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一项关于囊性纤维化患者的指导与远程监测的多中心、随机对照试验:conneCT CF。

A multi-centre, randomized, controlled trial on coaching and telemonitoring in patients with cystic fibrosis: conneCT CF.

作者信息

Thee Stephanie, Stahl Mirjam, Fischer Rainald, Sutharsan Sivagurunathan, Ballmann Manfred, Müller Axel, Lorenz Daniel, Urbanski-Rini Dominika, Püschner Franziska, Amelung Volker Eric, Fuchs Carola, Mall Marcus Alexander

机构信息

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.

出版信息

BMC Pulm Med. 2021 Apr 21;21(1):131. doi: 10.1186/s12890-021-01500-y.

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 ).

摘要

背景

肺部疾病的严重程度仍然是囊性纤维化(CF)患者生存的最重要预后因素,而治疗依从性差是治疗失败的主要原因。因此,早期发现肺功能恶化并优化依从性在CF护理中至关重要。我们开展了一项随机对照试验,以评估使用创新数字技术进行依从性、肺功能和健康状况远程监测并结合行为改变干预措施的疗效。

方法

这是一项多中心、随机、对照、非盲试验,旨在纳入402名年龄≥12岁的CF患者。将一个标准治疗组与一个接受以下干预的组进行比较:对吸入疗法的依从性进行客观、持续监测,使用电子设备每周在家进行肺功能测定并将数据传输给患者和护理医生,同时结合视频会议、一个自我管理应用程序和专业电话辅导。干预阶段为期18个月。主要终点是首次出现方案定义的肺部加重的时间。次要结局指标包括肺部加重的次数和两次加重之间的时间、吸入疗法的依从性、1秒用力呼气量相对于基线的变化、住院次数以及健康相关生活质量的变化。将通过对两组的探索性分析来评估CF相关的医疗治疗和护理以及医疗保健相关成本。

讨论

本研究提供了一个机会,以评估使用远程医疗设备进行依从性干预对依从性和肺部健康的影响,这可能为在CF患者的常规护理中实施远程医疗铺平道路。

试验注册

本研究已在德国临床试验注册中心注册(标识符:DRKS00024642,注册日期2021年3月1日,网址:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024642 )。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f8a1/8061199/22a0f88a1dff/12890_2021_1500_Fig1_HTML.jpg

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