Pieroni Domenic, Leon Silvia J, Krueger Amanda L, Burton Lauren, Tremblay-Savard Olivier, Tangri Navdeep, Komenda Paul, Bohm Clara, Rigatto Claudio
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Department of Internal Medicine, University of Manitoba, Winnipeg, Canada.
Can J Kidney Health Dis. 2023 Nov 21;10:20543581231212125. doi: 10.1177/20543581231212125. eCollection 2023.
During the 30-day period prior to initiating dialysis, there is a 10-fold rise in emergency department visits and hospitalizations related to kidney failure.
The Virtual Ward Incorporating Electronic Wearables (VIEWER) trial implemented a home telemonitoring system to track changes in patients' vitals and assess their adherence and the acceptability of telemonitoring in a chronic kidney disease (CKD) population.
A pilot prospective clinical trial using a mixed methods approach was performed.
The research was conducted in Winnipeg, Manitoba.
There were 2 phases: Phase 1 was a 2-week-long pilot trial consisting of 10 participants. Phase 2 was a 3-month-long trial with a total of 26 participants. Patients with an estimated glomerular filtration rate <15 and a >40% risk of beginning dialysis in the next 2 years according to the kidney failure risk equation were eligible to participate in the study.
The primary quantitative outcome was adherence, defined as the proportion of daily self-assessments completed using VIEWER over the follow-up period. The usability and acceptability of VIEWER was assessed qualitatively at the end of the trial through structured questionnaires and focus groups.
Phase 1 participants (n = 10) had a median adherence of 77.17% for the 2-week observation period. Phase 2 participants (n = 26) showed a lower median adherence of 36% for the 3-month period. Focus group participants (n = 11) identified many positive aspects of VIEWER, including increased awareness and empowerment over health, simplicity of the data platform, and the ability to show clinical staff their health trends. Some challenges identified with VIEWER were connectivity issues with the Bluetooth, perceived inconvenience, and negative thoughts toward their health.
Limitations of the study include a small sample size, which limited our ability to measure quantitative outcomes. In addition, patients agreeing to participate in any trial are generally more highly motivated and engaged in their care than those declining participation. Therefore, our results may not be generalizable to individuals who are not interested in self-management of their health.
Our results suggest that home telemonitoring in patients with advanced CKD is feasible using a CKD-specific platform like VIEWER. We anticipate that improved functionality with incorporation of feedback from this study will result in greater long-term adherence. A future randomized clinical trial is planned.
在开始透析前的30天内，因肾衰竭而前往急诊科就诊和住院的人数增加了10倍。
“整合电子可穿戴设备的虚拟病房”（VIEWER）试验实施了一个家庭远程监测系统，以跟踪患者生命体征的变化，并评估慢性肾脏病（CKD）患者对远程监测的依从性和接受程度。
采用混合方法进行了一项前瞻性试点临床试验。
研究在加拿大曼尼托巴省温尼伯市进行。
分为两个阶段：第一阶段是为期2周的试点试验，有10名参与者。第二阶段是为期3个月的试验，共有26名参与者。根据肾衰竭风险方程，估计肾小球滤过率<15且未来2年内开始透析风险>40%的患者有资格参与本研究。
主要定量结果是依从性，定义为在随访期间使用VIEWER完成的每日自我评估的比例。在试验结束时，通过结构化问卷和焦点小组对VIEWER的可用性和可接受性进行了定性评估。
第一阶段的参与者（n = 10）在为期2周的观察期内的中位依从性为77.17%。第二阶段的参与者（n = 26）在3个月期间的中位依从性较低，为36%。焦点小组的参与者（n = 11）指出了VIEWER的许多积极方面，包括对健康状况的认识和掌控力增强、数据平台简单，以及能够向临床工作人员展示自己的健康趋势。与VIEWER相关的一些挑战包括蓝牙连接问题、感觉不便以及对自身健康的消极想法。
本研究的局限性包括样本量小，这限制了我们测量定量结果的能力。此外，同意参与任何试验的患者通常比拒绝参与的患者更有积极性并更关注自身护理。因此，我们的结果可能不适用于那些对自我健康管理不感兴趣的个体。
我们的结果表明，使用像VIEWER这样的CKD专用平台对晚期CKD患者进行家庭远程监测是可行的。我们预计，结合本研究的反馈改进功能将带来更高的长期依从性。计划开展未来的随机临床试验。
