Summary of findings 2. Digital technology (web‐based platform CFHealthHub) compared with usual care for monitoring adherence to inhaled therapies in people with cystic fibrosis.
| Digital technology (CFHealthHub) compared to usual care for monitoring adherence to inhaled therapies | ||||||
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Patient or population: people with CF aged 16 years and over Settings: outpatients Intervention: CFHealthHub ‐ electronic data‐logging nebulisers plus a digital web‐based platform with feedback to support participants Comparison: usual care ‐ electronic data‐logging nebulisers but no access to digital platform or feedback | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) |
Relative effect (95% CI) |
No of participants (studies) |
Certainty of the evidence (GRADE) |
Comments | |
| Assumed risk | Corresponding risk | |||||
| Usual care | CFHealthHub | |||||
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Adherence to the inhaled treatment: percentage adherence Follow‐up: 12 months |
The mean (SD) adherence in the usual care group was 34.9% (31.7). | The mean adherence in the CFHealthHub group was 18% higher (2.95% higher to 45.05% higher). | MD 18.00 (12.90 to 23.10) | 588 (1) |
⊕⊕⊕⊝ Moderatea |
The study authors also present data adjusted for baseline differences MD 9.5 (95% CI 8.6 to 10.4), and once these are allowed for, adherence is still 10% higher in the intervention group (CFHealthHub 2017) |
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Treatment burden: CFQ‐R treatment burden domain score (higher score is better) Follow‐up: 12 months |
The mean (SD) treatment burden domain score in the usual care group was 51.5 (19.7) | The mean treatment burden score in the CFHealthHub group was 5.10 points higher (1.79 points higher to 8.41 points higher). | MD 5.10 (1.79 to 8.41) | 539 (1) |
⊕⊕⊕⊝ Moderatea |
P = 0.003 There was an improvement in treatment burden domain score in the intervention group compared to the usual care group which remains the same when the analysis was adjusted for baseline differences MD 3.9 (95% CI 1.2 to 6.7) (CFHealthHub 2017). |
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QoL: CFQ‐R domain scores at end of study Follow‐up: 12 months |
There was no difference in any quality of life domain score between groups. Physical domain MD 3.20 (95% CI ‐1.94 to 8.34; P = 0.22); emotional domain MD 0.10 (95% CI ‐3.92 to 4.12; P = 0.96); social domain MD 0.90 (95% CI ‐2.48 to 4.28; P = 0.60); eating domain MD 3.00 (95% CI‐0.78 to 6.78; P = 0.12); body image domain 2.10 (95% CI‐2.68 to 6.88; P = 0.39); respiratory domain MD 1.40 (95% CI ‐2.37 to 5.17; P = 0.47); digestion domain MD 0.20 (95% CI ‐3.28 to 3.68; P = 0.91). |
538 (1) |
⊕⊕⊕⊝ Moderatea |
The results remained the same when the analysis was adjusted for baseline differences. Physical domain MD 2.3 (95% CI ‐1.0 to 5.6); emotional domain MD 0.2 (95% CI ‐2.9 to 3.2); social domain MD 0.3 (95% CI ‐2.2 to 2.7); eating domain MD 1.9 (95% CI ‐1.3 to 5.2); body image domain MD 1.7 (95% CI ‐1.4 to 4.8); respiratory domain MD 0.7 (95% CI ‐2.4 to 3.8); digestion domain MD 1.1 (95% CI ‐1.7 to 3.9) (CFHealthHub 2017). | ||
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FEV1: mean FEV1 % predicted at end of study Follow‐up: 12 months |
Mean (SD) FEV1 % predicted in the usual care group was 56.9% (23) | Mean FEV1 % predicted in the CFHealthHub group was 3.7% higher (0.23% lower to 7.63% higher). | MD 3.70 (‐0.23 to 7.63) | 556 (1) |
⊕⊕⊝⊝ Lowa,b |
When the results were adjusted for baseline differences, the effect was reduced but remained in the same direction (CFHealthHub 2017). |
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Number of pulmonary exacerbations Follow‐up: 12 months |
There was no difference between groups in the incidence of pulmonary exacerbations. Incidence rate ratio 0.92 (95% CI 0.77 to 1.11; P = 0.39). | 607 (1) |
⊕⊕⊕⊝ Moderatea |
Adjusted incidence rate ratio was 0.96 (95% CI 0.83 to 1.12; P = 0.64) (CFHealthHub 2017). | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CFQ‐R: Cystic Fibrosis Questionnaire ‐ Revised; CI: confidence interval; FEV1: forced expiratory volume in 1 second; MD: mean difference; QoL: quality of life | ||||||
| GRADE Working Group grades of evidence High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aDowngraded one level due to indirectness as the study only included people with CF over the age of 16. It is unclear whether the results would be applicable to a paediatric population. bDowngraded one level due to imprecision caused by wide confidence intervals which overlap between benefit and harm.