visit 2-3 (from visit 2 to visit 3) were compared. System satisfaction was evaluated with a self-questionnaire using a 5-point Likert scale at visit 3. Results The study was approved by the Institutional Review Board in September 2016, and participants were enrolled from September to December 2016. Among the 110 patients enrolled for the study, 99 were included in our analyses. The mean stroke awareness score (baseline: 59.6 [SD 18.1]; 4 weeks: 67.6 [SD 16.0], P<.001; 12 weeks: 74.7 [SD 14.0], P<.001) and BDI score (baseline: 12.7 [SD 10.1]; 4 weeks: 11.2 [SD 10.2], P=.01; 12 weeks: 10.7 [SD 10.2], P<.001) showed gradual improvement; however, no significant differences were found in the mean EQ-5D score (baseline: 0.66 [SD 0.33]; 4 weeks: 0.69 [SD 0.34], P=.01; 12 weeks: 0.69 [SD 0.34], P<.001). Twenty-six patients who had uncontrolled BP at baseline had −13.92 mmHg (P=.001) and −6.19 mmHg (P<.001) reductions on average in systolic and diastolic BP, respectively, without any antihypertensive medication change. Medication compliance was better at visit 2-3 (60.9% [SD 37.2%]) than at visit 1-2 (47.8% [SD 38.7%], P<.001). Conclusions Awareness of stroke, depression, and BP was enhanced when using the smartphone-based mHealth system. Emerging mHealth techniques have potential as new nonpharmacological secondary prevention methods because of their ubiquitous access, near real-time responsiveness, and comparatively lower cost.

Background: Lung cancer patients experience various symptoms during treatment. Although pulmonary rehabilitation is an effective way to improve these symptoms, a medical environment of limited availability makes it difficult to provide seamless and adequate rehabilitation for lung cancer patients. Objective: This study aimed to investigate the effects of a personalized pulmonary rehabilitation program using real-time mobile patient health data for patients with non–small cell lung cancer. Methods: We conducted a prospective clinical trial in 64 patients with non–small cell lung cancer aged between 20 and 80 years at a large tertiary hospital in Seoul, South Korea. A 12-week personalized pulmonary rehabilitation program, called efil breath, was administered to determine the effectiveness of the newly developed rehabilitation app. Participants were randomly allocated to the fixed exercise or fixed-interactive exercise group (which received the personalized program). We measured changes in 6-minute walk distance (6MWD) and dyspnea (modified Medical Research Council [mMRC] score) at 6 weeks; and quality of life and service satisfaction at 12 weeks. We used the paired t test to analyze the variables. Results: Patients used the newly developed mobile health pulmonary rehabilitation app and a real-time patient monitoring website. In all participants, significant changes were observed in 6MWD at 12 weeks from a mean of 433.43m (SD 65.60) to 471.25m (SD 75.69; P=.001), and mMRC from a mean score of 0.94 (0.66) to 0.61 (SD 0.82; P=.02). The intervention significantly improved their quality of life (EuroQol-visual analog scale [EQ-VAS]) compared with baseline (mean score 76.05, SD 12.37 vs 82.09, SD 13.67, respectively; P=.002). Conclusions: A personalized mobile health–based pulmonary rehabilitation app for recording and monitoring real-time health data of patients with non–small cell lung cancer can supplement traditional health care center–based rehabilitation programs. This technology can encourage improvement of physical activity, dyspnea, and quality of life.

Background: Advanced lung cancer patients often have chronic lung disease with reduced exercise capacities and various symptoms leading to altered quality of life (QoL). No studies have assessed pulmonary rehabilitation (PR) employing a mobile app and an Internet of Things device in advanced lung cancer patients undergoing chemotherapy. Objective: This study aimed to determine the feasibility and efficacy of smartphone app-based PR on exercise capacity, symptom management, and QoL in patients with advanced lung cancer undergoing chemotherapy. Methods: A total of 100 patients were recruited in a prospective, single-arm intervention study using a smartphone app-based PR program for 12 weeks. Exercise capacity (6-min walking distance, 6MWD), QoL, symptom scale scores, and distress indexes were investigated. Results: A total of 90 patients completed the PR program. The most common cause of drop out was hospitalization because of cancer progression. After PR, there was significant improvement in the 6MWD; 380.1 m (SD 74.1) at baseline, 429.1 m (SD 58.6) at 6 weeks (P<.001), and 448.1 m (SD 50.0) at 12 weeks (P<.001). However, the dyspnea scale score showed no significant improvement in the patients overall, but there was a trend for improvement in those with a stable tumor response (P=.07). Role (P=.02), emotional (P<.001), and social functioning (P=.002) scale scores showed significant improvement after PR. Symptom scale scores for fatigue (P<.001), anorexia (P=.047), and diarrhea (P=.01) also showed significant improvement. There was significant improvement in depression (P=.048) and anxiety (P=.01), whereas there was no significant change in QoL (P=.06) and severity of pain (P=.24). Conclusions: Smartphone app-based PR represents an effective and feasible program to improve exercise capacity and to manage symptoms and distress in patients with advanced lung cancer who are undergoing chemotherapy.

BACKGROUND:Chronic obstructive pulmonary disease (COPD) is one of the major morbidities in public health, and the use of mHealth technology for rehabilitation of patients with COPD can help increase physical activity and ameliorate respiratory symptoms. OBJECTIVE:This study aimed to develop a comprehensive rehabilitation management platform to improve physical activity and quality of life in patients with COPD. METHODS:The study comprised the following 2 stages: (1) a pilot stage in which a prototype app was developed; and (2) a fully-fledged platform development stage in which 2 apps and 1 COPD patient monitoring website were developed. We conducted a randomized clinical trial to investigate the efficacy of the apps developed in the second stage of the study. In addition, two 12-week exercise regimens (fixed and fixed-interactive) were tested for the trial. The clinical parameters of the respiratory function and patient global assessment (PGA) of the app were obtained and analyzed. Notably, Android was the chosen operating system for apps. RESULTS:We developed 2 COPD rehabilitation apps and 1 patient monitoring website. For the clinical trial, 85 patients were randomized into the following 3 groups: 57 were allocated to the 2 intervention groups and 28 to the control group. After 6 weeks, the COPD assessment test scores were significantly reduced in the fixed group (P=.01), and signs of improvement were witnessed in the fixed-interactive group. In addition, the PGA score was moderate or high in all aspects of the user experience of the apps in both intervention groups. CONCLUSIONS:A well-designed mobile rehabilitation app for monitoring and managing patients with COPD can supplement or replace traditional center-based rehabilitation programs and achieve improved patient health outcomes. TRIAL REGISTRATION:ClinicalTrials.gov NCT03432117; https://clinicaltrials.gov/ct2/show/NCT03432117 (Archived by WebCite at http://www.webcitation.org/71Yp0P64a).

Background: Mobile health apps have emerged as supportive tools in the management of advanced cancers. However, only a few apps have self-monitoring features, and they are not standardized and validated. Objective: This study aimed to develop and validate a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer. Methods: The development of the multidisciplinary mobile health management system was divided into 3 steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. The app was developed to achieve 3 major clinical goals: support for quality of life, nutrition, and rehabilitation. Three main functional themes were developed to achieve clinical goals: a to-do list, health education, and in-app chat. Thirteen clinically oriented measures were included: the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire, Scored Patient-Generated Subjective Global Assessment (PG-SGA), distress, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, International Physical Activity Questionnaire-Short Form, Low anterior resection syndrome score, satisfaction rate, etc. To validate the system, a prospective observational study was conducted. Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited. We followed the subjects for 12 weeks, and selected clinical measures were taken online and offline. Results: After the development process, a multidisciplinary app, the Life Manager, was launched. For evaluation, 203 patients were recruited for the study, of whom 101 (49.8%) had gastric cancer, and 102 (50.2%) were receiving palliative care. Most patients were in their fifties (35.5%), and 128 (63.1%) were male. Overall, 176 subjects (86.7%) completed the study. Among subjects who dropped out, the most common reason was the change of patient's clinical condition (51.9%). During the study period, subjects received multiple health education sessions. For the gastric cancer group, the "general gastric cancer education" was most frequently viewed (322 times), and for the colon cancer group, the "warming-up exercise" was most viewed (340 times). Of 13 measurements taken from subjects, 9 were taken offline (response rate: 52.0% to 90.1%), and 3 were taken online (response rate: 17.6% to 57.4%). The overall satisfaction rate among subjects was favorable and ranged from 3.93 (SD 0.88) to 4.01 (SD 0.87) on the 5-point Likert scale. Conclusions: A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinically oriented measures. A prospective study was performed for its evaluation, which showed favorable satisfaction.

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It is not well known how the nonoperated contralateral hand behaves in bilateral carpal tunnel syndrome (CTS). The postoperative clinical course of the nonoperated contralateral hand in unilateral CTS is not well documented either. Of 324 CTS patients, the authors studied 37 who had carpal tunnel release on one hand only to evaluate the postoperative outcome of the nonoperated contralateral hand. The other 287 patients had operations on both hands. Seven patients were excluded because of missing data or because they could not be contacted. All 324 patients were subject to clinical and electrodiagnostic studies on both hands. The patients were divided into three groups. Group I was composed of patients who had bilateral CTS, diagnosed clinically and electrophysiologically, but who had surgery done only on the hand with the most pronounced symptoms. The patients in group II showed symptoms of CTS in one hand only. However, the opposite hand was diagnosed with subclinical CTS: Electrodiagnostic studies showed involvement of the median nerve, but without symptoms. Group III was composed of true unilateral CTS patients, diagnosed by symptoms and electrodiagnostic study. The results of the electrodiagnosis were categorized according to the severity of median nerve damage (mild, moderate, severe). The outcome and postoperative clinical course of the nonoperated contralateral hand were evaluated by electromyography and telephone survey. This method of survey was used because of the vast spread of patients throughout the country. Within 1 year, all 30 operated hands showed significant improvement, 20 of which belonged to group I. Regarding progress of the nonoperated contralateral hand, 10 patients showed improvement of one grade whereas 5 patients showed three grades of improvement. In another 5 patients there was no change whatsoever. In addition, from groups II and III there were 5 patients who showed no change in the nonoperated hand. The postoperative electromyographic findings of the nonoperated contralateral hand was not commensurate with the symptoms. However, regardless of electromyographic results, the nonoperated contralateral hand showed significant improvement (p < 0.0001). Patients with unilateral CTS did not experience any symptom development in the nonoperated contralateral hand.