a Department of Respiratory Medicine , Aintree University Hospitals NHS Foundation Trust , Liverpool , UK.
b Physiotherapist Department , Aintree University Hospital NHS Foundation Trust , Liverpool , UK.
Amyotroph Lateral Scler Frontotemporal Degener. 2019 Aug;20(5-6):336-347. doi: 10.1080/21678421.2019.1587630. Epub 2019 Mar 26.
: Previous studies suggest a positive impact of telehealth in the care of people with motor neuron disease/amyotrophic lateral sclerosis (MND/ALS). This study reports the development of self-reported questions for telemonitoring, using a tablet-based device Careportal, in the care of patients with MND on noninvasive ventilation (NIV) and its initial impact. : The study consisted of a question development phase and an evaluation phase of the use of Careportal. The development phase employed a modified Delphi process. The evaluation phase involved a 24-week pilot study with 13 patients (median age = 66; median illness duration = 14 m), who were using NIV. The participants completed overnight oximetry and self-report questions Careportal each week, generating interventions where required. Patient-ventilator interaction (PVI) data were monitored and the revised ALS functional rating scale (ALSFRS-R) was completed. : Telemonitoring encompassing the newly developed 26-item symptom questions showed good feasibility and validity. During the evaluation phase, 61 interventions were made for 10 patients, including seven patients who had routine clinic appointments during the trial to optimize care. ALSFRS-R showed significant illness deteriorations. Blood oxygen saturation (SpO) levels were maintained, time ventilated and inspiratory pressures increased during the trial. : The MND OptNIVent question set together with weekly ventilator and oximetry monitoring facilitated the maintenance of ventilation and SpO levels despite illness progression. The use of the question set, and devices, such as Careportal, facilitate care and may further enable a single point of contact for patients from which clinicians may offer proactive interventions to optimize care.
先前的研究表明,远程医疗在运动神经元病/肌萎缩侧索硬化症(MND/ALS)患者的护理中具有积极影响。本研究报告了使用基于平板电脑的设备 Careportal 进行远程监测的自我报告问题的开发情况,并介绍了其初步应用效果。
该研究包括问题开发阶段和 Careportal 使用评估阶段。开发阶段采用了改良 Delphi 流程。评估阶段涉及一项为期 24 周的试点研究,共纳入 13 名接受无创通气(NIV)治疗的 MND 患者(中位年龄=66 岁;中位病程=14 个月)。参与者每周使用 Careportal 完成夜间血氧饱和度和自我报告问题的监测,根据需要生成干预措施。监测患者-呼吸机交互(PVI)数据,并完成修订后的肌萎缩侧索硬化功能评定量表(ALSFRS-R)。
涵盖新开发的 26 项症状问题的远程监测具有良好的可行性和有效性。在评估阶段,对 10 名患者中的 61 名患者进行了干预,其中包括 7 名患者在试验期间进行了常规门诊就诊,以优化治疗。ALSFRS-R 显示疾病明显恶化。血氧饱和度(SpO)水平在试验期间保持稳定,通气时间和吸气压力增加。
MND OptNIVent 问题集以及每周的呼吸机和血氧监测有助于在疾病进展的情况下维持通气和 SpO 水平。问题集以及 Careportal 等设备的使用有助于护理,并可能进一步为患者提供一个单一的联系点,以便临床医生主动提供干预措施来优化治疗。