RESUMEN
Remote monitoring using electronic patient reported outcomes (ePROs) in axial spondyloarthritis (axSpA) may improve self-management and reduce the need for consultations. However, knowledge regarding patients' willingness to use remote care and adherence to reporting ePROs is scarce. The objective of this study was to assess axSpA patients' willingness to use remote care and adherence to reporting of ePROs. The study was part of a three-armed randomized controlled trial testing digital follow-up strategies (The ReMonit study, NCT: 05031767). AxSpA patients in low disease activity were randomized to usual care, remote monitoring, or patient-initiated care. Demographics, clinical data, and patients' willingness to use remote care were collected at baseline. EPROs were reported either monthly or quarterly by the remote monitoring- and patient-initiated care group over 18 months, respectively. Adherence to reporting was calculated as number of ePROs completed divided by the total number requested. Mixed model logistic regression was utilized to assess factors associated with adherence to reporting of ePROs. In total 242 patients (median age 43 years, 75% males) were included. The majority (96%) reported high willingness to use remote care. Adherence to reporting ePROs remained high over 18 months by remote monitoring and patient-initiated care groups [median (IQR): 88% (77-100) vs. 83% (66-100)]. No patient characteristics were significantly associated with adherence to reporting of ePROs. The high degree of willingness and adherence to reporting ePROs over time indicates that the majority of axSpA patients with low disease activity are motivated to use remote care.
Asunto(s)
Espondiloartritis Axial , Medición de Resultados Informados por el Paciente , Telemedicina , Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Espondiloartritis Axial/terapia , Cooperación del Paciente/estadística & datos numéricosRESUMEN
Background: Patients' beliefs and attitudes toward a treatment can affect treatment response. In unblinded trials this can affect outcomes. Aims: The aim of this analysis was to examine the association between treatment preference and expectation and outcome in a trial of pain treatments. Methods: In a randomized trial (ISRCTN67013851) of four treatments for chronic widespread pain, participants were asked which they would prefer and what improvement they expect from each. The proportion of participants reporting positive health outcomes at three time points after treatment were compared between those matched or unmatched with their preference and between those with and without expectation for improvement. Odds ratios were calculated adjusted for baseline characteristics associated with preference and expectation. Results: Four hundred forty-two participants were recruited to the trial (69.5% female). The proportion reporting positive outcomes among participants matched to their preference compared to those unmatched was 33.3% vs. 34.4% at the end of treatment (adjusted odds ratio [aOR] = 0.80, 95% confidence interval [CI], 0.44-1.46), 34.4% vs. 29.0% at 3 months (aOR = 1.23, 95% CI, 0.67-2.26), and 34.8% vs. 30.3% at 2 years (aOR = 1.31, 95% CI, 0.70-2.46). The proportion of participants reporting positive outcomes among those expecting improvement compared to those not expecting improvement was 36.6% vs. 15.0% at the end of treatment (aOR = 2.03, 95% CI, 1.07-3.85), 34.1% vs. 13.2% at 3 months (aOR = 2.31, 95% CI, 1.22-4.38), and 32.8% vs. 19.1% at 2 years (aOR = 1.16, 95% CI, 0.67-2.36). Conclusions: Treatment preference had no clear effect on outcomes, but expectation did. These results could inform future approaches to management, and researchers assessing treatments should take into account this expectation effect.
Contexte: Les croyances et les attitudes des patients à l'égard d'un traitement peuvent influencer la réponse à ce traitement. Dans des essais sans insu, il peut y avoir un effet sur les résultats. Buts: Le but de cette analyse était d'étudier le lien entre les préférences et les attentes à l'égard du traitement, et le résultat obtenu dans un essai portant sur les traitements de la douleur. Méthodes: Dans un essai randomisé (ISRCTN67013851) portant sur quatre traitements pour la douleur chronique généralisée, on a demandé aux participants quelle était leur préférence quant au traitement, ainsi que l'amélioration qu'ils attendaient de chacun de ces traitements. Une comparaison de la proportion de participants ayant rapporté des résultats positifs sur leur santé à trois moments différents après le traitement a été effectuée entre ceux qui ont reçu le traitement qu'ils préféraient et ceux qui ont reçu un traitement autre que celui qu'ils préféraient, ainsi qu'entre ceux qui s'attendaient à une amélioration et ceux qui n'avaient pas de telles attentes. Les rapports de cotes ont été calculés et ajustés selon les caractéristiques de départ en ce qui concerne la préférence et les attentes. Résultats: Le nombre de participants recrutés pour cet essai était de 442 (69,5 % de femmes). La proportion de participants ayant rapporté un résultat positif parmi ceux qui ont reçu le traitement qu'ils préféraient comparativement à ceux qui ont reçu un traitement autre que celui qu'ils préféraient était de 33,3 % comparativement à 34,4 % à la fin du traitement (RC ajusté 0,80, 95 % IC 0,44-1,46); de 34,4 % comparativement à 29,0 % après trois mois (RCa 1,23, 0,67 2,26) et de 34,8 % comparativement à 30,3 % après deux ans (RCa 1,31, 0,70 2,46). La proportion de participants ayant rapporté des résultats positifs parmi ceux qui s'attendaient à une amélioration comparativement à ceux qui n'avaient pas de telles attentes était de 36,6 % comparativement à 15,0 % à la fin du traitement (RCa 2,03, 1,07-3,85), de 34,1 % comparativement à 13,2 % après trois mois (RCa 2,31, 1,22-4,38), et de 32,8 % comparativement à 19,1 % après deux ans (RCa 1,16, 0,67-2,36).Conclusions: La préférence en matière de traitement n'a pas eu d'effet clair sur les résultats, contrairement aux attentes. Ces résultats pourraient inspirer les approches futures en matière de prise en charge, tandis que les chercheurs qui évaluent des traitements devraient tenir compte de l'effet des attentes.
RESUMEN
The general relationship between cancers of the upper aerodigestive tract (UADT) and alcohol drinking is established. Nevertheless, it is uncertain whether different types of alcoholic beverages (wine, beer and liquor) carry different UADT cancer risks. Our study included 2,001 UADT cancer cases and 2,125 controls from 14 centres in 10 European countries. All cases were histologically or cytologically confirmed squamous cell carcinomas. Controls were frequency matched by sex, age and centre. Logistic regression models were used to estimate odds ratios (OR) and 95 % confidence intervals (95 %CI) adjusted for age, sex, centre, education level, vegetable and fruit intake, tobacco smoking and alcohol drinking, where appropriate. Risk of beverage-specific alcohol consumption were calculated among 'pure drinker' who consumed one beverage type exclusively, among 'predominant drinkers' who consumed one beverage type to more than 66 % and among 'mixed drinkers' who consumed more than one beverage type to similar proportions. Compared to never drinkers and adjusted for cumulative alcohol consumption, the OR and 95 %CI for wine, beer and liquor drinking, respectively, were 1.24 (0.86, 1.78), 1.54 (1.05, 2.27) and 0.94 (0.53, 1.64) among 'pure drinkers' (p value for heterogeneity across beverage types = 0.306), 1.05 (0.76,1.47), 1.25 (0.87,1.79) and 1.43 (0.95, 2.16) among 'predominant drinkers' (p value = 0.456), and 1.09 (0.79, 1.50), 1.20 (0.88, 1.63) and 1.12 (0.82, 1.53) among 'mixed drinkers' (p value = 0.889). Risk of UADT cancer increased with increasing consumption of all three alcohol beverage types. Our findings underscore the strong and comparable carcinogenic effect of ethanol in wine, beer and liquor on organs of the UADT.