TY - JOUR
T1 - A comparison of clinic and home spirometry as longtudinal outcomes in cystic fibrosis
AU - Paynter, Alex
AU - Khan, Umer
AU - Heltshe, Sonya L.
AU - Goss, Christopher H.
AU - Lechtzin, Noah
AU - Hamblett, Nicole Mayer
N1 - Funding Information:
NMH was supported by the Cystic Fibrosis Foundation (CFF) and National Institutes of Health (NIH) grant UL1 TR002319 . CHG was supported by grants from the Cystic Fibrosis Foundation , the NIH ( UM1 HL119073 , P30 DK089507 , U01 HL114589 , UL1 TR000423 ) and the FDA ( R01 FD003704 , R01 FD006848 ). SLH was supported by the Cystic Fibrosis Foundation (CFF) and National Institutes of Health (NIH) grant P30 DK 089507 . UK and AP are supported by grants from the Cystic Fibrosis Foundation (CFF).
Publisher Copyright:
© 2021
PY - 2022/1
Y1 - 2022/1
N2 - Background: The COVID-19 pandemic has accelerated the transition to telehealth, including the use of home spirometry in cystic fibrosis. Evaluating the accuracy and precision of longitudinal home spirometry is a requisite for telehealth-based research. This secondary analysis of a CF study (eICE) evaluates whether there are cross-sectional or longitudinal differences between home and clinic spirometry. Methods: Participants age ≥14 years with ppFEV1>25 were recruited from 2011-2015, issued a home spirometer, and asked to complete spirometry efforts twice per week for one year. Clinic spirometry was collected at baseline and every three months. Cross-sectional differences between clinic spirometry and the closest home spirometry measurement were analyzed. Longitudinally, we apply 5 methods to analyze the precision of home spirometry, and differences between clinic vs. home data. Results: Home spirometry is estimated to be 2.0 (95% CI: 0.3, 3.5) percentage points lower than clinic spirometry cross-sectionally. Longitudinally, the estimates of 12-month change in home spirometry varied by analysis method from -2.6 to -1.0 ppFEV1/ year, with precision markedly different. However, home spirometry change estimates were qualitatively similar to the clinic results: -3.0 ppFEV1/year (95% CI: -4.1, -1.9). Conclusions: To leverage the potential cost, feasibility and convenience of home spirometry, the differences with clinic spirometry must be acknowledged. Significantly lower ppFEV1 in home devices shows that direct comparison to clinic spirometers may induce a spurious change from baseline, and additional variability in home devices impacts statistical power. The effect of coaching, setting, and equipment must be understood to use and improve home spirometry in CF.
AB - Background: The COVID-19 pandemic has accelerated the transition to telehealth, including the use of home spirometry in cystic fibrosis. Evaluating the accuracy and precision of longitudinal home spirometry is a requisite for telehealth-based research. This secondary analysis of a CF study (eICE) evaluates whether there are cross-sectional or longitudinal differences between home and clinic spirometry. Methods: Participants age ≥14 years with ppFEV1>25 were recruited from 2011-2015, issued a home spirometer, and asked to complete spirometry efforts twice per week for one year. Clinic spirometry was collected at baseline and every three months. Cross-sectional differences between clinic spirometry and the closest home spirometry measurement were analyzed. Longitudinally, we apply 5 methods to analyze the precision of home spirometry, and differences between clinic vs. home data. Results: Home spirometry is estimated to be 2.0 (95% CI: 0.3, 3.5) percentage points lower than clinic spirometry cross-sectionally. Longitudinally, the estimates of 12-month change in home spirometry varied by analysis method from -2.6 to -1.0 ppFEV1/ year, with precision markedly different. However, home spirometry change estimates were qualitatively similar to the clinic results: -3.0 ppFEV1/year (95% CI: -4.1, -1.9). Conclusions: To leverage the potential cost, feasibility and convenience of home spirometry, the differences with clinic spirometry must be acknowledged. Significantly lower ppFEV1 in home devices shows that direct comparison to clinic spirometers may induce a spurious change from baseline, and additional variability in home devices impacts statistical power. The effect of coaching, setting, and equipment must be understood to use and improve home spirometry in CF.
KW - CF outcome measures
KW - COVID-19
KW - Coronavirus
KW - Forced expiratory volume in one second (FEV1)
KW - Remote monitoring
KW - Telehealth
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U2 - 10.1016/j.jcf.2021.08.013
DO - 10.1016/j.jcf.2021.08.013
M3 - Article
C2 - 34474987
AN - SCOPUS:85115025925
SN - 1569-1993
VL - 21
SP - 78
EP - 83
JO - Journal of Cystic Fibrosis
JF - Journal of Cystic Fibrosis
IS - 1
ER -