1
|
Yanaz M, Yilmaz Yegit C, Gulieva A, Kalyoncu M, Selcuk M, Uzunoglu B, Tastan G, Ergenekon AP, Gokdemir Y, Erdem Eralp E, Karakoc F, Karadag B. Electronic home monitoring of children with cystic fibrosis to detect and treat acute pulmonary exacerbations and its effect on 1-year FEV 1. J Cyst Fibros 2024; 23:329-333. [PMID: 37748990 DOI: 10.1016/j.jcf.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/29/2023] [Accepted: 09/13/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND We aimed to investigate the effect of the use of electronic home spirometry in children with cystic fibrosis (CF) on 1-year FEV1 (% predicted, pp) change. METHODS This is a randomised, one-year prospective study including children with CF between 6 and 18 years of age. Subjects were randomised into home spirometry group (HSG) and usual care group (UCG). Children in HSG performed two pulmonary function tests (PFT) per week. Data regarding acute pulmonary exacerbations (PEx) was obtained from patients' records. At baseline and 12th month, health related quality of life questionnaire for CF patients (CFQ-R) and lung clearance index (LCI) were performed. RESULTS Sixty children were recruited with a median (IQR) age of 13.3 (11.4-15.4) years. Absolute change in FEV1pp from baseline to 12th month as median (IQR) was +1% (-6.75-9.75) in HSG and -2.50% (-7.50-3.25) in UCG (p = 0.10). Sensitivity analysis including only adherent children in HSG (n = 22), yielded an increase of 5% (-3.50-12) in HSG and a decrease of 2.50% (-7.50-3.25) in UCG (p = 0.009). A total of 29 (96.7%) subjects in HSG and 23 (76.7%) in UCG had PEx (p = 0.05). Absolute change in median (IQR) LCI2.5 from baseline to the 12th month was -1.6 [-2.9-0] (p<0.001) in HSG and -1.5 [-2.8-(-0.6)] (p<0.001) in UCG (p = 0.94). There was a significant increase in the social domain of the CFQ-R in HSG (from 59.1 to 76.2, p = 0.01). CONCLUSIONS Electronic home monitoring of children with CF by spirometry may result in improvement in lung function.
Collapse
Affiliation(s)
- Muruvvet Yanaz
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey.
| | - Cansu Yilmaz Yegit
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Aynur Gulieva
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Mine Kalyoncu
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Merve Selcuk
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Burcu Uzunoglu
- Selim Coremen Cystic Fibrosis Center, Marmara University School of Medicine, Istanbul, Turkey
| | - Gamze Tastan
- Selim Coremen Cystic Fibrosis Center, Marmara University School of Medicine, Istanbul, Turkey
| | - Almala Pinar Ergenekon
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Yasemin Gokdemir
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Ela Erdem Eralp
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Fazilet Karakoc
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| | - Bulent Karadag
- Division of Pediatric Pulmonology, Marmara University School of Medicine, Fevzi Çakmak mahallesi, Muhsin Yazıcıoğlu caddesi, No:10, Pendik, Istanbul 34899, Turkey
| |
Collapse
|
2
|
Morsa M, Perrin A, David V, Rault G, Le Roux E, Alberti C, Gagnayre R, Pougheon Bertrand D. Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research. JMIR Form Res 2024; 8:e38064. [PMID: 38261372 PMCID: PMC10848132 DOI: 10.2196/38064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/01/2022] [Accepted: 10/25/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. OBJECTIVE This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users' point of view to detect PEx early and treat it. This study focused on the patients' experiences as the first and main users of home monitoring. METHODS A qualitative study was conducted to explore patients' and professionals' experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. RESULTS A total of 20 patients completed the study. Three main categories emerged from the patients' verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients' learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. CONCLUSIONS We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. TRIAL REGISTRATION ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028.
Collapse
Affiliation(s)
- Maxime Morsa
- Adaptation, Resilience and Change Research Unit, University of Liège, Liège, Belgium
- Laboratory Health Promotion and Education (UR3412), Sorbonne Paris North University, Bobigny, France
| | - Amélie Perrin
- Paediatrics CF Centre, Nantes University Hospital, Nantes, France
| | - Valérie David
- Paediatrics CF Centre, Nantes University Hospital, Nantes, France
| | - Gilles Rault
- Laboratoire Educations et Pormotion de la santé, Université Sorbonne Paris Nord, Bobigny, France
| | - Enora Le Roux
- Institut National de la Santé et de la Recherche Médicale (UMR 1123 ECEVE), Université de Paris, Paris, France
- Unit of Clinical Epidemiology (CIC-EC 1426), Hôpital Universitaire Robert Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Corinne Alberti
- Institut National de la Santé et de la Recherche Médicale (UMR 1123 ECEVE), Université de Paris, Paris, France
- Unit of Clinical Epidemiology (CIC-EC 1426), Hôpital Universitaire Robert Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Rémi Gagnayre
- Laboratory Health Promotion and Education (UR3412), Sorbonne Paris North University, Bobigny, France
| | | |
Collapse
|
3
|
Blamires J, Dickinson A, Byrnes CA, Tautolo ES. Sore and tired. A qualitative study exploring the symptom experience of youth with bronchiectasis. J Child Health Care 2023; 27:587-598. [PMID: 35379016 DOI: 10.1177/13674935221082437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This qualitative study was conducted to explore the experiences of youth living with bronchiectasis in New Zealand (NZ). Semi-structured interviews were conducted with youth with bronchiectasis. Key themes were identified using an inductive approach through constant comparative analysis and guided by Thorne's interpretive description (ID). Fifteen young people of mixed ethnicity (nine females and six males) aged between 13 and 23 years participated. Three key themes 'sore and tired', 'life interrupted and 'looking after self' were identified. This paper will focus on 'sore and tired' and its three subthemes which describe the participants symptom experience. While there was variability in physical symptom patterns, cough, soreness and fatigue were prominent features impacting physical, emotional and social aspects of day-to-day life. All identified pervasive and profound fatigue as significant. The identification of prodromal symptoms provides opportunity for greater appreciation of the varied and personal symptom experience of young people with bronchiectasis. Early identification of these symptoms and inclusion within management plans for escalating treatment has the potential to improve outcomes, reducing delays in seeking additional medical management and preventing further exacerbation.
Collapse
Affiliation(s)
- Julie Blamires
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Annette Dickinson
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Catherine A Byrnes
- Department of Paediatrics, Child and Youth Health, Faculty of Health & Medical Sciences, University of Auckland, Auckland, New Zealand
| | - El Shadan Tautolo
- School of Public Health & Interdisciplinary Studies. Director - AUT Pacific Health Research Centre, Auckland University of Technology, Auckland, New Zealand
| |
Collapse
|
4
|
Oates GR, Mims C, Geurs R, Bergquist R, Hager A, Guimbellot JS, Hartzes AM, Gutierrez HH. Mobile health platform for self-management of pediatric cystic fibrosis: Impact on patient-centered care outcomes. J Cyst Fibros 2023; 22:823-829. [PMID: 37085386 DOI: 10.1016/j.jcf.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/29/2023] [Accepted: 04/15/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND Previously, we adapted a mobile health platform (Genia) to the needs of patients and families in a pediatric CF center in the United States. In this feasibility study, we tested the impact of Genia on measures of patient-centered care. METHODS In a one-group pre-post study with adolescents with CF and caregivers of children with CF, we tested Genia's effect over 6 months on patient satisfaction with chronic illness care (PACIC) and shared decision-making (CollaboRate). Feasibility and acceptability were assessed with exit interviews and app analytics. RESULTS The intervention included 40 participants: 30 caregivers of children with CF age ≤14 years and 10 patients with CF age ≥15 years. The use of Genia was associated with increased satisfaction with care (p = 0.024), including delivery system and decision support (p = 0.017), goal setting (p = 0.006), and shared decision-making (p<0.001). The use of Genia was associated with nominal improvements in all QOL domains and symptom scales. The platform was feasible, with participants recording more than 4,400 observations (mean 84.2) and submitting 496 weekly reports (mean 13.8) and 70 quarterly reports (mean 1.8), and acceptable (95% retention rate). For participants, the most useful app feature was pre-visit reports (66.7%), and the top symptom trackers were those for cough (23.7%), appetite (21.1%), energy (18.4%), and medicines (18.4%). CONCLUSION The use of Genia over 6 months was feasible, acceptable, and associated with improved measures of patient-centered care. Study results support wider use of Genia in clinical settings. Efficacy for clinical outcomes should be assessed in a randomized clinical trial.
Collapse
Affiliation(s)
- Gabriela R Oates
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Cathy Mims
- Children's of Alabama, Birmingham, AL, USA
| | - Robin Geurs
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rikard Bergquist
- Motivo Management, LLC, Reno, NV, USA; Upstream Dream AB, Stockholm, Sweden
| | | | - Jennifer S Guimbellot
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anastasia M Hartzes
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hector H Gutierrez
- Pediatric Pulmonary and Sleep Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
5
|
Fainardi V, Capoferri G, Tornesello M, Pisi G, Esposito S. Telemedicine and Its Application in Cystic Fibrosis. J Pers Med 2023; 13:1041. [PMID: 37511654 PMCID: PMC10381340 DOI: 10.3390/jpm13071041] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The care of cystic fibrosis (CF) traditionally consists of regular visits to the clinic where a multidisciplinary team can visit the patient, adjust treatments and monitor the disease. During the COVID-19 pandemic when access to hospitals and medical environments was very limited, the role of telemedicine was crucial to keep in touch with patients with chronic diseases such as CF. Increasing evidence demonstrates that electronic health can successfully support healthcare professionals in the management of people with CF. The use of devices connected to digital platforms or smartphones results in a continuous flow of data that can be shared with the clinician and the team in order to improve the knowledge of patients' diseases and the level of care needed. This narrative review aims to describe the application of telemedicine in CF disease with pros and cons. A literature analysis showed that telemedicine has several advantages in the management of patients with CF. With the evolving support of digital technology, telemedicine can promote clinical visits, adherence to daily treatment, including respiratory physiotherapy and physical exercise, early identification of pulmonary exacerbations and management of psychological issues. The main disadvantages are missed physical exam findings, lack of physical contact that can prevent conversation on sensitive topics, lack of access to technology and lack of technological skills. Furthermore, healthcare operators need appropriate training for telemedicine systems and need time to organise and analyse data generated remotely, which may increase the burden of daily work. Hybrid personalised care models that marge telemedicine and traditional care can be an ideal solution.
Collapse
Affiliation(s)
- Valentina Fainardi
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Gaia Capoferri
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Marco Tornesello
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Giovanna Pisi
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| | - Susanna Esposito
- Cystic Fibrosis Unit, Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
| |
Collapse
|
6
|
Vagg T, Deasy KF, Chapman WW, Ranganathan SC, Plant BJ, Shanthikumar S. Virtual monitoring in CF - the importance of continuous monitoring in a multi-organ chronic condition. Front Digit Health 2023; 5:1196442. [PMID: 37214343 PMCID: PMC10192704 DOI: 10.3389/fdgth.2023.1196442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023] Open
Abstract
Cystic Fibrosis (CF) is a chronic life-limiting condition that affects multiple organs within the body. Patients must adhere to strict medication regimens, physiotherapy, diet, and attend regular clinic appointments to manage their condition effectively. This necessary but burdensome requirement has prompted investigations into how different digital health technologies can enhance current care by providing the opportunity to virtually monitor patients. This review explores how virtual monitoring has been harnessed for assessment or performance of physiotherapy/exercise, diet/nutrition, symptom monitoring, medication adherence, and wellbeing/mental-health in people with CF. This review will also briefly discuss the potential future of CF virtual monitoring and some common barriers to its current adoption and implementation within CF. Due to the multifaceted nature of CF, it is anticipated that this review will be relevant to not only the CF community, but also those investigating and developing digital health solutions for the management of other chronic diseases.
Collapse
Affiliation(s)
- Tamara Vagg
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Kevin F. Deasy
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Wendy W. Chapman
- The Centre for Digital Transformation of Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sarath C. Ranganathan
- Respiratoryand Sleep Medicine Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Respiratory Diseases Research, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Barry J. Plant
- Cork Centre for Cystic Fibrosis (3CF), Cork University Hospital, Cork, Ireland
- HRB Clinical Research Facility Cork, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Shivanthan Shanthikumar
- Respiratoryand Sleep Medicine Department, Royal Children’s Hospital, Melbourne, VIC, Australia
- Respiratory Diseases Research, Murdoch Children’s Research Institute, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
7
|
Wong CH, Smith S, Kansra S. Digital technology for early identification of exacerbations in people with cystic fibrosis. Cochrane Database Syst Rev 2023; 4:CD014606. [PMID: 37057835 PMCID: PMC10103544 DOI: 10.1002/14651858.cd014606.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Cystic fibrosis (CF) is a life-limiting genetic condition affecting various organ systems including the gastrointestinal tract, endocrine system and especially the respiratory tract. Pulmonary exacerbations in CF result in increased symptoms, an acceleration in the rate of lung decline and an increased need for treatment. Early detection of infections or clinical worsening provides an opportunity for proactive treatment that may affect clinical outcomes. OBJECTIVES To evaluate whether digital technology can effectively predict pulmonary exacerbations to allow earlier intervention and improved health outcomes without increasing the burden of treatment in people with CF. SEARCH METHODS We used standard, extensive Cochrane search methods. We searched the Cochrane Cystic Fibrosis Trials Register and the reference lists of relevant articles and reviews on 13 October 2022. We searched Embase and the clinical trial registries on 3 January 2023. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs in people with CF looking at whether digital technology can effectively predict pulmonary exacerbations to allow earlier intervention and improved health outcomes without increasing the burden of treatment. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were 1. pulmonary exacerbations and 2. quality of life (QoL). Our secondary outcomes were 3. lung function, 4. hospitalisations, 5. intravenous (IV) antibiotics, 6. microbiology, 7. cost-effectiveness and 8. ADVERSE EVENTS We used GRADE to assess certainty of evidence. MAIN RESULTS We included three studies (415 participants) in people with CF aged 15 to 41 years over a 12-month period. One was a multicentre RCT, whilst two were single-centre RCTs. The three studies were mostly similar in their risk of bias, having low or unclear risk of selection bias but a high risk of detection bias, due to the unblinded design of these studies. The studies used a variety of digital technologies to monitor symptoms such as a digital symptom diary either with or without home spirometry monitoring. As the trials only included adults and older children, we are not certain that the results would apply to younger children. One of our primary outcomes was to assess time to detection of pulmonary exacerbation and number of pulmonary exacerbations identified between the intervention and routine care groups. We were largely unable to pool results in a meta-analysis due to the variety of methodologies and ways of reporting data. Two studies noted a shorter time to detection of exacerbations in the intervention group and one of these also reported that the intervention group had a shorter time to first exacerbation (hazard ratio for time to first exacerbation 1.45, 95% confidence interval (CI) 1.09 to 1.93), whilst a further study reported a shorter time to detection of exacerbations in the intervention group requiring oral or IV antibiotics compared to the control group (median: 70 (interquartile range (IQR) 123) days with intervention versus 141 (IQR 140) days with control; P = 0.02). However, all three studies were concordant in finding no probable effect on spirometry in the intervention groups when compared with their routine care groups over a 12-month period. We found that there is probably no difference between groups with regard to QoL scores across most domains except for Weight and Body Image, which favoured the usual care group. There is also probably no difference in the number of days of additional IV antibiotics needed or newly detected pathogens. No studies reported serious adverse events directly linked to the intervention and one study reported their smartphone application was generally well received. AUTHORS' CONCLUSIONS Pulmonary exacerbations are universally accepted to be detrimental to progression of CF-related lung disease, therefore, it is intuitive that early detection and intervention would help to improve outcomes. Digital technology provides an opportunity to detect physiological and symptomatic changes to identify exacerbations early. Our review found that digital technologies based on recording physiological change (spirometry) and symptoms probably allow earlier identification of exacerbations as a group. However, this may not reduce the number of exacerbations warranting IV antibiotics and there is probably no effect on lung function. This may be partly due to inconsistent definitions of pulmonary exacerbations and discrepancy in the management strategies for pulmonary exacerbations. Overall, the intervention may make little or no difference to QoL scores. The adherence to and uptake of digital technologies, especially those which include physiological measurements, are not well sustained and the costs of these need to be balanced against the clinical efficacy.
Collapse
Affiliation(s)
- Chu-Hai Wong
- Department of Paediatric Respiratory Medicine, Sheffield Children's Hospital NHS Trust, Sheffield, UK
| | - Sherie Smith
- Division of Child Health, Obstetrics & Gynaecology (COG), School of Medicine, University of Nottingham, Nottingham, UK
| | - Sonal Kansra
- Department of Paediatric Respiratory Medicine, Sheffield Children's Hospital NHS Trust, Sheffield, UK
| |
Collapse
|
8
|
Nash EF, Choyce J, Carrolan V, Justice E, Shaw KL, Sitch A, Mistry H, Whitehouse JL. A prospective randomised controlled mixed-methods pilot study of home monitoring in adults with cystic fibrosis. Ther Adv Respir Dis 2022; 16:17534666211070133. [PMID: 35274585 PMCID: PMC8921750 DOI: 10.1177/17534666211070133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/02/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Home monitoring (HM) is able to detect more pulmonary exacerbations (PEx) than routine care (RC) in individuals with cystic fibrosis (CF), but there is currently no evidence for benefits in health outcomes. Patient experiences of using HM and a health economics assessment have not been rigorously assessed to date. This study aimed to assess the effects of HM on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience. METHODS This randomised controlled mixed-methods pilot study recruited CF adults cared for in one large regional CF centre. Participants were randomly allocated 1:1 to the intervention cohort [twice-weekly HM of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and forced expiratory volume in one second (FEV1)] or a control cohort (routine clinical care) for the 12-month study period. Measurements were recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, comorbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous) and PEx (defined by the modified Fuchs criteria) were recorded at each study visit. Health status, capability and cost-effectiveness were measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience of HM was assessed by semi-structured qualitative interviews at baseline and 12 months. RESULTS Eighty-eight participants were recruited, with 44 (50%) randomised to receive HM and 44 (50%) randomised to receive RC. Patient hospital inpatient bed days per annum and overall health-related quality of life were similar between the groups. Protocol-defined PEx requiring intravenous and oral antibiotics were detected more frequently in the HM group, with no other differences between the groups in the secondary outcomes. The total mean National Health Service (NHS) costs were approximately £1500 more per patient for the RC arm than the HM group. The qualitative analysis demonstrated that the patient experience of HM was generally positive and overall the intervention was well accepted. CONCLUSION The findings of this trial confirm that HM is effective in detecting PEx in adults with CF. There were no significant differences in hospital inpatient bed days and overall health-related quality of life between the groups. Despite the cost of the HM equipment and the salary of the research fellow to respond to the results, health economics analysis suggests the intervention was less expensive than RC. HM was generally well accepted, with most participants reporting that it resulted in them feeling more empowered and reassured. TRIAL REGISTRATION The study protocol was registered with Clinicaltrials.gov (NCT02994706) on 16 July 2014 and published in a peer reviewed journal.Data from this trial has been presented in abstract form at the ECFS Conference in Lyon in September 2020.
Collapse
Affiliation(s)
- Edward F. Nash
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Bordesley Green East, Birmingham B9 5SS, UK
| | - Jocelyn Choyce
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Victoria Carrolan
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edwin Justice
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Karen L. Shaw
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Hema Mistry
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Joanna L. Whitehouse
- West Midlands Adult CF Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
9
|
Desimone ME, Sherwood J, Soltman SC, Moran A. Telemedicine in cystic fibrosis. J Clin Transl Endocrinol 2021; 26:100270. [PMID: 34765457 PMCID: PMC8571077 DOI: 10.1016/j.jcte.2021.100270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 02/08/2023] Open
Abstract
Cystic Fibrosis (CF) requires lifetime multidisciplinary care to manage both pulmonary and extra pulmonary manifestations. The median age of survival for people with CF is rising and the number of adults with CF is expected to increase dramatically over the coming years. People with CF have better outcomes when managed in specialty centers, however access can be limited. Telemedicine and technology-based care solutions may help to overcome barriers to availability and improve access. This review outlines the use of telehealth for CF management. Telehealth has been utilized for CF across a broad variety of indications, even prior to the COVID-19 pandemic, and in general has been well accepted by patients and providers. There are a paucity of data, however, related to health outcomes, and the healthcare utilization specific to CF and its related comorbidities. Future studies are needed to address the questions of health outcomes, cost, burdens of telehealth and barriers to implementation.
Collapse
Affiliation(s)
- Marisa E. Desimone
- Division of Endocrinology, Diabetes and Metabolism, State University of New York at Upstate Medical University 750 East Adams Street, Syracuse, NY 13210, USA
| | - Jordan Sherwood
- Division of Pediatric Endocrinology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sarah C. Soltman
- Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, 3270 SW Pavilion Loop, Portland, OR 97239, USA
| | - Antoinette Moran
- Division of Pediatric Endocrinology, University of Minnesota, 2512 S 7th Street, Minneapolis, MN 55454, USA
| |
Collapse
|
10
|
Morsa M, Perrin A, David V, Rault G, Le Roux E, Alberti C, Gagnayre R, Pougheon Bertrand D. Use of Home-Based Connected Devices in Patients With Cystic Fibrosis for the Early Detection and Treatment of Pulmonary Exacerbations: Protocol for a Qualitative Study. JMIR Res Protoc 2021; 10:e14552. [PMID: 34406124 PMCID: PMC8411325 DOI: 10.2196/14552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 02/11/2021] [Accepted: 03/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis (CF) is important to quickly trigger treatment and reduce respiratory damage. We hypothesized that using home-based and wearable connected devices (CDs) and educating patients to react in case of abnormal variations in a set of parameters would allow patients to detect and manage their PEx early with their care team. OBJECTIVE This qualitative study aimed to assess the feasibility and appropriate conditions of a new PEx management process from the users' point of view by analyzing the experience of patients and of CF center teams regarding the education program, the use of CDs, and the relationship between the patient and the care team during PEx management. METHODS We have been conducting a multicenter pilot study involving 36 patients with CF aged ≥12 years. The intervention was divided into 3 phases. In phase 1 (3 months), patients were equipped with CDs, and their parameters were collected on 3 nonconsecutive days each week. Phase 2 involved the development of a "React to PEx" educational program aimed at providing patients with a personalized action plan. A training session to the educational program was organized for the physicians. Physicians then determined the patients' personalized alert thresholds by reviewing the data collected during phase 1 and their patients' clinical history. In phase 3 (12 months), patients were educated by the physician during a clinic visit, and their action plan for reacting in timely fashion to their PEx signs was defined. Education and action plans were revised during clinic visits. At the end of the project, the patients' experience was collected during semistructured interviews with a researcher as part of the qualitative study. The experience of CF teams was collected during focus groups using a semistructured guide once all their patients had finished the study. The interviews and focus groups were recorded and transcribed verbatim to be analyzed. Data from educational sessions were collected throughout the educational program to be put into perspective with the learnings reported by patients. Analyses are being led by 2 researchers using NVivo (QSR International). RESULTS The study received the favorable reception of the Committee for the Protection of Persons (CPP NORTH WEST III) on June 10, 2017 (#2017-A00723-50). Out of the 36 patients included in phase 1, 27 were educated and entered phase 3. We completed collection of all data from the patients and care providers. Qualitative analysis will provide a better understanding of users' experience on the conditions of data collection, how useful CDs are for detecting PEx, how useful the PEx action plan is for reacting quickly, what patients learned about PEx management, and the conditions for this PEx management to be sustainable in routine care. CONCLUSIONS This study will open new perspectives for further research into the implementation of an optimal PEx care process in the organization of care teams in order to support patient self-management. TRIAL REGISTRATION ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14552.
Collapse
Affiliation(s)
- Maxime Morsa
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| | - Amélie Perrin
- Pediatric Cystic Fibrosis Center, Nantes University Hospital, Nantes, France
| | - Valérie David
- Pediatric Cystic Fibrosis Center, Nantes University Hospital, Nantes, France
| | - Gilles Rault
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| | - Enora Le Roux
- Unité Mixte de Recherche 1123 Epidémiologie Clinique et EValuation Economique appliquées aux populations vulnérables, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre d'Investigation Clinique 1426 Unit of Clinical Epidemiology, Hôpital Universitaire R Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Corinne Alberti
- Unité Mixte de Recherche 1123 Epidémiologie Clinique et EValuation Economique appliquées aux populations vulnérables, Université de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France.,Centre d'Investigation Clinique 1426 Unit of Clinical Epidemiology, Hôpital Universitaire R Debré, Assistance Publique des Hôpitaux de Paris, Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - Rémi Gagnayre
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| | - Dominique Pougheon Bertrand
- The Health Education and Practices Laboratory (LEPS UR 3412), Sorbonne Paris North University, Bobigny, France
| |
Collapse
|
11
|
Rutland SB, Bergquist RP, Hager A, Geurs R, Mims C, Gutierrez HH, Oates GR. A Mobile Health Platform for Self-Management of Pediatric Cystic Fibrosis: Qualitative Study of Adaptation to Stakeholder Needs and Integration in Clinical Settings. JMIR Form Res 2021; 5:e19413. [PMID: 33496667 PMCID: PMC7872830 DOI: 10.2196/19413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/03/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background Cystic fibrosis (CF) is an inherited chronic condition that requires extensive daily care and quarterly clinic visits with a multidisciplinary care team. The limited exchange of information outside of the quarterly clinic visits impedes optimal disease self-management, patient engagement, and shared decision making. Objective The aim of this study is to adapt a mobile health (mHealth) app originally developed in Sweden to the needs of patients, families, and health care providers in a CF center in the United States and to test it as a platform for sharing patient-generated health data with the CF health care team. Methods Focus groups with health care providers of patients with CF, adolescents with CF, and caregivers of children with CF were conducted to determine what modifications were necessary. Focus group data were analyzed using a thematic analysis, and emergent themes were ranked according to desirability and technical feasibility. The mHealth platform was then modified to meet the identified needs and preferences, and the flow of patient-generated health data to a secure Research Electronic Data Capture database was tested. Protocols for data management and clinical follow-up were also developed. Results A total of 5 focus groups with 21 participants were conducted. Recommended modifications pertained to all functionalities of the mHealth platform, including tracking of symptoms, treatments, and activities of daily care; creating and organizing medication lists and setting up reminders; generating reports for the health care team; language and presentation; sharing and privacy; and settings and accounts. Overall, health care providers recommended changes to align the mHealth platform with US standards of care, people with CF and their caregivers requested more tracking functionalities, and both groups suggested the inclusion of a mental health tracker as well as more detailed response options and precise language. Beta testers of the modified platform reported issues related to translatability to US environment and various bugs. Conclusions This study demonstrated the importance of identifying the needs and preferences of target users and stakeholders before adopting existing mHealth solutions. All relevant perspectives, including those of clinicians, patients, and caregivers, should be thoroughly considered to meet both end users’ needs and evidence-based practice recommendations.
Collapse
Affiliation(s)
- Sarah B Rutland
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | | | | | - Robin Geurs
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Cathy Mims
- Children's of Alabama, Birmingham, AL, United States
| | - Hector H Gutierrez
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gabriela R Oates
- Pediatric Pulmonary and Sleep Medicine, The University of Alabama at Birmingham, Birmingham, AL, United States
| |
Collapse
|
12
|
Nasr SZ, Lechtzin N. CF: There's an app for that! J Cyst Fibros 2020; 19:172-173. [PMID: 32089516 DOI: 10.1016/j.jcf.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Samya Z Nasr
- Cystic Fibrosis Center, University of Michigan Health System, 1500 E. Medical Center Dr./L2221 Women's, Ann Arbor, MI 48109-5212, United States.
| | - Noah Lechtzin
- Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins University School of Medicine, 1830 E. Monument Street, 5th Floor, Baltimore, MD 21205, United States.
| |
Collapse
|
13
|
Bell SC, Mall MA, Gutierrez H, Macek M, Madge S, Davies JC, Burgel PR, Tullis E, Castaños C, Castellani C, Byrnes CA, Cathcart F, Chotirmall SH, Cosgriff R, Eichler I, Fajac I, Goss CH, Drevinek P, Farrell PM, Gravelle AM, Havermans T, Mayer-Hamblett N, Kashirskaya N, Kerem E, Mathew JL, McKone EF, Naehrlich L, Nasr SZ, Oates GR, O'Neill C, Pypops U, Raraigh KS, Rowe SM, Southern KW, Sivam S, Stephenson AL, Zampoli M, Ratjen F. The future of cystic fibrosis care: a global perspective. THE LANCET. RESPIRATORY MEDICINE 2020; 8:65-124. [PMID: 31570318 PMCID: PMC8862661 DOI: 10.1016/s2213-2600(19)30337-6] [Citation(s) in RCA: 553] [Impact Index Per Article: 138.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/19/2019] [Accepted: 08/14/2019] [Indexed: 02/06/2023]
Abstract
The past six decades have seen remarkable improvements in health outcomes for people with cystic fibrosis, which was once a fatal disease of infants and young children. However, although life expectancy for people with cystic fibrosis has increased substantially, the disease continues to limit survival and quality of life, and results in a large burden of care for people with cystic fibrosis and their families. Furthermore, epidemiological studies in the past two decades have shown that cystic fibrosis occurs and is more frequent than was previously thought in populations of non-European descent, and the disease is now recognised in many regions of the world. The Lancet Respiratory Medicine Commission on the future of cystic fibrosis care was established at a time of great change in the clinical care of people with the disease, with a growing population of adult patients, widespread genetic testing supporting the diagnosis of cystic fibrosis, and the development of therapies targeting defects in the cystic fibrosis transmembrane conductance regulator (CFTR), which are likely to affect the natural trajectory of the disease. The aim of the Commission was to bring to the attention of patients, health-care professionals, researchers, funders, service providers, and policy makers the various challenges associated with the changing landscape of cystic fibrosis care and the opportunities available for progress, providing a blueprint for the future of cystic fibrosis care. The discovery of the CFTR gene in the late 1980s triggered a surge of basic research that enhanced understanding of the pathophysiology and the genotype-phenotype relationships of this clinically variable disease. Until recently, available treatments could only control symptoms and restrict the complications of cystic fibrosis, but advances in CFTR modulator therapies to address the basic defect of cystic fibrosis have been remarkable and the field is evolving rapidly. However, CFTR modulators approved for use to date are highly expensive, which has prompted questions about the affordability of new treatments and served to emphasise the considerable gap in health outcomes for patients with cystic fibrosis between high-income countries, and low-income and middle-income countries (LMICs). Advances in clinical care have been multifaceted and include earlier diagnosis through the implementation of newborn screening programmes, formalised airway clearance therapy, and reduced malnutrition through the use of effective pancreatic enzyme replacement and a high-energy, high-protein diet. Centre-based care has become the norm in high-income countries, allowing patients to benefit from the skills of expert members of multidisciplinary teams. Pharmacological interventions to address respiratory manifestations now include drugs that target airway mucus and airway surface liquid hydration, and antimicrobial therapies such as antibiotic eradication treatment in early-stage infections and protocols for maintenance therapy of chronic infections. Despite the recent breakthrough with CFTR modulators for cystic fibrosis, the development of novel mucolytic, anti-inflammatory, and anti-infective therapies is likely to remain important, especially for patients with more advanced stages of lung disease. As the median age of patients with cystic fibrosis increases, with a rapid increase in the population of adults living with the disease, complications of cystic fibrosis are becoming increasingly common. Steps need to be taken to ensure that enough highly qualified professionals are present in cystic fibrosis centres to meet the needs of ageing patients, and new technologies need to be adopted to support communication between patients and health-care providers. In considering the future of cystic fibrosis care, the Commission focused on five key areas, which are discussed in this report: the changing epidemiology of cystic fibrosis (section 1); future challenges of clinical care and its delivery (section 2); the building of cystic fibrosis care globally (section 3); novel therapeutics (section 4); and patient engagement (section 5). In panel 1, we summarise key messages of the Commission. The challenges faced by all stakeholders in building and developing cystic fibrosis care globally are substantial, but many opportunities exist for improved care and health outcomes for patients in countries with established cystic fibrosis care programmes, and in LMICs where integrated multidisciplinary care is not available and resources are lacking at present. A concerted effort is needed to ensure that all patients with cystic fibrosis have access to high-quality health care in the future.
Collapse
Affiliation(s)
- Scott C Bell
- Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia; QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
| | - Marcus A Mall
- Charité - Universitätsmedizin Berlin, Berlin Institute of Health, Berlin, Germany; German Center for Lung Research, Berlin, Germany
| | | | - Milan Macek
- Department of Biology and Medical Genetics, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | - Susan Madge
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jane C Davies
- Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Pierre-Régis Burgel
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes, Institut Cochin, Paris, France
| | - Elizabeth Tullis
- St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Claudio Castaños
- Hospital de Pediatria "Juan P Garrahan", Buenos Aires, Argentina
| | - Carlo Castellani
- Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Catherine A Byrnes
- Starship Children's Hospital, Auckland, New Zealand; University of Auckland, Auckland, New Zealand
| | - Fiona Cathcart
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Sanjay H Chotirmall
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | | | - Isabelle Fajac
- Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France; Université Paris Descartes, Institut Cochin, Paris, France
| | | | - Pavel Drevinek
- Department of Medical Microbiology, Second Faculty of Medicine, Motol University Hospital, Charles University, Prague, Czech Republic
| | | | - Anna M Gravelle
- Cystic Fibrosis Clinic, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Trudy Havermans
- Cystic Fibrosis Centre, University Hospital Leuven, Leuven, Belgium
| | - Nicole Mayer-Hamblett
- University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Joseph L Mathew
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Edward F McKone
- School of Medicine, St Vincent's University Hospital, Dublin, Ireland; University College Dublin School of Medicine, Dublin, Ireland
| | - Lutz Naehrlich
- Universities of Giessen and Marburg Lung Center, German Center of Lung Research, Justus-Liebig-University Giessen, Giessen, Germany
| | - Samya Z Nasr
- CS Mott Children's Hospital, Ann Arbor, MI, USA; University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Steven M Rowe
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kevin W Southern
- Alder Hey Children's Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK
| | - Sheila Sivam
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Anne L Stephenson
- St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Marco Zampoli
- Division of Paediatric Pulmonology and MRC Unit for Child and Adolescent Health, University of Cape Town, Cape Town, South Africa; Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Felix Ratjen
- University of Toronto, Toronto, ON, Canada; Division of Respiratory Medicine, Department of Paediatrics, Translational Medicine Research Program, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
14
|
Wood J, Jenkins S, Putrino D, Mulrennan S, Morey S, Cecins N, Bear N, Hill K. A smartphone application for reporting symptoms in adults with cystic fibrosis improves the detection of exacerbations: Results of a randomised controlled trial. J Cyst Fibros 2019; 19:271-276. [PMID: 31522924 DOI: 10.1016/j.jcf.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/02/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Respiratory exacerbations impair lung function and health-related quality of life in people with CF, with delayed identification of exacerbations often resulting in worse outcomes. We developed a smartphone application (app) for adults with CF to report symptoms to the CF team, and investigated its impact on antibiotic use and other outcomes. METHODS Participants were randomised to intervention (use of the app weekly or sooner if symptoms had worsened) or control (usual care). The app comprised questions relating to symptoms suggestive of an exacerbation. If worsening symptoms were reported, the participant was contacted by the nurse practitioner. The primary outcome measure was the number of courses and days of intravenous (IV) antibiotics. RESULTS Sixty participants (29 female, aged [mean ± SD] 31 ± 9 years, FEV1 60 ± 18% predicted) were recruited, with 29 (48%) allocated to the intervention group. Over the 12-month follow-up, there was no clear effect of the app on the number of courses of IV antibiotics (incidence rate ratio [IRR] 1; 95% confidence interval [CI] 0.6 to 1.7), however number of courses of oral antibiotics increased (IRR 1.5; 95% CI 1.0 to 2.2). The median [IQR] time to detection of exacerbation requiring oral or IV antibiotics was shorter in the intervention group compared with the control group (70 [123] vs. 141 [140] days; p = .02). No between-group differences were observed in other outcomes. CONCLUSION The use of an app reduced time to detect respiratory exacerbations that required antibiotics, however did not demonstrate a clear effect on the number of courses of IV antibiotics.
Collapse
Affiliation(s)
- Jamie Wood
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - David Putrino
- Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Siobhain Mulrennan
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Morey
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Nola Cecins
- Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, Western Australia, Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| |
Collapse
|
15
|
Early detection of pulmonary exacerbations in children with Cystic Fibrosis by electronic home monitoring of symptoms and lung function. Sci Rep 2017; 7:12350. [PMID: 28955051 PMCID: PMC5617859 DOI: 10.1038/s41598-017-10945-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 08/08/2017] [Indexed: 01/13/2023] Open
Abstract
Pulmonary exacerbations (PEx) in Cystic Fibrosis (CF) are associated with an increased morbidity and even mortality. We investigated whether early detection of PEx in children with CF is possible by electronic home monitoring of symptoms and lung function. During this one-year prospective multi-centre study, 49 children with CF were asked to use a home monitor three times a week. Measurements consisted of a respiratory symptom questionnaire and assessment of Forced Expiratory Volume in one second (FEV1). Linear mixed-effects and multiple logistic regression analyses were used. In the 2 weeks before a PEx, the Respiratory Symptom Score (RSS) of the home monitor increased (p = 0.051). The FEV1 as percentage of predicted (FEV1%pred) did not deteriorate in the 4 weeks before a PEx. Nevertheless, the FEV1%pred at the start of exacerbation was significantly lower than the FEV1%pred in the non-exacerbation group (mean difference 16.3%, p = 0.012). The combination of FEV1%pred and RSS had a sensitivity to predict an exacerbation of 92.9% (CI 75.0-98.8%) and a specificity of 88.9% (CI 50.7-99.4%). The combination of home monitor FEV1%pred and RSS can be helpful to predict a PEx in children with CF at an early stage.
Collapse
|
16
|
Choyce J, Shaw KL, Sitch AJ, Mistry H, Whitehouse JL, Nash EF. A prospective pilot study of home monitoring in adults with cystic fibrosis (HOME-CF): protocol for a randomised controlled trial. BMC Pulm Med 2017; 17:22. [PMID: 28114922 PMCID: PMC5256574 DOI: 10.1186/s12890-017-0366-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/11/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Home monitoring has the potential to detect early pulmonary exacerbations in people with cystic fibrosis (CF), with consequent improvements in health outcomes and healthcare associated costs. This study aims to assess the effects of home monitoring on hospital admissions, quality of life, antibiotic requirements, exacerbation frequency, lung function, nutritional outcomes, anxiety, depression, costs and health outcomes, as well as the qualitative effects on the patient experience. METHODS This randomised controlled mixed-methods trial aims to recruit 100 adults with CF cared for in one large regional CF centre. Participants are randomly allocated 1:1 to the intervention group (twice-weekly home monitoring of symptoms measured by the Cystic Fibrosis Respiratory Symptom Diary - Chronic Respiratory Infection Symptom Score (CFRSD-CRISS) and Forced Expiratory Volume in one second (FEV1)) or a control group (routine clinical care) for the 12-month study period. Measurements are recorded at study visits at baseline, 3, 6, 9 and 12 months. Spirometry, body weight, co-morbidities, medications, hospital inpatient days, courses of antibiotics (oral and intravenous), pulmonary exacerbations (defined by the modified Fuchs criteria) are recorded at each study visit. Health status, capability and health economics are measured at each study visit by the Hospital Anxiety and Depression Scale (HADS), the ICEpop CAPability measure for Adults (ICECAP-A), EuroQol 5 dimensions (EQ-5D-5L) questionnaire and an adapted resource use questionnaire. The patient experience is assessed by semi-structured qualitative interviews at baseline and 12 months. DISCUSSION Results from this study will help to determine the effect of home monitoring on inpatient bed days and quality of life in adults with CF, as well as other relevant health and health economic outcomes. TRIAL REGISTRATION This study protocol is registered with Clinicaltrials.gov ( NCT02994706 ), date registered 16th July 2014.
Collapse
Affiliation(s)
- Jocelyn Choyce
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Karen L. Shaw
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Alice J. Sitch
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Hema Mistry
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Joanna L. Whitehouse
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Edward F. Nash
- West Midlands Adult CF Centre, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| |
Collapse
|
17
|
Wood J, Mulrennan S, Hill K, Cecins N, Morey S, Jenkins S. Telehealth clinics increase access to care for adults with cystic fibrosis living in rural and remote Western Australia. J Telemed Telecare 2016; 23:673-679. [PMID: 27444187 DOI: 10.1177/1357633x16660646] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction A significant proportion (15%, n = 28) of the adults with cystic fibrosis (CF) in Western Australia (WA) live in rural and remote areas and have difficulty accessing specialist care at the state adult CF centre, located in Perth. We aimed to increase access by offering telehealth clinics, and evaluate the impact on health outcomes. Methods Telehealth clinics were offered via videoconference over a 12-month period, with uptake and satisfaction measured at the end of the intervention. Participants could still attend in person clinics at the CF centre if requested. Other outcomes comprised healthcare utilisation (HCU), spirometry, weight and health-related quality of life. Results In 21 participants, total clinic visits increased from 46 (median (range) per participant 2 (0-6)) in the 12-month period preceding the study to 100 (5 (2-8), p < 0.001) during the intervention. Of the 100 clinics in total, 66 were delivered via telehealth. Satisfaction with telehealth was high and most (94%) participants agreed that telehealth is a good way to deliver CF care. An increase in intravenous antibiotic days (incident rate ratio (IRR) 2.3, p = 0.03) and hospital admission days (IRR 3.7, p = 0.01) was observed. There was an improvement in the vitality domain of the Cystic Fibrosis Questionnaire - Revised ( p < 0.05). Discussion Telehealth had good uptake and increased clinic attendance in adults with CF living in rural and remote WA, and had high satisfaction amongst participants. The increase in HCU, resulting from increased detection and treatment of exacerbations, may improve long-term outcomes in this population.
Collapse
Affiliation(s)
- Jamie Wood
- 1 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,2 Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Siobhain Mulrennan
- 3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia.,4 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Kylie Hill
- 1 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Nola Cecins
- 2 Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Sue Morey
- 3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia.,4 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia
| | - Sue Jenkins
- 1 School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia.,2 Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia
| |
Collapse
|
18
|
Web-based symptom screening in cystic fibrosis patients: A feasibility study. J Cyst Fibros 2015; 15:102-8. [PMID: 26610859 DOI: 10.1016/j.jcf.2015.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) causes high illness burden. Screening may identify patients who could potentially benefit from interventions for symptoms or other sources of distress. We evaluated the feasibility of a web-based system for routine monitoring. METHODS Adult CF patients enrolled in a study of palliative care service delivery completed web-based assessments every 30 days on global distress, physical and psychological symptom distress, and the perceived benefits of discussing advance care planning (ACP) with CF clinicians. Feasibility was assessed by the rate of survey completion, survey reminders, and missed surveys during a 9-month rolling enrollment period. RESULTS Of 74 participants (47.3% women, 94.4% white), 36.7% had comorbid diabetes, and 56.9% had an FEV1% predicted score of 40-69. In total, patients completed 456 (80.6%) of 566 surveys every 30 days over the assessment period. Sixty-five (87.8%) completed 405 (79.7%) of 508 surveys online and 9 (12.2%) completed 51 (88.0%) of 58 surveys using a combination of online, telephone, and mail-based methods. Many surveys were completed without reminders (online: 261 [64.4%] of 405; combined methods: 29 [56.9%] of 51), with 166 (36.4%) surveys requiring 1 or more reminders. Further, 23.0% (17) of patients noted elevated global distress; 20.3% (15) endorsed physical symptom distress, 12.2% (9) had psychological distress, and 58.1% (43) reported that discussing ACP would be beneficial. CONCLUSIONS Repeated web-based screening for symptom distress and ACP preferences is feasible in adult CF patients. Future studies should assess the system's generalizability and staff resources when implementing reminders and non-web methods of completion.
Collapse
|
19
|
Jarad NA, Sequeiros IM, Patel P, Bristow K, Sund Z. Fatigue in cystic fibrosis. Chron Respir Dis 2012; 9:241-9. [DOI: 10.1177/1479972312464236] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fatigue is a debilitating symptom in patients with cystic fibrosis (CF). Although fatigue is commonly reported in these patients, an effective treatment for this symptom has not been found. The factors associated with fatigue in CF have not been investigated. We conducted a prospective, case–control study in adult patients with CF. All the patients were chronically infected with Pseudomonas aeruginosa and were enrolled in the study during disease stability. A gender and age-matched control group was also recruited. Subjective assessment included three questionnaires: the Chalder fatigue questionnaire, St Mary’s Hospital sleep questionnaire (SQ), and the scaled general health and Hillier questionnaire (GHQ). For patients with CF, spirometry, body mass index (BMI), haemoglobin level, C-reactive protein, and the burden of pulmonary exacerbations (PExs) were assessed. The control group completed all the three questionnaires, and their BMI was measured. A total of 78 participants were enrolled in the study (44 patients with CF and 34 control). Female patients with CF received antibiotics for more days than male patients with CF. The fatigue score did not differ between female and male participants in either the patients with CF or the control group; however, the fatigue score was greater for both the sexes in the patients with CF compared with the control group: p = 0.038 for female and p = 0.048 for male. The scores for the SQ and the GHQ did not differ between the two study groups. The fatigue score correlated with the total score for SQ ( p < 0.0001) in patients with CF, but not in control participants. In patients with CF and the individuals in the control group, a close correlation was found between the fatigue score and the GHQ domain-specific scores and with the total score; p < 0.0001 for patients with CF and p = 0.001 for control. No correlations were found between the fatigue score and any of the objective parameters studied.
Collapse
Affiliation(s)
- N A Jarad
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK
| | - I M Sequeiros
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK
| | - P Patel
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK
| | - K Bristow
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK
| | - Z Sund
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK
| |
Collapse
|
20
|
Abstract
BACKGROUND There is currently no simple scoring system to evaluate change in symptoms during a pulmonary exacerbation (PEx) in adult cystic fibrosis (CF) patients. PATIENTS AND METHODS We evaluated 265 episodes in 58 adult CF patients. A simple symptom score was administered at the start and the end of each PEx. The score evaluated four symptoms: cough, sputum, breathlessness and fatigue. Each symptom was scored from one (mild symptoms) to four (severe symptoms). The total symptom score was the summation of all the four symptoms. The total symptom score was compared with CF Respiratory Questionnaire (CFRQ) and with spirometry. RESULTS There was significant internal correlation between scores for each pair of symptoms. The total symptom score correlated with the functional activity score and the respiratory score domains and with the summary score for CFRQ. The total symptom score correlated with spirometry values. Symptom score improved after 2-week treatment with intravenous (IV) antibiotics in 88.3%, remained unchanged in 7.3% and worsened in 4.4% of all episodes. Changes in symptom score after IV treatment correlated with changes of all main spirometry measurements. CONCLUSION This new symptom score is simple and sensitive to change over a short period. It correlates with established quality-of-life questionnaires and with spirometry. The changes of symptom score over a short period correlate with changes in spirometry. This score can be used as an added tool to assess the outcome of CF PExs.
Collapse
Affiliation(s)
- N A Jarad
- Department of Respiratory Medicine, Bristol Royal Infirmary, Bristol, UK.
| | | |
Collapse
|
21
|
Cox NS, Alison JA, Rasekaba T, Holland AE. Telehealth in cystic fibrosis: a systematic review. J Telemed Telecare 2011; 18:72-8. [PMID: 22198961 DOI: 10.1258/jtt.2011.110705] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We conducted a systematic review of the use of telehealth in people with Cystic Fibrosis (CF). The studies reviewed were of adults and children with CF, and incorporated telehealth for monitoring symptoms, assessing adherence to prescribed therapies or providing a therapeutic intervention. Searches of four electronic databases returned 293 references. Eight studies met the inclusion criteria. Variability in study design and outcome measures precluded meta-analysis. Seven studies assessed telemonitoring feasibility for patient usability and acceptance, or for physiological monitoring. Two studies were randomised controlled trials, although only one showed differences in outcome between the intervention and usual care with improved spirometry stability and significantly increased antibiotic use in the intervention group. In four studies participants were asked to transmit data on spirometry (FEV(1)) or symptoms. Participant non-compliance with data reporting ranged from 43-63%. Generally, participants reported being able to use the required technology. There is insufficient evidence to reach a firm conclusion about the benefits of telehealth in people with CF, but it remains a promising area for future investigation.
Collapse
Affiliation(s)
- Narelle S Cox
- La Trobe/Alfred Health Clinical School, Level 4, The Alfred Centre, 99 Commercial Road, Prahran, Victoria 3181, Australia.
| | | | | | | |
Collapse
|
22
|
Jarad NA, Sund ZM. Telemonitoring in chronic obstructive airway disease and adult patients with cystic fibrosis. J Telemed Telecare 2010; 17:127-32. [DOI: 10.1258/jtt.2010.100309] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We compared the use of telemonitoring in patients with chronic obstructive pulmonary disease (COPD) and adult patients with cystic fibrosis (CF). Seventy patients (51 CF and 19 COPD) were enrolled in two studies of six months' duration. Patients used a personal data assistant (PDA) attached to a spirometer to score symptoms and to perform daily spirometry. Criteria for diagnosis of exacerbations of COPD and CF were pre-defined. When exacerbations were detected, patients were offered treatment according to a pre-designed protocol. Thirty-two (63%) CF patients and one (5%) COPD patient withdrew from the studies due to lack of adherence to daily recording. For those who remained in the study, COPD patients recorded more study days (139) than CF patients (113), P = 0.03. The median number of exacerbations detected during the study was greater in COPD than in CF patients, although this was not significant. The median number of device-detected exacerbations in the COPD group was significantly greater than in the CF group, P = 0.024. When compared to a parallel period in the previous year, the number of hospitalisations for COPD exacerbations was reduced, whereas the number of intravenous antibiotics in CF patients did not differ. Adherence to telemonitoring was much greater for COPD than CF patients and the results appear to be more favourable for COPD patients than for CF patients.
Collapse
Affiliation(s)
- Nabil A Jarad
- Department of Respiratory Medicine, Bristol Royal Infirmary, UK
| | - Zoe M Sund
- Department of Respiratory Medicine, Bristol Royal Infirmary, UK
| |
Collapse
|
23
|
Selvadurai H. Detecting acute pulmonary exacerbations in cystic fibrosis--evolving concepts. THE CLINICAL RESPIRATORY JOURNAL 2010; 4:65-66. [PMID: 20565478 DOI: 10.1111/j.1752-699x.2010.00189.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
|