Development, usability testing, and feasibility of telerehabilitation system, including the Mhealth and SMART OPEP in Chronic Obstructive Pulmonary Disorders (COPD)

Abstract

Pulmonary rehabilitation (PR) for patients with COPD effectively improves treatment outcomes (TOMs). However, it is challenged worldwide and in Malaysia by underdiagnosis, underrecognition, and underdevelopment. The advantages of telerehabilitation (TR) programs would provide solutions to these challenges. In this project, we aimed to develop and evaluate a TR system for patients with COPD in Malaysia and evaluate the potential of integrating it into clinical practice. A need assessment study was conducted to explore the PR and PTR requirements for patients with COPD and respiratory physiotherapy in low- and middle-income countries (LMICs). Review studies were carried out to identify the roadmaps for designing and evaluating TR systems for chronic diseases that improve TOMs. We deployed the usercentered design (UCD), IPO framework, STEERING model, Lung Foundation Australia Guideline, and multimedia learning to develop the ChestCare mHealth app and its education module. Thereafter, we conducted iterative convergent usability mixed-methods research to evaluate the app’s effectiveness, efficiency, user satisfaction, and quality. Finally, we conducted a feasibility piloting study to identify the possibilities of integrating the TR system within the healthcare system. The study of needs revealed the sequential COPD triad (CST), which lists three levels of factors influencing the launching of TR programs in LMICs; national, institutional, and professional factors. The literature review showed the input-process-output (IPO) framework for designing and testing the usability of TR systems and identified the STEERING model for developing effective TR systems to improve TOMs. The UCD and other models were deployed to develop the ChestCare mHealth app and its selfmanagement education (SME) module, which were tested for usability and feasibility in moderated laboratory and unmoderated home environments. The TR system was enhanced accordingly, and the possibilities of implementing it within the healthcare system were explored. Here, we highlighted the roadmap for launching the TR system for COPD through five phases of research: need assessment, identification of frameworks for effective TR system design and evaluation, TR development, usability, and feasibility testing. This roadmap will benefit patients, healthcare professionals, and researchers. Integrating the TR system into the Malaysian public healthcare system would facilitate the delivery of PR programs for patients with COPD.