Use of electronic data collection to assess pain in thalassaemia: a feasibility study

Patient- and Caregiver-Reported Burden of Transfusion-Dependent β-Thalassemia Measured Using a Digital Application

Background and Objective

Transfusion-dependent β-thalassemia (TDT) is a rare genetic disease characterized by a deficiency of functional β-globin, ultimately leading to lifelong dependence on blood transfusions. There is little patient- and caregiver-reported data with which to understand the holistic and societal impact of TDT. The objective of this study was to evaluate the patient- and caregiver-reported disease-management, symptom, and quality-of-life burden of TDT.

Methods

We conducted a prospective, observational, real-world study of adults with TDT and caregivers of adolescents with TDT, in Italy, the UK, and the USA. Over 90 days, participants used a smartphone application to respond to surveys about their or their dependent’s TDT, including bespoke background and disease-management surveys, the Brief Fatigue Inventory (BFI), the Transfusion-dependent Quality of life questionnaire (TranQol), and the Brief Pain Inventory Short Form (BPI-SF).

Results

Eighty-five individuals participated. Mean BFI and TranQol scores on enrollment were 5.0 (0–10 scale; 10 = worst symptoms) and 51 (0–100 scale; 100 = best quality of life), respectively. Mean transfusion frequency was every 3.2 weeks. Mean time spent on TDT management was 592 min on transfusion days and 91 min on non-transfusion days (11 h per week). Mean BFI and BPI-SF “worst fatigue” and “worst pain” scores were higher in the 5 days pre-transfusion than in the 5 days post-transfusion (fatigue 5.05 vs 4.29; pain 4.33 vs 3.85; 0–10 scale; 10 = worst symptoms).

Conclusions

The patient- and caregiver-reported burden of TDT is high, influenced by disease-management time, fatigue, pain, and quality-of-life impairment.

Electronic supplementary material

The online version of this article (10.1007/s40271-020-00473-0) contains supplementary material, which is available to authorized users.

Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia

BACKGROUND

Thalassemia syndromes are inherited hemoglobin disorders that result when the synthesis of normal hemoglobin is lacking or significantly reduced. For people with thalassemia, long-term red blood cell transfusion remains the mainstay of therapy, which may lead to iron overload causing severe complications and damage in different body organs. Long-term iron chelation therapy is essential for people with thalassemia to minimize the ongoing iron-loading process. In addition, suboptimal adherence can increase adverse events associated with iron overload and result in increased morbidity, mortality, healthcare utilization and cost of care.

OBJECTIVES

To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including:- evaluating the effects of using computer and mobile technology interventions for medication adherence and disease management on health and behavioral outcomes;- identifying and assessing the effects of computer and mobile technology interventions specific to different age groups (children, adolescents and adults) and type of modality (e.g. cell phone, the Internet).

SEARCH METHODS

We searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO, ProQuest Dissertations & Theses Global, Psychology and Behavioral Sciences Collection, Web of Science Science & Social Sciences Conference Proceedings Indexes, IEEE Xplore and ongoing trial databases (22 February 2018). We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register (20 June 2019). We also searched for unpublished work in the abstract book of nine major conferences in the related field.

SELECTION CRITERIA

Randomized controlled trials (RCT) and quasi-RCTs comparing single- or multi-component interventions versus no intervention, placebo or standard care, with adherence to iron chelation as the primary outcome were eligible for inclusion. Non-randomized studies of interventions, controlled before-after studies, and interrupted-time-series studies were also eligible for inclusion.

DATA COLLECTION AND ANALYSIS

Three authors independently assessed study eligibility. If we had included any studies, we would have independently assessed risk of bias and extracted data; we planned to assess the quality of the evidence using GRADE.

MAIN RESULTS

We did not identify any eligible studies for inclusion in the review.

AUTHORS' CONCLUSIONS

Due to lack of evidence, we cannot comment on the efficacy or effectiveness of computer and mobile technology intervention strategies to promote disease management and adherence to iron chelation therapy in people with thalassemia.We concluded that RCTs are needed to examine a variety of computer and mobile technology intervention strategies that may be useful for promoting disease management and increasing adherence to iron chelation therapy in individuals with thalassemia.

Electronic and paper mode of data capture when assessing patient-reported outcomes in the National Dental Practice-Based Research Network

AIM

Our objectives were to describe the approach used in the National Dental Practice-Based Research Network to capture patient-reported outcomes and to compare electronic and paper modes of data capture in a specific network study.

METHODS

This was a prospective, multicenter cohort study of 1862 patients with dentin hypersensitivity. Patient-reported outcomes were assessed based on patients' perception of pain using Visual Analog Scales and Labeled Magnitude scales at baseline and at 1, 4 and 8 weeks post-baseline.

RESULTS

Eighty-five percent of study patients chose to complete follow-up assessments via an electronic mode; 15% completed them via a paper mode. There was not a significant difference in the proportions of patients who completed the 8-week assessment when comparing the electronic mode to the paper mode (92% vs. 90.8%, P = 0.31, Rao-Scott clustered χ² -test).

CONCLUSION

The electronic mode of data capture was as operational as the traditional paper mode, while also providing the advantage of eliminating data entry errors, not involving site research coordinators in measuring the patient-reported outcomes, and not incurring cost and potential delays due to mailing study forms. Electronic data capture of patient reported outcomes could be successfully implemented in the community dental practice setting.