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Long‐Term Follow‐up of a Randomized Controlled Trial Evaluating a Mobile Health Intervention for Self‐Management in Lung Transplant Recipients
Author(s) -
Rosenberger E. M.,
DeVito Dabbs A. J.,
DiMartini A. F.,
Landsittel D. P.,
Pilewski J. M.,
Dew M. A.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14062
Subject(s) - medicine , randomized controlled trial , self management , intervention (counseling) , term (time) , intensive care medicine , physical therapy , surgery , nursing , physics , quantum mechanics , machine learning , computer science
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.