title: Telemonitoring and Mobile Phone-Based Health Coaching Among Finnish Diabetic and Heart Disease Patients: Randomized Controlled Trial.
abstract: BACKGROUND
  There is a strong will and need to find alternative models of health care delivery driven by the ever-increasing burden of chronic diseases.
  
  
  OBJECTIVE
  The purpose of this 1-year trial was to study whether a structured mobile phone-based health coaching program, which was supported by a remote monitoring system, could be used to improve the health-related quality of life (HRQL) and/or the clinical measures of type 2 diabetes and heart disease patients.
  
  
  METHODS
  A randomized controlled trial was conducted among type 2 diabetes patients and heart disease patients of the South Karelia Social and Health Care District. Patients were recruited by sending invitations to randomly selected patients using the electronic health records system. Health coaches called patients every 4 to 6 weeks and patients were encouraged to self-monitor their weight, blood pressure, blood glucose (diabetics), and steps (heart disease patients) once per week. The primary outcome was HRQL measured by the Short Form (36) Health Survey (SF-36) and glycosylated hemoglobin (HbA1c) among diabetic patients. The clinical measures assessed were blood pressure, weight, waist circumference, and lipid levels.
  
  
  RESULTS
  A total of 267 heart patients and 250 diabetes patients started in the trial, of which 246 and 225 patients concluded the end-point assessments, respectively. Withdrawal from the study was associated with the patients' unfamiliarity with mobile phones—of the 41 dropouts, 85% (11/13) of the heart disease patients and 88% (14/16) of the diabetes patients were familiar with mobile phones, whereas the corresponding percentages were 97.1% (231/238) and 98.6% (208/211), respectively, among the rest of the patients (P=.02 and P=.004). Withdrawal was also associated with heart disease patients' comorbidities—40% (8/20) of the dropouts had at least one comorbidity, whereas the corresponding percentage was 18.9% (47/249) among the rest of the patients (P=.02). The intervention showed no statistically significant benefits over the current practice with regard to health-related quality of life—heart disease patients: beta=0.730 (P=.36) for the physical component score and beta=-0.608 (P=.62) for the mental component score; diabetes patients: beta=0.875 (P=.85) for the physical component score and beta=-0.770 (P=.52) for the mental component score. There was a significant difference in waist circumference in the type 2 diabetes group (beta=-1.711, P=.01). There were no differences in any other outcome variables.
  
  
  CONCLUSIONS
  A health coaching program supported with telemonitoring did not improve heart disease patients' or diabetes patients' quality of life or their clinical condition. There were indications that the intervention had a differential effect on heart patients and diabetes patients. Diabetes patients may be more prone to benefit from this kind of intervention. This should not be neglected when developing new ways for self-management of chronic diseases.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01310491; http://clinicaltrials.gov/ct2/show/NCT01310491 (Archived by WebCite at http://www.webcitation.org/6Z8l5FwAM).
authors.affiliation: Eksote, South Karelia Social and Health Care District, Lappeenranta, Finland.
authors.forename: Tuula
authors.identifier: http://orcid.org/0000-0001-7192-0582
authors.initials: T
authors.lastname: Karhula
authors.forename: Anna-Leena
authors.identifier: http://orcid.org/0000-0002-5658-1305
authors.initials: AL
authors.lastname: Vuorinen
authors.forename: Katja
authors.identifier: http://orcid.org/0000-0001-7794-6820
authors.initials: K
authors.lastname: Rääpysjärvi
authors.forename: Mira
authors.identifier: http://orcid.org/0000-0002-3104-2655
authors.initials: M
authors.lastname: Pakanen
authors.forename: Pentti
authors.identifier: http://orcid.org/0000-0002-8624-4561
authors.initials: P
authors.lastname: Itkonen
authors.forename: Merja
authors.identifier: http://orcid.org/0000-0001-9012-1989
authors.initials: M
authors.lastname: Tepponen
authors.forename: Ulla-Maija
authors.identifier: http://orcid.org/0000-0002-3676-3312
authors.initials: UM
authors.lastname: Junno
authors.forename: Tapio
authors.identifier: http://orcid.org/0000-0003-3407-8669
authors.initials: T
authors.lastname: Jokinen
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0002-0029-1771
authors.initials: M
authors.lastname: van Gils
authors.forename: Jaakko
authors.identifier: http://orcid.org/0000-0002-9358-6332
authors.initials: J
authors.lastname: Lähteenmäki
authors.forename: Kari
authors.identifier: http://orcid.org/0000-0002-2126-3550
authors.initials: K
authors.lastname: Kohtamäki
authors.forename: Niilo
authors.identifier: http://orcid.org/0000-0003-0024-3064
authors.initials: N
authors.lastname: Saranummi
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D001794:Blood Pressure; D001795:Blood Pressure Determination; D001835:Body Weight; D040421:Cell Phone; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D005387:Finland; D006442:Glycated Hemoglobin / Q000032:analysis; D006293:Health Promotion / Q000379:methods*; D006304:Health Status; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D008991:Monitoring, Physiologic; D017202:Myocardial Ischemia / Q000628:therapy*; D011788:Quality of Life; D012648:Self Care / Q000379:methods*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: health coaching; health-related quality of life; heart disease; personal health record; telemonitoring; type 2 diabetes