A Randomized Controlled Trial of a Mobile Health Intervention to Promote Self-Management After Lung Transplantation
Lung transplant recipients are encouraged to perform self-management behaviors, including (i) monitoring health indicators, (ii) adhering to their regimen, and (iii) reporting abnormal health indicators to the transplant coordinator, yet performance is suboptimal. When hospital discharge was imminent, this two-group trial randomized 201 recipients to use either the mobile health (mHealth) intervention (n = 99) or usual care (n = 102), to compare efficacy for promoting self-management behaviors (primary outcomes) and self-care agency, rehospitalization, and mortality (secondary outcomes) at home during the first year after transplantation. The mHealth intervention group performed self-monitoring (odds ratio [OR] 5.11, 95% confidence interval [CI] 2.95-8.87, p < 0.001), adhered to medical regimen (OR 1.64, 95% CI 1.01-2.66, p = 0.046), and reported abnormal health indicators (OR 8.9, 95% CI 3.60-21.99, p < 0.001) more frequently than the usual care group. However, the two groups did not differ in rehospitalization (OR 0.78, 95% CI 0.36-1.66, p = 0.51) or mortality (hazard ratio 1.71, 0.68-4.28, p = 0.25). The positive impact of the mHealth intervention on self-management behaviors suggests that the intervention holds promise and warrants further testing.
CET Conclusion
| Reviewer: | Sir Peter Morris, Centre for Evidence in Transplantation, The Royal College of Surgeons of England. |
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| Conclusion: | This is a very nice study from Pittsburgh evaluating the use of a mobile health intervention (Pocket PATH) to allow patients after lung transplantation to monitor their own course. The outcomes were compared with a similar group of recipients who just had usual care. Two hundred and one patients were randomised in this study (so it is a sizeable group) and the self-management behaviours, such as self-care, rehospitalisation and mortality, were evaluated during the first year after transplantation. The mobile mHealth intervention group performed better with self-monitoring, adherence to the medical regimen and the reporting of abnormal health indicators than the usual care group, but there was no difference in rehospitalisation or mortality between the two groups. Thus, as the authors suggest, this mHealth intervention on self-management behaviours does hold promise and warrants further testing. I could not agree more and this approach might well be applicable to transplantation of other organs. |
Expert Review
| Reviewer: | Associate Professor Lianne G. Singer and Ms Paulette Dalton, University of Toronto and Toronto Lung Transplant Program, Canada |
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| Conflicts of Interest: | No |
| Clinical Impact Rating | 3 |
| Review: | This is a good quality RCT conducted in Pittsburgh to evaluate the effectiveness of a mobile health intervention (Pocket PATH) in 201 lung transplant recipients recruited prior to discharge and followed for one year. The study reports improved self-management behaviours in the Pocket PATH group over usual care, specifically self-monitoring, adherence and reporting critical abnormal health indicators. Of note though, both groups showed a decline in self-management behaviours over time, which perhaps contributed to the lack of difference noted in health outcomes (survival and readmission) between the two groups. Limitations to generalizability include the relatively old patient cohort (either mainly or exclusively in their 50s and 60s), whereas nonadherence may be more prevalent among younger patients. Furthermore about half the patients had obstructive disease as the indication for transplantation which may not be representative of many contemporary transplant programs. The exact study intervention may not be easy to replicate in other programs since it required provision of smartphones to patients and may not use contemporary technology. However the study serves as a good model for other programs, highlighting the promise and pitfalls of mobile health interventions. |
Methodological quality
| Jadad score | 3 |
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| Allocation concealment | YES |
| Data analysis | AVAILABLE CASE ANALYSIS |
Study Details
| Aims: | To compare the mobile health intervention pocket PATH in promoting self-management behaviours versus usual care in lung transplant recipients. |
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| Interventions: | Participants were randomized to receive either Pocket PATH or usual care. |
| Participants: | 201 lung transplant recipients aged > 18 years. |
| Outcomes: | Primary outcomes measured were self-monitoring, adhering to the regime, and reporting critical health changes. Secondary measured outcomes were perceived capability to engage in self care, rehospitalisation and mortality. |
| Follow Up: | 12 months |
Metadata
| Funding: | Non-industry funding |
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| Publication type: | Randomized Controlled Trial, Randomised Controlled Trial |
| Trial registration: | ClinicalTrials.gov - NCT00818025 |
| Organ: | Lung |
| Language: | English |
| Author email: | ajdst42@pitt.edu |
| MeSH terms: | Aged; Female; Follow-Up Studies; Health Behavior; Humans; Lung Transplantation; Male; Medication Adherence; Middle Aged; Prognosis; Quality of Life; Reminder Systems; Self Care; Telemedicine |