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Am J Transplant. 2017 May;17(5):1286-1293. doi: 10.1111/ajt.14062. Epub 2016 Oct 31.

Long-Term Follow-up of a Randomized Controlled Trial Evaluating a Mobile Health Intervention for Self-Management in Lung Transplant Recipients.

Author information

1
Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.
2
Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA.
3
Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
4
Departments of Medicine, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.
5
Departments of Medicine, Pediatrics, and Cell Biology and Physiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
6
Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA.

Abstract

Mobile health interventions may help transplant recipients follow their complex medical regimens. Pocket Personal Assistant for Tracking Health (Pocket PATH) is one such intervention tailored for lung transplant recipients. A randomized controlled trial showed Pocket PATH's superiority to usual care for promoting the self-management behaviors of adherence, self-monitoring and communication with clinicians during posttransplant year 1. Its long-term impact was unknown. In this study, we examined associations between Pocket PATH exposure during year 1 and longer term clinical outcomes-mortality and bronchiolitis obliterans syndrome (BOS)-among 182 recipients who survived the original trial. Cox regression assessed whether (a) original group assignment and (b) performance of self-management behaviors during year 1 predicted time to outcomes. Median follow-up was 5.7 years after transplant (range 4.2-7.2 years). Pocket PATH exposure had no direct effect on outcomes (p-values >0.05). Self-monitoring was associated with reduced mortality risk (hazard ratio [HR] 0.45; 95% confidence interval [CI] 0.22-0.91; p = 0.027), and reporting abnormal health indicators to clinicians was associated with reduced risks of mortality (HR 0.15; 95% CI 0.04-0.65; p = 0.011) and BOS (HR 0.27; 95% CI 0.08-0.86; p = 0.026), regardless of intervention group assignment. Although Pocket PATH did not have a direct impact on long-term outcomes, early improvements in self-management facilitated by Pocket PATH may be associated with long-term clinical benefit.

KEYWORDS:

allied health/nursing; bronchiolitis obliterans (BOS); clinical research/practice; compliance/adherence; lung transplantation/pulmonology; patient survival; social sciences

PMID:
27664940
PMCID:
PMC5365382
DOI:
10.1111/ajt.14062
[Indexed for MEDLINE]
Free PMC Article

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