An interventional study of Adherence to digital incentive spirometer in the postop period after major chest surgery. in Pulmonary Function, Incentive Spirometry and Patient Adherence, sponsored by University of Pennsylvania. Completed at 6 sites in United States. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-10-20.
Sponsored by University of Pennsylvania · Not applicable, Interventional, and Prevention
This single-arm proof-of-concept research study aims to assess the effect of a digital incentive spirometer (IS) device and a companion mobile-based app on incentive spirometry adherence in patients post-surgery. The digital IS utilizes a sensor to measure inspiratory breaths, and these data are transmitted wirelessly to a secure cloud database. The spirometer and app include a patient reminder system, exercise gamification strategies, progress tracking, and additional features designed to promote patient IS use.
Incentive spirometry is frequently prescribed as a standard-of-care for patients post-surgery to reduce the risk of developing postoperative pulmonary complications associated with atelectasis. An incentive spirometer (IS) is a mechanical breathing device that assists with pulmonary rehabilitation through improving lung expansion by encouraging deep breathing. While performing incentive spirometry exercises is effective at lowering atelectasis severity, ventilation time, and pulmonary complication rates, patient adherence to performing exercises is very poor. Medical staff, due to time constraints, often cannot supervise all of their patients' entire incentive spirometry regimens (usually every 10-15 min during wakeful hours), contributing to low adherence and incorrect exercise completion. This is compounded by current incentive spirometers lacking a method for accurately collecting patient exercise and adherence data. The present study seeks to evaluate the effect of a digital IS that provides instruction signals and exercise reminders on patients' incentive spirometry adherence.
This single-arm proof-of-concept research study aims to assess the effect of a digital incentive spirometer (IS) device and a companion mobile-based app on incentive spirometry adherence in patients post-surgery. The digital IS utilizes a sensor to measure inspiratory breaths, and these data are transmitted wirelessly to a secure cloud database. The spirometer and app include a patient reminder system, exercise gamification strategies, progress tracking, and additional features designed to promote patient IS use.
The objective of this study is to evaluate the effect of a digital IS that provides gentle auditory and haptic reminders and exercise guidance on patient adherence to incentive spirometry. Secondarily, this study will evaluate metrics relating to lung function to assess post-surgery lung recovery in patients using the digital IS.
114 studies on the registry are indexed under Patient Compliance; 38 are open to participants now.
This study's enrollment of 31 is below the median of 120 across 87 interventional studies indexed under Patient Compliance.
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Exclusion Criteria:
There are no exclusions based on economic status, gender, race, or ethnicity. An individual who meets any of the following criteria will be excluded from participation in this study:
This single-arm proof-of-concept research study aims to assess the effect of a digital incentive spirometer (IS) device and a companion mobile-based app on incentive spirometry adherence in patients post-surgery. The digital IS utilizes a sensor to measure inspiratory breaths, and these data are transmitted wirelessly to a secure cloud database. The spirometer and app include a patient reminder system, exercise gamification strategies, progress tracking, and additional features designed to promote patient IS use.
Device: Adherence to digital incentive spirometer in the postop period after major chest surgery.
Major chest surgery can lead to respiratory compromise and traditional breathing exercises are not supervised or monitored. The primary objective of this study is to evaluate the effect of a multifeatured digital IS and integrated phone app on patient adherence to incentive spirometry. Together the device and app will include the following functions: an auditory and haptic reminder cue, visual and auditory cues to guide exercise completion, exercise gamification, and data tracking and visualization features.
Incentive Spirometry Adherence (Breath Attempts Per Day)
Number of inspiratory breath attempts performed with the digital IS per day.
Time frame: Till discharge or up to 7 days
Incentive Spirometry Consistency (Hours Per Day With ≥1 Breath)
Number of hours in which at least one inspiratory breath was attempted using the digital IS per day.
Time frame: Till discharge or up to 7 days
Volume of Inspiratory Breaths Attempted With the Digital IS
Inspiratory volume in milliliters measured from one inhalation from the device
Time frame: Till discharge or up to 7 days
Blood Oxygen Saturation
Average postoperative SpO2 per patient. Mean is the mean across the patient cohort.
Time frame: Till discharge or up to 7 days
Pain Scores
Postoperative pain scores will be reported on a scale from 0 (no pain) to 10 (unbearable pain). These are then averaged per patient. Mean and range is reported for the entirely of the patient cohort.
Time frame: Till discharge or up to 7 days
Flow Rate of Inspiratory Breaths Attempted From the Digital IS
Flow rate over time (mL/sec) of each inspiratory breath measured from one inhalation from the device.
Time frame: Till discharge or up to 7 days
Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO)
Preoperative diffusing capacity of the lung for carbon monoxide to move from air sacs into the bloodstream as a percent of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Forced Expiratory Volume in 1 Second (FEV-1)
Preoperative forced expiration volume in 1 second as a percentage of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Forced Vital Capacity (FVC)
Preoperative forced vital capacity of the lungs as a percentage of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Vital Capacity (VC)
Preoperative vital capacity of the lungs.
Time frame: up to 2 weeks before the surgery
Residual Volume (RV)
Preoperative residual volume of the lungs as a percentage of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Total Lung Capacity (TLC)
Preoperative total lung capacity as a percentage of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Forced Expiratory Flow (FEF25-75)
Forced expiratory flow rate between 25% and 75% of the forced vital capacity, pre-bronchodilator, as a percentage of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Thoracic Gas Volume (TGV)
Total gas volume within the chest cavity when the airway is temporarily blocked as a percent of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Expiratory Reserve Volume (ERV)
Expiratory reserve volume of the lungs as a percentage of predicted value based on the person's age, sex, height, and other factors.
Time frame: up to 2 weeks before the surgery
Discharge Survey Responses - Device Engagement
Device engagement survey responses. Patients are instructed on the paper survey to "Circle how much you agree or disagree with the following statements:"
Time frame: On the day of patient discharge from the hospital, an average of 3 days
Discharge Survey Responses - Previous Incentive Spirometry
Have you used an incentive spirometer prior to this hospital stay?
Time frame: On the day of patient discharge from the hospital, an average of 3 days
Discharge Survey Responses - Exercise Completion Self-Reported Adherence
Discharge Survey Question: How much of you exercises do you think you completed?
Time frame: On the day of patient discharge from the hospital, an average of 3 days
31 patients enrolled. 30 patients completed per protocol.
| Milestone | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Started | 31 |
| Completed | 30 |
| Not completed | 1 |
| Withdrew: Withdraw by clinician decision | 1 |
Number of inspiratory breath attempts performed with the digital IS per day.
| Breath attempts | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Incentive Spirometry Adherence (Breath Attempts Per Day) | 45 (23 to 59) |
Number of hours in which at least one inspiratory breath was attempted using the digital IS per day.
| Hours | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Incentive Spirometry Consistency (Hours Per Day With ≥1 Breath) | 7.6 (5.75 to 10) |
Inspiratory volume in milliliters measured from one inhalation from the device
| milliliters | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Average postoperative volume | 1314 (403 to 2517) |
| Maximum postoperative volume | 2375 (716 to 7506) |
Average postoperative SpO2 per patient. Mean is the mean across the patient cohort.
| percentage of oxygen saturation | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Blood Oxygen Saturation | 96 (93 to 98) |
Postoperative pain scores will be reported on a scale from 0 (no pain) to 10 (unbearable pain). These are then averaged per patient. Mean and range is reported for the entirely of the patient cohort.
| units on a scale from 0 to 10 | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Pain Scores | 4 (0 to 7) |
Flow rate over time (mL/sec) of each inspiratory breath measured from one inhalation from the device.
| Milliliters per second | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Average flow rate | 186 (132 to 288) |
| Maximum flow rate | 357 (172 to 405) |
Preoperative diffusing capacity of the lung for carbon monoxide to move from air sacs into the bloodstream as a percent of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Diffusing Capacity of the Lungs for Carbon Monoxide (DLCO) | 79.0 (26.1 to 124) |
Preoperative forced expiration volume in 1 second as a percentage of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Forced Expiratory Volume in 1 Second (FEV-1) | 90.6 (21.5 to 129.3) |
Preoperative forced vital capacity of the lungs as a percentage of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Forced Vital Capacity (FVC) | 94.4 (66.3 to 135.5) |
Preoperative vital capacity of the lungs.
No measurements were reported for this outcome.
Preoperative residual volume of the lungs as a percentage of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Residual Volume (RV) | 108 (75.3 to 203.6) |
Preoperative total lung capacity as a percentage of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Total Lung Capacity (TLC) | 94.1 (74.3 to 123.0) |
Forced expiratory flow rate between 25% and 75% of the forced vital capacity, pre-bronchodilator, as a percentage of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Forced Expiratory Flow (FEF25-75) | 93.9 (8.2 to 189.3) |
Total gas volume within the chest cavity when the airway is temporarily blocked as a percent of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Thoracic Gas Volume (TGV) | 99.9 (74.7 to 155) |
Expiratory reserve volume of the lungs as a percentage of predicted value based on the person's age, sex, height, and other factors.
| percentage of predicted value | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Expiratory Reserve Volume (ERV) | 95.5 (29.8 to 166.9) |
Device engagement survey responses. Patients are instructed on the paper survey to "Circle how much you agree or disagree with the following statements:"
| Participants | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| It was easy to know when to do my exercises with my device. — Strongly Agree | 14 |
| It was easy to know when to do my exercises with my device. — Agree | 6 |
| It was easy to know when to do my exercises with my device. — Neutral | 1 |
| It was easy to know when to do my exercises with my device. — Disagree | 1 |
| It was easy to know when to do my exercises with my device. — Strongly Disagree | 0 |
| It was easy to know when to do my exercises with my device. — Incomplete | 2 |
| It was easy to know when to do my exercises with my device. — Not applicable | 0 |
| I felt motivated to do my exercises. — Strongly Agree | 7 |
| I felt motivated to do my exercises. — Agree | 10 |
| I felt motivated to do my exercises. — Neutral | 5 |
| I felt motivated to do my exercises. — Disagree | 0 |
| I felt motivated to do my exercises. — Strongly Disagree | 0 |
| I felt motivated to do my exercises. — Incomplete | 2 |
| I felt motivated to do my exercises. — Not applicable | 0 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Strongly Agree | 14 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Agree | 10 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Neutral | 0 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Disagree | 0 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Strongly Disagree | 0 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Incomplete | 0 |
| It was easy to click the button on my device to start an exercise when I wanted to. — Not applicable | 0 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Strongly Agree | 9 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Agree | 8 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Neutral | 3 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Disagree | 2 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Strongly Disagree | 1 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Incomplete | 1 |
| I liked how the device gave spoken (audio) instructions for the exercises. — Not applicable | 0 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Strongly Agree | 11 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Agree | 8 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Neutral | 2 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Disagree | 0 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Strongly Disagree | 1 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Incomplete | 2 |
| I liked how my nurse/doctor could see my breathing exercise measurements. — Not applicable | 0 |
| I was able to set up the app easily. — Strongly Agree | 6 |
| I was able to set up the app easily. — Agree | 5 |
| I was able to set up the app easily. — Neutral | 0 |
| I was able to set up the app easily. — Disagree | 0 |
| I was able to set up the app easily. — Strongly Disagree | 0 |
| I was able to set up the app easily. — Incomplete | 2 |
| I was able to set up the app easily. — Not applicable | 11 |
| I liked the app features. — Strongly Agree | 3 |
| I liked the app features. — Agree | 6 |
| I liked the app features. — Neutral | 3 |
| I liked the app features. — Disagree | 0 |
| I liked the app features. — Strongly Disagree | 0 |
| I liked the app features. — Incomplete | 2 |
| I liked the app features. — Not applicable | 10 |
Have you used an incentive spirometer prior to this hospital stay?
| Participants | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| YES | 7 |
| NO | 12 |
| Incomplete | 5 |
Discharge Survey Question: How much of you exercises do you think you completed?
| Participants | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| 0-20%, Close to none | 0 |
| 21-40%, A few of them | 2 |
| 41-60%, Around half | 7 |
| 61-80%, More than half | 9 |
| 81-100%, Almost all | 6 |
| Incomplete | 0 |
Collected over From Enrollment Until 4 Months After Discharge, up to 18 weeks. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| Single Arm Proof of Concept Study of a Digital Incentive Spirometer | 0/30 (0%) | 0/30 (0%) | 0/30 (0%) |
The baseline analysis includes age, sex, height, weight, race, and ethnicity.
| Age, Continuous(years) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Mean | 66 (33 to 84) |
| Sex: Female, Male(Participants) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Female | 17 |
| Male | 13 |
| Ethnicity (NIH/OMB)(Participants) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Hispanic or Latino | 2 |
| Not Hispanic or Latino | 28 |
| Unknown or Not Reported | 0 |
| Race (NIH/OMB)(Participants) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| American Indian or Alaska Native | 0 |
| Asian | 1 |
| Native Hawaiian or Other Pacific Islander | 0 |
| Black or African American | 6 |
| White | 22 |
| More than one race | 0 |
| Unknown or Not Reported | 1 |
| Height(inches) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Mean | 66.7 (62 to 74) |
| Weight(pounds (lbs)) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Mean | 177 (75 to 269) |
| Procedure Target Lobe(Participants) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Right Upper Lobe | 10 |
| Right Lower Lobe | 8 |
| Left Upper Lobe | 5 |
| Left Lower Lobe | 3 |
| Right Middle Lobe | 1 |
| More than one lobe | 3 |
| Preoperative Incentive Spirometry Volume(milliliters) | Single Arm Proof of Concept Study of a Digital Incentive Spirometer |
|---|---|
| Average preoperative volume | 2066 (532 to 3941) |
| Maximum preoperative volume | 2339 (915 to 4204) |
1 further baseline measures are reported on the registry.
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