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Ortiz Ortigosa L, Vinolo-Gil MJ, Pastora Bernal JM, Casuso-Holgado MJ, Rodriguez-Huguet M, Martín-Valero R. Telerehabilitation and telemonitoring interventions programs used to improving quality of life in people with cystic fibrosis: A systematic review. Digit Health 2023; 9:20552076231197023. [PMID: 37654722 PMCID: PMC10467216 DOI: 10.1177/20552076231197023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/02/2023] Open
Abstract
Background Cystic fibrosis causes mucus to build up in the lungs, digestive tract, and other areas. It is the most common chronic lung disease in children and young adults. It requires daily medical care. Before the COVID-19 pandemic, telerehabilitation and telehealth were used, but it was after this that there was a boom in these types of assistance in order to continue caring for cystic fibrosis patients. Objective The objective is to evaluate the effect of telemedicine programs in people with cystic fibrosis. Methods For the search, the PubMed, Scopus, Web of Science, PEDro, Cochrane, and CINAHL databases were used. Randomized controlled trials, pilot studies, and clinical trials have been included. The exclusion criteria have considered that the population did not have another active disease or that telemedicine was not used as the main intervention. This study follows the PRISMA statement and has been registered in the PROSPERO database (CRD42021257647). Results A total of 11 articles have been included in the systematic review. No improvements have been found in quality of life, forced expiratory volume, and forced vital capacity. Good results have been found in increasing physical activity and early detection of exacerbations. Adherence and satisfaction are very positive and promising. Conclusions Despite not obtaining significant improvements in some of the variables, it should be noted that the adherence and satisfaction of both patients and workers reinforce the use of this type of care. Future studies are recommended in which to continue investigating this topic.
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Affiliation(s)
- Lucía Ortiz Ortigosa
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, CTS-1071 Research Group, Málaga, Spain
| | | | - José-Manuel Pastora Bernal
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, CTS-1071 Research Group, Málaga, Spain
| | - María Jesús Casuso-Holgado
- Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain
| | | | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Málaga, CTS-1071 Research Group, Málaga, Spain
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Pifarré M, Tena A, Clarià F, Solsona F, Vilaplana J, Benavides A, Mas L, Abella F. A Machine-Learning Model for Lung Age Forecasting by Analyzing Exhalations. Sensors (Basel) 2022; 22:1106. [PMID: 35161850 DOI: 10.3390/s22031106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/17/2022]
Abstract
Spirometers are important devices for following up patients with respiratory diseases. These are mainly located only at hospitals, with all the disadvantages that this can entail. This limits their use and consequently, the supervision of patients. Research efforts focus on providing digital alternatives to spirometers. Although less accurate, the authors claim they are cheaper and usable by many more people worldwide at any given time and place. In order to further popularize the use of spirometers even more, we are interested in also providing user-friendly lung-capacity metrics instead of the traditional-spirometry ones. The main objective, which is also the main contribution of this research, is to obtain a person’s lung age by analyzing the properties of their exhalation by means of a machine-learning method. To perform this study, 188 samples of blowing sounds were used. These were taken from 91 males (48.4%) and 97 females (51.6%) aged between 17 and 67. A total of 42 spirometer and frequency-like features, including gender, were used. Traditional machine-learning algorithms used in voice recognition applied to the most significant features were used. We found that the best classification algorithm was the Quadratic Linear Discriminant algorithm when no distinction was made between gender. By splitting the corpus into age groups of 5 consecutive years, accuracy, sensitivity and specificity of, respectively, 94.69%, 94.45% and 99.45% were found. Features in the audio of users’ expiration that allowed them to be classified by their corresponding lung age group of 5 years were successfully detected. Our methodology can become a reliable tool for use with mobile devices to detect lung abnormalities or diseases.
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [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.
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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
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4
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Costa RLF, Costa RF, Gonçalves CP, Cohen RWF, Santana NN. Telemedicine of patients with cystic fibrosis during the COVID-19 pandemic. Rev paul pediatr 2022; 40:e2021118. [PMID: 35544907 PMCID: PMC9095059 DOI: 10.1590/1984-0462/2022/40/2021118in] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 09/05/2021] [Indexed: 11/21/2022]
Abstract
Objective: To describe then experience of implementing routine teleconsultations in respiratory physiotherapy at a reference center for Cystic Fibrosis (CF) in Rio de Janeiro / Brazil, during the COVID-19 pandemic. Methods: Cross-sectional, descriptive, study with children and adolescents with CF. The sample was divided between participants and those who did not participate in the teleconsultations. The teleconsultations were multidisciplinary and carried out by videoconference or telephone, depending on the patient’s availability. The sequence of care provided by the team was organized together with the professionals, so that everyone could carry out individual and sequential teleconsultations. Physiotherapy appointments were divided into two segments: teleconsultation and telemonitoring. Demographic and clinical data were collected. Results: Among the 184 patients assisted in the center, 153 (83.2%) participated in the teleservices and, of these, 33 (21.6%) required telemonitoring; 31 (16.8%) patients did not participate in the teleconsultations for not answering the calls. There was no statistical difference between the group that participated or not in teleservices, nor among those who participated in teleconsultations and telemonitoring. The mean age of the studied population was 7.0±0.4 years. Regarding the CFTR gene mutation, 64.7% had at least one F508del allele and 30.9% of the sample had no pathogens in the sputum test. Conclusions: Most participants with CF participated in teleconsultations, highlighting the importance of remote assistance activities during the COVID-19 pandemic period. This strategy was considered as positive, and it may become permanent in the care of patients with CF.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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7
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Abstract
Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure. Educational aims To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.
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Affiliation(s)
- Neeraj M Shah
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
| | - Georgios Kaltsakas
- Lane Fox Respiratory Service, St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Lane Fox Clinical Respiratory Physiology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Centre for Human and Applied Physiological Sciences (CHAPS), King's College London, London, UK
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8
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Thee S, Stahl M, Fischer R, Sutharsan S, Ballmann M, Müller A, Lorenz D, Urbanski-Rini D, Püschner F, Amelung VE, Fuchs C, Mall MA. A multi-centre, randomized, controlled trial on coaching and telemonitoring in patients with cystic fibrosis: conneCT CF. BMC Pulm Med 2021; 21:131. [PMID: 33882893 PMCID: PMC8058751 DOI: 10.1186/s12890-021-01500-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background The extend of lung disease remains the most important prognostic factor for survival in patients with cystic fibrosis (CF), and lack of adherence is the main reason for treatment failure. Early detection of deterioration in lung function and optimising adherence are therefore crucial in CF care. We implement a randomized controlled trial to evaluate efficacy of telemonitoring of adherence, lung function, and health condition in combination with behavior change interventions using innovative digital technologies. Methods This is a multi-centre, randomized, controlled, non-blinded trial aiming to include 402 patients ≥ 12 years-of-age with CF. A standard-of-care arm is compared to an arm receiving objective, continuous monitoring of adherence to inhalation therapies, weekly home spirometry using electronic devices with data transmission to patients and caring physicians combined with video-conferencing, a self-management app and professional telephone coaching. The duration of the intervention phase is 18 months. The primary endpoint is time to the first protocol-defined pulmonary exacerbation. Secondary outcome measures include number of and time between pulmonary exacerbations, adherence to inhalation therapy, changes in forced expiratory volume in 1 s from baseline, number of hospital admissions, and changes in health-related quality of life. CF-associated medical treatment and care, and health care related costs will be assessed by explorative analysis in both arms. Discussion This study offers the opportunity to evaluate the effect of adherence interventions using telemedicine capable devices on adherence and lung health, possibly paving the way for implementation of telemedicine in routine care for patients with CF. Trial registration: This study has been registered with the German Clinical Trials Register (Identifier: DRKS00024642, date of registration 01 Mar 2021, URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024642). Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01500-y.
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Affiliation(s)
- Stephanie Thee
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Mirjam Stahl
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Lung Research (DZL), Associated Partner, Berlin, Germany
| | | | - Sivagurunathan Sutharsan
- Department of Pulmonary Medicine, Division of Cystic Fibrosis, University Medicine Essen -Ruhrlandklinik, University of Duisburg-Essen, Essen, Germany
| | - Manfred Ballmann
- Department of Pediatrics, University Medicine Rostock, Rostock, Germany
| | | | | | | | - Franziska Püschner
- Private Institute for Applied Health Services Research (Inav) GmbH, Berlin, Germany
| | - Volker Eric Amelung
- Private Institute for Applied Health Services Research (Inav) GmbH, Berlin, Germany
| | | | - Marcus Alexander Mall
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Division of Cystic Fibrosis, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,German Centre for Lung Research (DZL), Associated Partner, Berlin, Germany. .,Berlin Institute of Health (BIH), Berlin, Germany.
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9
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Jaclyn D, Andrew N, Ryan P, Julianna B, Christopher S, Nauman C, Powers M, Gregory S S, George M S. Patient and family perceptions of telehealth as part of the cystic fibrosis care model during COVID-19. J Cyst Fibros 2021; 20:e23-e28. [PMID: 33775604 PMCID: PMC7997421 DOI: 10.1016/j.jcf.2021.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cystic Fibrosis (CF) is a chronic multi-system disease best cared for at Care centers with routine monitoring by interdisciplinary teams. Previously, remote home monitoring technology has been explored to augment in-person care. During the COVID-19 pandemic, traditional in-person care was limited and CF centers rapidly adapted to a telehealth delivery model. The purpose of this study was to understand how people with CF (PwCF) and families of PwCF experienced the shift to telehealthcare delivery. METHODS This was a cross-sectional survey-based study conducted in 11 CF Centers. Two surveys were designed (one for adult PwCF and one for parents/guardians of PwCF) by participating CF center members with patient and family partner input. Surveys were disseminated electronically via email/text to all patients who completed a telehealth visit, and data were collected on secure Google Forms. RESULTS Respondents rated their telehealth experiences as positive. Most were highly satisfied with their telehealth visit (77% adult, 72% pediatric) and found the visits to be highly convenient (85% for all surveyed). A majority of patients reported they had adequate time during the visit and had all questions and concerns addressed. Importantly, we also identified concerns regarding lack of in-person assessments including pulmonary function testing (PFT) and throat/sputum culture. CONCLUSION Telehealth was a feasible and well-accepted mechanism for delivering care in a chronic CF care model during the COVID-19 pandemic and may be useful in the post-pandemic era. Further work is needed to understand the impact of telehealth on patient outcomes, healthcare utilization and associated cost.
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Affiliation(s)
| | - NeSmith Andrew
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Siracusa Christopher
- Cincinnati Children's Hospital, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - M Powers
- Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR, USA
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology, goal setting and text message feedback. HRB Open Res 2020; 3:21. [PMID: 33283151 PMCID: PMC7689601 DOI: 10.12688/hrbopenres.13025.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov
NCT03672058 (14/09/2018)
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Affiliation(s)
- Maire Curran
- School of Allied Health, University of Limerick, Limerick, Ireland.,University Hospital Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Audrey C Tierney
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Health Implementation Science and Technology Research Group, Health Research Institute, University of Limerick, Ireland.,Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | | | | | | | | | - Ali Sheikhi
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Cathal Walsh
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Brenda Button
- Departments of Respiratory Medicine and Physiotherapy, The Alfred, Melbourne, Australia.,Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Rose Galvin
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Ageing Research Centre, Health Research Institute, University of Limerick, Ireland
| | | | - Roisin Cahalan
- School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland.,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
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11
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity in adults with cystic fibrosis: Study Protocol for a pilot randomised trial using wearable technology. HRB Open Res 2020; 3:21. [DOI: 10.12688/hrbopenres.13025.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; wearable technology, smartphone use and remote monitoring, all of which may have potential to impact on PA in adults with CF. The objective of this pilot randomised trial is to explore the effect of wearable technology, which is remotely monitored, combined with personalised text message feedback and goal setting, on PA in adults with CF. Secondary endpoints include lung function, aerobic capacity, quality of life, body composition, wellbeing and sleep. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of wearable technology (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set individualised PA goals with each participant at baseline and will send text message feedback each week. The text messages will be personalised, one-way texts with positive reinforcement on step count attained by the participant. The active comparator group will receive this wearable technology which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. A semi structured interview will assess satisfaction and acceptability of the intervention. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on PA in adults with CF. Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)
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12
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Curran M, Tierney AC, Collins L, Kennedy L, McDonnell C, Jurascheck AJ, Sheikhi A, Walsh C, Button B, Galvin R, Casserly B, Cahalan R. Steps Ahead: optimising physical activity and health in people with cystic fibrosis: Study Protocol for a pilot randomised trial. HRB Open Res 2020; 3:21. [DOI: 10.12688/hrbopenres.13025.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2020] [Indexed: 01/11/2023] Open
Abstract
Background: Physical activity (PA) and exercise are widely documented as key components in the management of cystic fibrosis (CF). In recent years there have been significant improvements in telehealth, in particular; fitness tracking, smartphone use and remote monitoring, all of which may have potential to impact on positive health outcomes in people with CF. The objective of this pilot randomised trial is to explore the potential efficacy of a fitness tracker, which is remotely monitored, combined with personalised text message feedback and goal setting, on lung function, aerobic capacity and PA in adults with CF. Secondary endpoints include quality of life, body composition and wellbeing. Methods: This is a pilot randomised trial which will be conducted at the University Hospital Limerick, Ireland. Participants will be randomised to the intervention or active comparator after their baseline assessment. The 12-week intervention will consist of a fitness tracker (Fitbit Charge 2) which is linked to an online monitoring system (Fitabase) for data collection purposes that enables the physiotherapist to remotely monitor participant data. The CF physiotherapist will set short- and long-term goals with participants and will send one-way text message feedback on Fitbit data and weekly progress. This message will consist of positive reinforcement and re-assess participant goals. The active comparator group will receive a fitness tracker which is also linked to Fitabase; however, no feedback will be provided to participants in this group. Both groups will be re-assessed at 12 weeks. After this point, both groups will continue with the Fitbit alone for a further 12 weeks. Both groups will be re-assessed at 24 weeks. Discussion: This is a novel concept which utilises modern technology, remote monitoring and personalised feedback to investigate the effect on health outcomes in people with CF. Trial registration: ClinicalTrials.gov NCT03672058 (14/09/2018)
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Compton M, Soper M, Reilly B, Gettle L, List R, Bailey M, Bruschwein H, Somerville L, Albon D. A Feasibility Study of Urgent Implementation of Cystic Fibrosis Multidisciplinary Telemedicine Clinic in the Face of COVID-19 Pandemic: Single-Center Experience. Telemed J E Health 2020; 26:978-984. [PMID: 32357084 DOI: 10.1089/tmj.2020.0091] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: The coronavirus 2019 (COVID-19) pandemic has become a major world health problem. All U.S. states have advised their cystic fibrosis (CF) populations to socially isolate. Major health care payors such as Medicare and most private insurance companies have agreed to reimburse health care providers for telemedicine and telephone visits. Methods: The CF adult team at the University of Virginia (UVA) transitioned from face-to-face clinics to multidisciplinary telemedicine clinics by using WebEx® (Cisco Systems, San Jose, CA), a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant platform. Interventions: Patients were contacted before scheduled visits and triaged into: (1) patients eligible for the multidisciplinary telemedicine clinic, (2) patients to be seen in clinic urgently due to acute needs, and (3) stable patients who can be rescheduled at a later time. Ineligible patients for the telemedicine clinic due to lack of access to technology were followed up via telephone. Results: A total of 63 patients were scheduled to be seen in the UVA clinic over 4 weeks, 10 clinic days. Of these patients, 20 (32%) rescheduled their appointment. In addition, 2 patients (3%) were seen in clinic for acute needs and 38 (60%) were seen by the multidisciplinary team through telemedicine. Conclusions: In the context of the COVID-19 pandemic, implementing a telemedicine clinic process that serves the needs of a multidisciplinary care team is paramount to preserving the CF care model. Through a systematic design and test process, a feasible and sustainable program was created that can be utilized by other multidisciplinary programs to adapt to their context.
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Affiliation(s)
- Martina Compton
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Morgan Soper
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Bonnie Reilly
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Lucy Gettle
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Rhonda List
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Molly Bailey
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Heather Bruschwein
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia, USA
| | - Lindsay Somerville
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Dana Albon
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA
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Wood J, Jenkins S, Putrino D, Mulrennan S, Morey S, Cecins N, Hill K. A smartphone application for reporting symptoms in adults with cystic fibrosis: protocol of a randomised controlled trial. BMJ Open 2018; 8:e021136. [PMID: 29680812 PMCID: PMC5914721 DOI: 10.1136/bmjopen-2017-021136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION In people with cystic fibrosis (CF), exacerbations have been shown to have profound and prolonged negative effects such as reducing physical activity and health-related quality of life, increasing the rate of decline of lung function and healthcare costs, and ultimately increasing the risk of mortality. Delayed initiation of treatment following the signs of an exacerbation has been shown to be associated with failure to recover to baseline. Therefore, the late identification and treatment of an exacerbation due to delayed presentation will potentially worsen short-term and long-term outcomes. We have developed a smartphone application, containing questions which require yes or no responses relating to symptoms suggestive of a respiratory exacerbation. Its use is intended to facilitate the early identification of symptoms suggestive of a respiratory exacerbation, and allow the CF team to initiate treatment sooner, thereby potentially reducing the risk of severe exacerbations which require intravenous antibiotics (IVAB) and often a hospital admission. METHODS We will undertake a randomised controlled trial. 60 adults with CF will be recruited and randomised to either the intervention or control group. The intervention group will use the smartphone application weekly for 12 months, or earlier than the next weekly reporting time if they feel their symptoms have worsened. The control group will continue to receive usual care, involving regular (approximately 3 monthly) CF outpatient clinic appointments. The primary outcome measure will be courses and days of IVAB. ETHICS AND DISSEMINATION Approval was obtained from the Sir Charles Gairdner Group Human Research Ethics Committee for WA Health (2015-030) and Curtin University Human Research Ethics Committee (HR212/2015), and has been registered with the Australian and New Zealand Clinical Trials Registry. Results of this study will be presented at international conferences and published in peer-reviewed journals in accordance with the Consolidated Standards of Reporting Trials statement. TRIAL REGISTRATION NUMBER ACTRN12615000599572.
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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, 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, Australia
| | - David Putrino
- Abilities Research Center, Mount Sinai Health System, New York City, New York, USA
- Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Siobhain Mulrennan
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Sue Morey
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, 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
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
- Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Australia
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15
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Abstract
Despite rapid changes in Information and Communication Technology, outpatient chronic disease management has changed very little in decades. However, the introduction of Telemedicine defined here as the use of remote patient-centred clinical services including the use of video and audio connections, telemonitoring and mobile applications provides us with an ideal opportunity to revolutionise care. Its appeal in cystic fibrosis (CF) care is clear offering better access to services, the opportunity of earlier intervention and improved monitoring and self management through virtual clinics and the use of real-time applications for adherence monitoring. It has the potential to reduce costs and has been shown to be effective in other chronic disease conditions. There is a lack of good quality data in CF and studies are needed to provide supportive evidence. Nonetheless, it would seem that telemedicine is the future of CF care.
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van Horck M, Winkens B, Wesseling G, van Vliet D, van de Kant K, Vaassen S, de Winter-de Groot K, de Vreede I, Jöbsis Q, Dompeling E. 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 DOI: 10.1038/s41598-017-10945-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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17
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Wood J, Jenkins S, Putrino D, Mulrennan S, Morey S, Cecins N, Hill K. High usability of a smartphone application for reporting symptoms in adults with cystic fibrosis. J Telemed Telecare 2017; 24:547-552. [PMID: 28799841 DOI: 10.1177/1357633x17723366] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction In cystic fibrosis, exacerbations impair lung function and health-related quality of life, increase healthcare costs and reduce survival. Delayed reporting of worsening symptoms can result in more severe exacerbations and worse clinical outcomes; therefore there is a need for a novel approach to facilitate the early identification and treatment of exacerbations in this population. This study investigated the usability of a smartphone application to report symptoms in adults with cystic fibrosis, and the observer agreement in clinical decision-making between senior clinicians interpreting smartphone application responses. Methods Adults with cystic fibrosis used the smartphone application weekly for four weeks. The application comprised 10 yes/no questions regarding respiratory symptoms and two regarding emotional well-being. Usability was measured with the System Usability Scale; Observer agreement was tested by providing a cystic fibrosis physician and a nurse practitioner with 45 clinical scenarios. For each scenario the clinicians, who were blinded to each other's responses, were asked to indicate whether or not they would: (i) initiate telephone contact, and/or (ii) request a clinic visit for the individual. Results Ten participants (five female), aged mean (SD) 33 (11) years, FEV1 49 (27)% predicted completed the study. The mean (SD) System Usability Scale score was 94 (6). There was perfect agreement between clinicians for initiating contact with the participant ( κ = 1.0, p < 0.001), and near-perfect for requesting a clinic visit ( κ = 0.86, p < 0.001). Discussion The use of a smartphone application for reporting symptoms in adults with cystic fibrosis has excellent usability and near-perfect agreement between senior clinicians when interpreting the application responses.
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Affiliation(s)
- Jamie Wood
- 1 School of Physiotherapy and Exercise Science, Curtin University, Western Australia.,2 Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia
| | - Sue Jenkins
- 1 School of Physiotherapy and Exercise Science, Curtin University, Western Australia.,2 Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia
| | - David Putrino
- 4 Department of Telemedicine and Virtual Rehabilitation, Burke Institute of Medical Research, USA.,5 Department of Rehabilitation Medicine, Weill Cornell Medicine, USA
| | - Siobhain Mulrennan
- 3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia.,6 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Western Australia
| | - Sue Morey
- 3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia.,6 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Western Australia
| | - Nola Cecins
- 2 Physiotherapy Department, Sir Charles Gairdner Hospital, Western Australia
| | - Kylie Hill
- 1 School of Physiotherapy and Exercise Science, Curtin University, Western Australia.,3 Institute for Respiratory Health, Sir Charles Gairdner Hospital, Western Australia
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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19
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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20
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Balzano J, Fresenius A, Walker P, Berdella M, Portenoy RK, Bookbinder M, Glajchen M, Plachta A, Langfelder-Schwind E, Chen J, Dhingra L. Web-based symptom screening in cystic fibrosis patients: A feasibility study. J Cyst Fibros 2016; 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] [What about the content of this article? (0)] [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.
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21
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Abstract
Health outcomes for individuals with cystic fibrosis (CF) have dramatically improved in parallel with better organization of clinical care systems, evolution of novel therapeutics, and improvements in diagnosis and screening for CF and CF-related complications. In parallel with these advances has come an increasing complexity and burden of care, leading to challenges with adherence to treatment regimens. As novel therapeutics continue to be developed and introduced to the CF care regimen, there are clear opportunities to refine and personalize care. This can be done by adding comparative effectiveness research to the CF clinical research paradigm and integrating novel technologies in drug delivery and remote monitoring that can facilitate adherence but also reduce the burden of treatment while maintaining efficacy. This review highlights both the challenges of the increasingly complex treatment regimens in CF and the opportunities to advance care by addressing adherence, implementation science, comparative effectiveness, and integration of novel technologies in CF care.
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Affiliation(s)
- Gregory S Sawicki
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts
| | - Christopher H Goss
- Division of Pulmonary Medicine, Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
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22
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Affiliation(s)
| | - Jennifer Mallow
- School of Nursing and West Virginia Clinical Translational Science Institute (WVCTSI), West Virginia University (WVU), Morgantown, WV, USA
| | - Georgia L Narsavage
- Robert C. Byrd Health Sciences Center, Mary Babb Randolph Cancer Center, and WVCTSI, West Virginia University, Morgantown, WV, USA
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23
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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.
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Affiliation(s)
- Narelle S Cox
- La Trobe/Alfred Health Clinical School, Level 4, The Alfred Centre, 99 Commercial Road, Prahran, Victoria 3181, Australia.
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