Long-Term Follow-up of a Randomized Controlled Trial Evaluating a Mobile Health Intervention for Self-Management in Lung Transplant Recipients.
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.
Department of Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.
E M
http://orcid.org/0000-0001-6387-4950
EM
Rosenberger
Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA.
A J
AJ
DeVito Dabbs
Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
A F
AF
DiMartini
Departments of Medicine, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA.
D P
DP
Landsittel
Departments of Medicine, Pediatrics, and Cell Biology and Physiology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
J M
JM
Pilewski
Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA.
M A
http://orcid.org/0000-0002-4666-1870
MA
Dew
D001989:Bronchiolitis Obliterans / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D000073278:Self-Management; D017216:Telemedicine / Q000706:statistics & numerical data*; D066027:Transplant Recipients
allied health/nursing; bronchiolitis obliterans (BOS); clinical research/practice; compliance/adherence; lung transplantation/pulmonology; patient survival; social sciences
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