Transplant Trial Watch

Impact of a Mobile Health Intervention on Long-term Nonadherence After Lung Transplantation: Follow-up After a Randomized Controlled Trial.

Geramita, E. M., et al.

Transplantation 2020; 104(3): 640-651.


Aims
The is a long-term follow-up study of a randomised controlled trial (RCT) which investigated the impact of a mobile health intervention, Pocket Personal Assistant for Tracking Health (Pocket PATH), on adherence of lung transplant recipients (LTRs) to the medical regimen compared LTRs receiving usual care. This study aimed to assess whether the adherence to the medical regimen was sustained beyond the 1-year follow-up period of the original RCT.

Interventions
Participants were randomised to Pocket PATH or usual care.

Participants
Lung transplant recipients

Outcomes
The main outcome was the assessment of nonadherence using the Health Habits Survey. The study assessed nonadherence in 8 different areas including taking the primary immunosuppressant, taking other medications, attending clinic appointments, monitoring of blood pressure, performing home spirometry, following a diet prescription, following an exercise prescription, and abstaining from the use of tobacco.

Follow-up
4 years (mean)

CET Conclusions
This is a long-term follow-up analysis of a trial comparing the Pocket PATH, a mobile health intervention targeting adherence, with usual care in adult lung transplant recipients. The 1-year results showed improved overall adherence for patients receiving the Pocket PATH. For the long-term follow-up participants were on average 3.9 years posttransplant. Non-adherence in the previous months was assessed for eight domains, e.g. regarding drug taking but also diet and exercise, using a validated patient and family caregiver report. The analysis included 105 out of the 201 participants in the original trial and only two participants of the original trial were still using the Pocket PATH. There were no significant differences between Pocket PATH and usual care groups for overall adherence or any of the adherence domains. Adherence rates were lower for the long-term follow-up compared to the end of the trial at 12 months. Regression analyses identified potential risk factors of long-term nonadherence to any of the domains that should be considered when addressing long-term adherence.

Quality notes
Previously assessed-QA not necessary

Trial registration
ClinicalTrials.Gov - NCT00818025

Funding source
Non-industry funded