Home Monitoring in Patients with Idiopathic Pulmonary Fibrosis
A Randomized Controlled Trial
Rationale: Idiopathic pulmonary fibrosis (IPF) is a deadly disease with increasingly impaired health-related quality of life (HRQOL). eHealth technologies facilitate collection of physiological outcomes and patient-reported outcomes at home, but randomized controlled trials (RCTs) on the effects of eHealth are scarce.
Objectives: To investigate whether a home monitoring program improves HRQOL and medication use for patients with IPF.
Methods: We performed a multicenter RCT in newly treated patients with IPF. Patients were randomly assigned to standard care or a home monitoring program on top of standard care for 24 weeks. The home monitoring program included home spirometry, reporting of symptoms and side effects, patient-reported outcomes, information, a medication coach, and eConsultations. The primary endpoint was between-group difference in change in King's Brief Interstitial Lung Disease Questionnaire (K-BILD) score at 24 weeks.
Measurements and Main Results: A total of 90 patients were randomized (46 assigned to the home monitoring group and 44 to the standard care group). After 24 weeks, no statistically significant difference was found in K-BILD total score, with a 2.70-point increase in the home monitoring group (SD = 9.5) and a 0.03-point increase in the standard care group (SD = 10.4); between-group difference was 2.67 points (95% confidence interval [CI], -1.85 to 7.17; P = 0.24). Between-group difference in psychological domain score was 5.6 points (95% CI, -1.13 to 12.3; P = 0.10), with an increase of 5.12 points in the home monitoring group (SD = 15.8) and a decline of 0.48 points in the standard care group (SD = 13.3). In the home monitoring group, medication was more often adjusted (1 vs. 0.3 adjustments per patient; 95% CI, 0.2 to 1.3; P = 0.027). Patient satisfaction with the home monitoring program was high. Home-based spirometry was highly correlated with hospital-based spirometry over time.
Conclusions: The results of this first-ever eHealth RCT in IPF showed that a comprehensive home monitoring program did not improve overall HRQOL measured with K-BILD but tended to improve psychological well-being. Home monitoring was greatly appreciated by patients and allowed for individually tailored medication adjustments.Clinical trial registered with www.clinicaltrials.gov (NCT03420235).
|Keywords||eHealth, home spirometry, idiopathic pulmonary fibrosis, interstitial lung disease, quality of life|
|Persistent URL||dx.doi.org/10.1164/rccm.202002-0328OC, hdl.handle.net/1765/129544|
|Journal||American Journal of Respiratory and Critical Care Medicine|
Moor, C.C, Mostard, R, Grutters, J.C, Bresser, P, Aerts, J.G.J.V, Chavannes, N.H, & Wijsenbeek-Lourens, M.S. (2020). Home Monitoring in Patients with Idiopathic Pulmonary Fibrosis. American Journal of Respiratory and Critical Care Medicine, 202(3), 393–401. doi:10.1164/rccm.202002-0328OC