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Dinh M, Lin CC, Whitfield C, Farhan Z, Meurer WJ, Bailey S, Skolarus LE. Exploring the Acceptability and Feasibility of Remote Blood Pressure Measurements and Cognition Assessments Among Participants Recruited From a Safety-Net Emergency Department (Reach Out Cognition): Nonrandomized Mobile Health Trial. JMIR Form Res 2024; 8:e54010. [PMID: 38805251 DOI: 10.2196/54010] [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: 10/31/2023] [Revised: 03/23/2024] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Hypertension is a prevalent cardiovascular risk factor disproportionately affecting Black Americans, who also experience a higher incidence of Alzheimer disease and Alzheimer disease-related dementias. Monitoring blood pressure (BP) and cognition may be important strategies in reducing these disparities. OBJECTIVE The objective of the Reach Out Cognition study was to explore the feasibility and acceptability of remote cognitive and BP assessments in a predominantly Black, low-income population. METHODS Reach Out was a randomized, controlled, mobile health-based clinical trial to reduce BP among patients with hypertension at an emergency department in a safety-net hospital (ie, a US hospital in which 25% of the patients are Medicaid recipients). Upon conclusion of Reach Out, participants were given the option of continuing into an extension phase, Reach Out Cognition, that included Bluetooth-enabled BP monitoring and digital cognitive assessments for 6 months. Digital cognitive assessments were text message-linked online surveys of the Self-Administered Gerocognitive Exam and Quality of Life in Neurological Disorders scale. BP assessments were measured with Bluetooth-enabled BP cuffs paired with an app and the data were manually sent to the research team. Outcomes were feasibility (ie, enrollment and 3- and 6-month completion of digital cognitive and BP assessments) and acceptability of assessments using a 4-item validated survey, ranging from 1 (not acceptable) to 5 (completely acceptable). RESULTS Of the 211 Reach Out participants, 107 (50.7%) consented and 71 (33.6%) completed enrollment in Reach Out Cognition. Participants had a mean age of 49.9 years; 70.4% were female and 57.8% identified as Black. Among the 71 participants, 51 (72%) completed cognitive assessments at 3 months and 34 (48%) completed these assessments at 6 months. BP assessments were completed by 37 (52%) and 20 (28%) of the 71 participants at 3 and 6 months, respectively. Participants were neutral on the acceptability of the digital cognitive assessments (mean 3.7) and Bluetooth self-measured BP (SMBP) monitoring (mean 3.9). Participants noted challenges syncing the BP cuff to the app, internet connection, and transmitting the data to the research team. CONCLUSIONS Enrollment and assessment completion were low, while acceptability was moderate. Technological advances will eliminate some of the Bluetooth SMBP barriers and offer new strategies for cognitive assessments. Subsequent studies could benefit from offering more comprehensive support to overcome Bluetooth-related hurdles, such as personalized training materials, video conferencing, or in-person research team support. Alternatively, strategies that do not require pairing with an app and passive transmission of data could be considered. Overall, further research is warranted to optimize participant engagement and overcome technological challenges. TRIAL REGISTRATION ClinicalTrials.gov NCT03422718; https://clinicaltrials.gov/study/NCT03422718.
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Affiliation(s)
- Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Chun Chieh Lin
- Division of Health Services Research, Department of Neurology, The Ohio State University, Columbus, OH, United States
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Zahera Farhan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - William J Meurer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Sarah Bailey
- Bridges into the Future, Flint, MI, United States
| | - Lesli E Skolarus
- Davee Department of Neurology, Northwestern University, Chicago, IL, United States
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Mamer LE, Sozener CB, Richards CT, Meurer WJ. Developing a Career in Stroke as an Emergency Physician. Stroke 2023; 54:e431-e433. [PMID: 37526010 DOI: 10.1161/strokeaha.122.040114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Affiliation(s)
- Lauren E Mamer
- Department of Emergency Medicine (L.E.M., C.B.S., W.J.M.), University of Michigan, Ann Arbor
- University of Michigan Stroke Program, Ann Arbor (L.E.M., C.B.S., W.J.M.)
| | - Cemal B Sozener
- Department of Emergency Medicine (L.E.M., C.B.S., W.J.M.), University of Michigan, Ann Arbor
- University of Michigan Stroke Program, Ann Arbor (L.E.M., C.B.S., W.J.M.)
| | - Christopher T Richards
- Department of Emergency Medicine, University of Cincinnati College of Medicine, OH (C.T.R.)
- University of Cincinnati (UC) Stroke Team, OH (C.T.R.)
| | - William J Meurer
- Department of Emergency Medicine (L.E.M., C.B.S., W.J.M.), University of Michigan, Ann Arbor
- Department of Neurology (W.J.M.), University of Michigan, Ann Arbor
- University of Michigan Stroke Program, Ann Arbor (L.E.M., C.B.S., W.J.M.)
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Vasanthakumari P, Kumarakuru K, Yousuff N. The Efficacy of Virtual-based Nutritional Interventions on Knowledge, Attitude, and Practices of Individuals with Hypertension: A Comparative Study Analysis. J Midlife Health 2023; 14:184-190. [PMID: 38312759 PMCID: PMC10836442 DOI: 10.4103/jmh.jmh_53_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 07/22/2023] [Indexed: 02/06/2024] Open
Abstract
Introduction Hypertension (HTN) is multifactorial, complex disorder predictable to affect all genders and foremost preventable risk factor for blood pressure and cardiovascular diseases. Objectives The present study was assessing the knowledge, attitude, and practices (KAPs) regarding HTN and creating the awareness of its better management among the hypertensive population through nutrition education intervention. Methodology A total of 82 participants were selected and questionnaire was used to elicit sociodemographic profile and KAP regarding HTN and its management. Nutrition education intervention was carried out through the online mode. Results and Discussion Results observed in preintervention between knowledge with attitude in experimental group and control group (r =+0.273 and r =+0.271), practice (r =+0.275 and r =+0.263), and attitude with practice (r =+0.521 and r =+0.186) were positive correlation similarly postintervention of both group obtained significant positive correlation. The statistical analysis of various sociodemographic factors of pre and postintervention in the experimental group and control group revealed a significant improvement in the mean posttest scores of KAP. Meanwhile, various sociodemographic factors obtained had nonsignificant (P > 0.005) in experimental group; a control group of pretest and posttest reported significant differences (P < 0.05). The posttest total mean score on nutritional knowledge and practice in the experimental group also showed a large significant (P < 0.05) increase when compared to the pretest mean score. There was no significant improvement in the total mean scores in any dimensions of the control group. Conclusion The study therefore helped the experimental group subjects in improving their overall knowledge about the importance of nutrition in HTN and also instilled positive attitude and practices toward the management of HTN through lifestyle modifications.
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Affiliation(s)
- P Vasanthakumari
- Department of Nutrition and Dietetics, Food Science and Nutrition, Mount Carmel College, Autonomous, Bengaluru, Karnataka, India
| | - K Kumarakuru
- Department of Food Science and Nutrition, School of Life Sciences, Nehru Arts and Science College, Coimbatore, Tamil Nadu, India
| | - Noorain Yousuff
- Department of Nutrition and Dietetics, Food Science and Nutrition, Mount Carmel College, Autonomous, Bengaluru, Karnataka, India
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Skolarus LE, Dinh M, Kidwell KM, Lin CC, Buis LR, Brown DL, Oteng R, Giacalone M, Warden K, Trimble DE, Whitfield C, Farhan Z, Flood A, Borgialli D, Montas S, Jaggi M, Meurer WJ. Reach Out Emergency Department: A Randomized Factorial Trial to Determine the Optimal Mobile Health Components to Reduce Blood Pressure. Circ Cardiovasc Qual Outcomes 2023; 16:e009606. [PMID: 37192282 DOI: 10.1161/circoutcomes.122.009606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 03/13/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Mobile health (mHealth) strategies initiated in safety-net Emergency Departments may be one approach to address the US hypertension epidemic, but the optimal mHealth components or dose are unknown. METHODS Reach Out is an mHealth, health theory-based, 2×2×2 factorial trial among hypertensive patients evaluated in a safety-net Emergency Department in Flint, Michigan. Reach Out consisted of 3 mHealth components, each with 2 doses: (1) healthy behavior text messaging (yes versus no), (2) prompted self-measured blood pressure (BP) monitoring and feedback (weekly versus daily), and (3) facilitated primary care provider appointment scheduling and transportation (yes versus no). The primary outcome was a change in systolic BP from baseline to 12 months. In a complete case analysis, we fit a linear regression model and accounted for age, sex, race, and prior BP medications to explore the association between systolic BP and each mHealth component. RESULTS Among 488 randomized participants, 211 (43%) completed follow-up. Mean age was 45.5 years, 61% were women, 54% were Black people, 22% did not have a primary care doctor, 21% lacked transportation, and 51% were not taking antihypertensive medications. Overall, systolic BP declined after 6 months (-9.2 mm Hg [95% CI, -12.2 to -6.3]) and 12 months (-6.6 mm Hg, -9.3 to -3.8), without a difference across the 8 treatment arms. The higher dose of mHealth components were not associated with a greater change in systolic BP; healthy behavior text messages (point estimate, mmHG=-0.5 [95% CI, -6.0 to 5]; P=0.86), daily self-measured BP monitoring (point estimate, mmHG=1.9 [95% CI, -3.7 to 7.5]; P=0.50), and facilitated primary care provider scheduling and transportation (point estimate, mmHG=0 [95% CI, -5.5 to 5.6]; P=0.99). CONCLUSIONS Among participants with elevated BP recruited from an urban safety-net Emergency Department, BP declined over the 12-month intervention period. There was no difference in change in systolic BP among the 3 mHealth components. Reach Out demonstrated the feasibility of reaching medically underserved people with high BP cared for at a safety-net Emergency Departments, yet the efficacy of the Reach Out mHealth intervention components requires further study. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03422718.
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Affiliation(s)
- Lesli E Skolarus
- Davee Department of Neurology, Northwestern University, Feinberg School of Medicine Chicago, IL (L.E.S.)
| | - Mackenzie Dinh
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
| | - Kelley M Kidwell
- Department of Statistics, University of Michigan School of Public Health, Ann Arbor (K.M.K.)
| | - Chun Chieh Lin
- Health Services Research Program (C.C.L.), University of Michigan, Ann Arbor
| | - Lorraine R Buis
- Institute for Healthcare Policy and Innovation (L.R.B.), University of Michigan, Ann Arbor
- Department of Family Medicine (L.R.B.), University of Michigan, Ann Arbor
| | - Devin L Brown
- Department of Neurology (D.L.B., W.J.M.), University of Michigan, Ann Arbor
- Stroke Program (D.L.B., W.J.M.), University of Michigan, Ann Arbor
| | - Rockefeller Oteng
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
- Department of Emergency Medicine, Hurley Medical Center, Flint, MI (R.O., D.B., M.J.)
| | | | | | - Deborah E Trimble
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
| | - Candace Whitfield
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
| | - Zahera Farhan
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
| | - Adam Flood
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
| | - Dominic Borgialli
- Department of Emergency Medicine, Hurley Medical Center, Flint, MI (R.O., D.B., M.J.)
| | - Sacha Montas
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
| | - Michael Jaggi
- Department of Emergency Medicine, Hurley Medical Center, Flint, MI (R.O., D.B., M.J.)
| | - William J Meurer
- Department of Emergency Medicine (M.D., R.O., D.E.T., C.W., Z.F., A.F., S.M., W.J.M.), University of Michigan, Ann Arbor
- Department of Neurology (D.L.B., W.J.M.), University of Michigan, Ann Arbor
- Stroke Program (D.L.B., W.J.M.), University of Michigan, Ann Arbor
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Landoll RR, Vargas SE, Samardzic KB, Clark MF, Guastaferro K. The preparation phase in the multiphase optimization strategy (MOST): a systematic review and introduction of a reporting checklist. Transl Behav Med 2021; 12:291-303. [PMID: 34850214 DOI: 10.1093/tbm/ibab146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Multicomponent behavioral interventions developed using the multiphase optimization strategy (MOST) framework offer important advantages over alternative intervention development models by focusing on outcomes within constraints relevant for effective dissemination. MOST consists of three phases: preparation, optimization, and evaluation. The preparation phase is critical to establishing the foundation for the optimization and evaluation phases; thus, detailed reporting is critical to enhancing rigor and reproducibility. A systematic review of published research using the MOST framework was conducted. A structured framework was used to describe and summarize the use of MOST terminology (i.e., preparation phase and optimization objective) and the presentation of preparation work, the conceptual model, and the optimization. Fifty-eight articles were reviewed and the majority focused on either describing the methodology or presenting results of an optimization trial (n = 38, 66%). Although almost all articles identified intervention components (96%), there was considerable variability in the degree to which authors fully described other elements of MOST. In particular, there was less consistency in use of MOST terminology. Reporting on the MOST preparation phase is varied, and there is a need for increased focus on explicit articulation of key design elements and rationale of the preparation phase. The proposed checklist for reporting MOST studies would significantly advance the use of this emerging methodology and improve implementation and dissemination of MOST. Accurate reporting is essential to reproducibility and rigor of scientific trials as it ensures future research fully understands not only the methodology, but the rationale for intervention and optimization decisions.
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Affiliation(s)
- Ryan R Landoll
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA
| | - Sara E Vargas
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kristen B Samardzic
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Madison F Clark
- Department of Family Medicine, Uniformed Services University of the Health Sciences School of Medicine, Bethesda, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kate Guastaferro
- Department of Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
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Skolarus LE, Dinh M, Kidwell KM, Farhan Z, Whitfield C, Levine DA, Meurer WJ. Supplement study update for Reach Out: a multi-arm randomized trial of behavioral interventions for hypertension initiated in the emergency department: Reach Out Cognition. Trials 2021; 22:836. [PMID: 34819115 PMCID: PMC8611628 DOI: 10.1186/s13063-021-05806-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Reach Out is a factorial trial studying multicomponent behavioral interventions to reduce blood pressure in hypertensive emergency department patients. The original study protocol was published in June 2020. Here, we describe the updated protocol, including a supplemental study, Reach Out Cognition. Reach Out Cognition is a remote study that will assess the acceptability, feasibility, and satisfaction of digital, self-administered cognitive assessments and Bluetooth-enabled, self-measured blood pressure monitoring in the Reach Out population. We will also estimate the prevalence of mild cognitive impairment in Reach Out participants. Methods Reach Out Cognition includes remote enrollment and follow-up assessments. Reach Out Cognition extends Reach Out data collection past the current 12 months to 15 and 18 months. Participants will be Reach Out participants who complete their 12-month outcome assessments and opt to continue in the cohort study. Participants will continue to receive the Reach Out intervention, consisting of (1) daily healthy behavior text messaging and (2) weekly self-measured blood pressure monitoring. Blood pressure will be measured using Bluetooth-enabled self-measured blood pressure monitoring devices, and cognition will be measured using digital self-administered cognitive assessments at 12, 15, and 18 months. Discussion Reach Out Cognition will explore the potential of remote, digital, self-administered assessments of blood pressure and cognition among predominantly working-age Black Americans. Reach Out Cognition will inform future clinical trials and clinical remote monitoring of blood pressure and cognition that may lead to new approaches to treating and reducing hypertension and cognitive disparities. Trial registration ClinicalTrials.gov NCT03422718. The record was first available to the public on January 30, 2018, prior to the enrollment of patients on March 25, 2019.
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Affiliation(s)
- Lesli E Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, USA.,Stroke Program, University of Michigan, Ann Arbor, USA
| | - Mackenzie Dinh
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA.
| | - Kelley M Kidwell
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, USA
| | - Zahera Farhan
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Candace Whitfield
- Department of Emergency Medicine, University of Michigan, Ann Arbor, USA
| | - Deborah A Levine
- Department of Neurology, University of Michigan, Ann Arbor, USA.,Stroke Program, University of Michigan, Ann Arbor, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA
| | - William J Meurer
- Department of Neurology, University of Michigan, Ann Arbor, USA.,Stroke Program, University of Michigan, Ann Arbor, USA.,Department of Emergency Medicine, University of Michigan, Ann Arbor, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, USA.,Michigan Institute for Integrative Research in Critical Care (MCIRCC), University of Michigan, Ann Arbor, USA
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Palmer MJ, Machiyama K, Woodd S, Gubijev A, Barnard S, Russell S, Perel P, Free C. Mobile phone-based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults. Cochrane Database Syst Rev 2021; 3:CD012675. [PMID: 33769555 PMCID: PMC8094419 DOI: 10.1002/14651858.cd012675.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non-fatal CVD is considered to be largely preventable through the control of risk factors by lifestyle modifications and preventive medication. Lipid-lowering and antihypertensive drug therapies for primary prevention are cost-effective in reducing CVD morbidity and mortality among high-risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor. Approximately 9% of CVD cases in the EU are attributed to poor adherence to vascular medications. Low-cost, scalable interventions to improve adherence to medications for the primary prevention of CVD have potential to reduce morbidity, mortality and healthcare costs associated with CVD. OBJECTIVES To establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and two other databases on 7 January 2020. We also searched two clinical trials registers on 5 February 2020. We searched reference lists of relevant papers. We applied no language or date restrictions. SELECTION CRITERIA We included randomised controlled trials investigating interventions delivered wholly or partly by mobile phones to improve adherence to cardiovascular medications prescribed for the primary prevention of CVD. We only included trials with a minimum of one-year follow-up in order that the outcome measures related to longer-term, sustained medication adherence behaviours and outcomes. Eligible comparators were usual care or control groups receiving no mobile phone-delivered component of the intervention. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. The main outcomes of interest were objective measures of medication adherence (blood pressure (BP) and cholesterol), CVD events, and adverse events. We contacted study authors for further information when this was not reported. MAIN RESULTS We included 14 trials with 25,633 randomised participants. Participants were recruited from community-based primary and tertiary care or outpatient clinics. The interventions varied widely from those delivered solely through short messaging service (SMS) to those involving a combination of modes of delivery, such as SMS in addition to healthcare worker training, face-to-face counselling, electronic pillboxes, written materials, and home blood pressure monitors. Some interventions only targeted medication adherence, while others additionally targeted lifestyle changes such as diet and exercise. Due to heterogeneity in the nature and delivery of the interventions and study populations, we reported most results narratively, with the exception of two trials which were similar enough to meaningfully pool in meta-analyses. The body of evidence for the effect of mobile phone-based interventions on objective outcomes of adherence (BP and cholesterol) was of low certainty, due to most trials being at high risk of bias, and inconsistency in outcome effects. Two trials were at low risk of bias. Among five trials (total study enrolment: 5441 participants) recording low-density lipoprotein cholesterol (LDL-C), two studies found evidence for a small beneficial intervention effect on reducing LDL-C (-5.30 mg/dL, 95% confidence interval (CI) -8.30 to -2.30; and -9.20 mg/dL, 95% CI -17.70 to -0.70). The other three studies found results varying from a small reduction (-7.7 mg/dL) to a small increase in LDL-C (0.77 mg/dL). All of which had wide confidence intervals that included no effect. Across 13 studies (25,166 participants) measuring systolic blood pressure, effect estimates ranged from a large reduction (MD -12.45 mmHg, 95% CI -15.02 to -9.88) to a small increase (MD 2.80 mmHg, 95% CI 0.30 to 5.30). We found a similar range of effect estimates for diastolic BP, ranging from -12.23 mmHg (95% CI 14.03 to -10.43) to 1.64 mmHg (95% CI -0.55 to 3.83) (11 trials, 19,716 participants). Four trials showed intervention benefits for systolic and diastolic BP with confidence intervals excluding no effect, and among these were all three of the trials evaluating self-monitoring of blood pressure with mobile phone-based telemedicine. The fourth trial included SMS and provider support (with additional varied features). Seven studies (19,185 participants) reported 'controlled' BP as an outcome, and intervention effect estimates varied from negligible effects (odds ratio (OR) 1.01, 95% CI 0.76 to 1.34) to large improvements in BP control (OR 2.41, 95% CI: 1.57 to 3.68). The three trials of clinician training or decision support combined with SMS (with additional varied features) had confidence intervals encompassing benefits and harms, with point estimates close to zero. Pooled analyses of the two trials of interventions solely delivered through SMS were indicative of little or no beneficial intervention effect on systolic BP (MD -1.55 mmHg, 95% CI -3.36 to 0.25; I2 = 0%) and small increases in controlled BP (OR 1.32, 95% CI 1.06 to 1.65; I2 = 0%). Based on four studies (12,439 participants), there was very low-certainty evidence (downgraded twice for imprecision and once for risk of bias) relating to the intervention effect on combined (fatal and non-fatal) CVD events. Two studies (2535 participants) provided low-certainty evidence for the effect of the intervention on cognitive outcomes, with little or no difference between trial arms for perceived quality of care and satisfaction with treatment. There was moderate-certainty evidence (downgraded due to risk of bias) that the interventions did not cause harm, based on six studies (8285 participants). Three studies reported no adverse events attributable to the intervention. One study reported no difference between groups in experience of adverse effects of statins, and that no participants reported intervention-related adverse events. One study stated that potential side effects were similar between groups. One study reported a similar number of deaths in each arm, but did not provide further information relating to potential adverse events. AUTHORS' CONCLUSIONS There is low-certainty evidence on the effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of CVD. Trials of BP self-monitoring with mobile-phone telemedicine support reported modest benefits. One trial at low risk of bias reported modest reductions in LDL cholesterol but no benefits for BP. There is moderate-certainty evidence that these interventions do not result in harm. Further trials of these interventions are warranted.
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Affiliation(s)
- Melissa J Palmer
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kazuyo Machiyama
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Susannah Woodd
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Anasztazia Gubijev
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Pablo Perel
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Wooliscroft L, Brown D, Cohen J, Skolarus L, Silbermann E. Continuing Clinical Research During Shelter-in-Place. Ann Neurol 2020; 88:658-660. [PMID: 32621372 PMCID: PMC7361568 DOI: 10.1002/ana.25840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Lindsey Wooliscroft
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,Department of Neurology, VA Portland Health Care System, Portland, OR, USA
| | - Devin Brown
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Cohen
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Lesli Skolarus
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth Silbermann
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA.,Department of Neurology, VA Portland Health Care System, Portland, OR, USA
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