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J Cyst Fibros. 2019 Sep 12. pii: S1569-1993(19)30887-2. doi: 10.1016/j.jcf.2019.09.002. [Epub ahead of print]

A smartphone application for reporting symptoms in adults with cystic fibrosis improves the detection of exacerbations: Results of a randomised controlled trial.

Author information

1
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, Western Australia, Australia.
2
Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America; Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America.
3
Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
4
Physiotherapy Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
5
Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, Western Australia, Australia.
6
School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia; Institute for Respiratory Health, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia. Electronic address: k.hill@curtin.edu.au.

Abstract

BACKGROUND:

Respiratory exacerbations impair lung function and health-related quality of life in people with CF, with delayed identification of exacerbations often resulting in worse outcomes. We developed a smartphone application (app) for adults with CF to report symptoms to the CF team, and investigated its impact on antibiotic use and other outcomes.

METHODS:

Participants were randomised to intervention (use of the app weekly or sooner if symptoms had worsened) or control (usual care). The app comprised questions relating to symptoms suggestive of an exacerbation. If worsening symptoms were reported, the participant was contacted by the nurse practitioner. The primary outcome measure was the number of courses and days of intravenous (IV) antibiotics.

RESULTS:

Sixty participants (29 female, aged [mean ± SD] 31 ± 9 years, FEV1 60 ± 18% predicted) were recruited, with 29 (48%) allocated to the intervention group. Over the 12-month follow-up, there was no clear effect of the app on the number of courses of IV antibiotics (incidence rate ratio [IRR] 1; 95% confidence interval [CI] 0.6 to 1.7), however number of courses of oral antibiotics increased (IRR 1.5; 95% CI 1.0 to 2.2). The median (IQR) time to detection of exacerbation requiring oral or IV antibiotics was shorter in the intervention group compared with the control group (70 [123] vs. 141 [140] days; p = .02). No between-group differences were observed in other outcomes.

CONCLUSION:

The use of an app reduced time to detect respiratory exacerbations that required antibiotics, however did not demonstrate a clear effect on the number of courses of IV antibiotics.

KEYWORDS:

Cystic fibrosis; Exacerbation; Smartphone; Telehealth; Telemedicine

PMID:
31522924
DOI:
10.1016/j.jcf.2019.09.002

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