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Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial

BACKGROUND: 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. OBJECTIVE: The Virtual Ward Incorporating Electronic Wearables (VIEWER) trial implemented a home telemonitoring system to track ch...

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Autores principales: Pieroni, Domenic, Leon, Silvia J., Krueger, Amanda L, Burton, Lauren, Tremblay-Savard, Olivier, Tangri, Navdeep, Komenda, Paul, Bohm, Clara, Rigatto, Claudio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10666721/
https://www.ncbi.nlm.nih.gov/pubmed/38020485
http://dx.doi.org/10.1177/20543581231212125
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author Pieroni, Domenic
Leon, Silvia J.
Krueger, Amanda L
Burton, Lauren
Tremblay-Savard, Olivier
Tangri, Navdeep
Komenda, Paul
Bohm, Clara
Rigatto, Claudio
author_facet Pieroni, Domenic
Leon, Silvia J.
Krueger, Amanda L
Burton, Lauren
Tremblay-Savard, Olivier
Tangri, Navdeep
Komenda, Paul
Bohm, Clara
Rigatto, Claudio
author_sort Pieroni, Domenic
collection PubMed
description BACKGROUND: 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. OBJECTIVE: 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. DESIGN: A pilot prospective clinical trial using a mixed methods approach was performed. SETTING: The research was conducted in Winnipeg, Manitoba. PARTICIPANTS: 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. METHODS: 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. RESULTS: 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: 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. CONCLUSION: 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.
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spelling pubmed-106667212023-11-21 Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial Pieroni, Domenic Leon, Silvia J. Krueger, Amanda L Burton, Lauren Tremblay-Savard, Olivier Tangri, Navdeep Komenda, Paul Bohm, Clara Rigatto, Claudio Can J Kidney Health Dis Original Clinical Research Mixed Method BACKGROUND: 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. OBJECTIVE: 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. DESIGN: A pilot prospective clinical trial using a mixed methods approach was performed. SETTING: The research was conducted in Winnipeg, Manitoba. PARTICIPANTS: 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. METHODS: 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. RESULTS: 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: 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. CONCLUSION: 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. SAGE Publications 2023-11-21 /pmc/articles/PMC10666721/ /pubmed/38020485 http://dx.doi.org/10.1177/20543581231212125 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Original Clinical Research Mixed Method
Pieroni, Domenic
Leon, Silvia J.
Krueger, Amanda L
Burton, Lauren
Tremblay-Savard, Olivier
Tangri, Navdeep
Komenda, Paul
Bohm, Clara
Rigatto, Claudio
Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
title Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
title_full Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
title_fullStr Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
title_full_unstemmed Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
title_short Use of Wearable and Wireless Technology in Real-World Clinical Settings to Improve Patient Outcomes in Chronic Kidney Disease: A Mixed Methods Pilot Prospective Trial
title_sort use of wearable and wireless technology in real-world clinical settings to improve patient outcomes in chronic kidney disease: a mixed methods pilot prospective trial
topic Original Clinical Research Mixed Method
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10666721/
https://www.ncbi.nlm.nih.gov/pubmed/38020485
http://dx.doi.org/10.1177/20543581231212125
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