The MObile Health InterVEntion in Pulmonary Arterial Hypertension (MOVE PAH) Study

摘要 患有肺动脉高压(PAH)的患者健康相关生活质量(HRQOL)和 运动能力受损。尽管已经批准了14种治疗方法，但大多数患者都会在十年内死亡。这可怕的一面 事实突出表明，有必要制定干预措施，改善高危人群的生活质量，特别是针对性机制 对现有的PAH疗法来说不是多余的。增加体力活动对PAH非常有效， 导致6分钟步行距离(6MWD)和HRQOL的改善通常超过 药物。以前的活动研究需要住院康复，这是不切实际的，很难维持，而且 对一种罕见疾病的可伸缩性很差。此外，帕金森病的康复通常不会得到保险的补偿 美国，强调需要替代方案来促进体力活动。此应用程序构建在 最近完成的，由美国国立卫生研究院资助的移动健康(MHealth)干预PAH的试点和可行性试验。在……里面 在飞行员中，受试者佩戴Fitbit设备，并被随机分成两组，一组是常规护理，另一组是全自动的智能护理 Text“干预。文本内容以行为改变理论为基础，针对每个受试者进行个性化。 每天向干预臂发送3次短信，并基于实时活动发送鼓励信息 数据。每个受试者都有一个个性化的步数目标，每4周增加20%。在…的末尾 12周后，干预组比对照组每天多走1019步，比对照组增加20% 基线。我们现在假设，增加步数将改善PAH患者的HRQOL。我们 建议进行一项为期6个月的智能短信与常规护理的随机试验。我们将随机选择100名PAH患者 接受mHealth干预或常规护理。所有注册、监控和数据收集都将在以下位置远程进行 范德比尔特。我们将在全美范围内招收受试者，增加普适性。我们的招生目标 是可行的，因为我们得到了两个大型的现有PAH队列的支持-NIH资助的PVDOMICS 财团和肺动脉高压协会登记处。R61里程碑(第1年)：IRB批准； 建立数据仓库；创建红帽数据库；数据使用协议；文本干预编程； 前10个科目招生。在目标1(主端点)中，我们将测试基于文本的mHealth的效果 使用PAH特定强调-10问卷对PAH患者的HRQOL进行干预。目标2(次要目标 终点)，我们将测试mHealth干预对运动能力的影响，通过高度可行的 和可重复性的有监督的家庭6MWD测试。在一个探索性的目标中，我们将检查 及时对临床恶化进行干预(PAH治疗升级、PAH住院和 死亡)随机分组一年后。该提案将测试一种新的、高度可扩展且负担得起的mHealth 干预以改善PAH患者的临床有意义的结果。

ABSTRACT Patients with pulmonary arterial hypertension (PAH) have reduced health related quality of life (HRQOL) and impaired exercise capacity. Despite fourteen approved therapies, most patients die within ten years. This grim fact underscores the need to develop interventions that improve HRQOL, particularly targeting mechanisms that are non-redundant to existing PAH therapies. Increasing physical activity is highly efficacious in PAH, resulting in six-minute walk distance (6MWD) and HRQOL improvement that often exceeds the effect of medications. Prior activity studies required inpatient rehabilitation, which is impractical, hard to sustain, and poorly scalable to a rare disease. Moreover, rehabilitation for PAH is not typically reimbursed by insurance in the United States, highlighting the need for alternatives to promote physical activity. This application builds on a recently-completed, NIH-funded pilot and feasibility trial of a mobile health (mHealth) intervention in PAH. In the pilot, subjects wore a Fitbit device and were randomized to either usual care or a fully automated “smart text” intervention. Text content was based on behavioral change theory and personalized to each subject. Texts were sent to the intervention arm 3 times/day with encouraging messages based on real-time activity data. Each subject had a personalized step count target which increased by 20% every 4 weeks. At the end of 12 weeks, the intervention arm took 1019 more steps per day than the control arm, an increase of 20% over baseline. We now hypothesize that increasing step counts will improve HRQOL in patients with PAH. We propose a randomized trial of smart texts versus usual care for 6 months. We will randomize 100 PAH patients to the mHealth intervention or usual care. All enrollment, monitoring, and data collection will occur remotely at Vanderbilt. We will enroll subjects across the United States, increasing generalizability. Our enrollment targets are feasible because we are supported by two large, existing PAH cohorts – the NIH-funded PVDOMICS Consortium and the Pulmonary Hypertension Association Registry. R61 Milestones (Year 1): IRB approval; establish DSMB; create REDCap database; Data Use Agreements; programming of text intervention; enrollment of first 10 subjects. In Aim 1 (primary endpoint), we will test the effect of a text-based mHealth intervention on HRQOL in PAH using the PAH-specific emPHasis-10 questionnaire. In Aim 2 (secondary endpoint), we will test the effect of an mHealth intervention on exercise capacity, measured by a highly feasible and reproducible supervised home-based 6MWD test. In an exploratory aim, we will examine the effect of the intervention on time to clinical worsening (composite of PAH therapy escalation, PAH hospitalization, and death) one year after randomization. This proposal will test a novel, highly scalable, and affordable mHealth intervention to improve clinically meaningful outcomes in patients with PAH.