Martinus C Oppelaar, Hanneke Ac van Helvoort, Michiel Age Bannier, Monique He Reijers, Hester van der Vaart, Renske van der Meer, Josje Altenburg, Lennart Conemans, Bart L Rottier, Marianne Nuijsink, Lara S van den Wijngaart, Peter Jfm Merkus, Jolt Roukema
{"title":"Accuracy, Reproducibility, and Responsiveness to Treatment of Home Spirometry in Cystic Fibrosis: Multicenter, Retrospective, Observational Study.","authors":"Martinus C Oppelaar, Hanneke Ac van Helvoort, Michiel Age Bannier, Monique He Reijers, Hester van der Vaart, Renske van der Meer, Josje Altenburg, Lennart Conemans, Bart L Rottier, Marianne Nuijsink, Lara S van den Wijngaart, Peter Jfm Merkus, Jolt Roukema","doi":"10.2196/60892","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Portable spirometers are increasingly used to measure lung function at home, but doubts about the accuracy of these devices persist. These doubts stand in the way of the digital transition of chronic respiratory disease care, hence there is a need to address the accuracy of home spirometry in routine care across multiple settings and ages.</p><p><strong>Objective: </strong>This study aimed to assess the accuracy, reproducibility, and responsiveness to the treatment of home spirometry in long-term pediatric and adult cystic fibrosis care.</p><p><strong>Methods: </strong>This retrospective observational study was carried out in 5 Dutch cystic fibrosis centers. Home spirometry outcomes (forced expiratory volume in one second [FEV<sub>1</sub>], and forced vital capacity [FVC]) for 601 anonymized users were collected during 3 years. For 81 users, data on clinic spirometry and elexacaftor/tezacaftor/ivacaftor (ETI) use were available. Accuracy was assessed using Bland-Altman plots for paired clinic-home measurements on the same day and within 7 days of each other (nearest neighbor). Intratest reproducibility was assessed using the American Thoracic Society/European Respiratory Society repeatability criteria, the coefficient of variation, and spirometry quality grades. Responsiveness was measured by the percentage change in home spirometry outcomes after the start of ETI.</p><p><strong>Results: </strong>Bland-Altman analysis was performed for 86 same-day clinic-home spirometry pairs and for 263 nearest neighbor clinic-home spirometry pairs (n=81). For both sets and for both FEV<sub>1</sub> and FVC, no heteroscedasticity was present and hence the mean bias was expressed as an absolute value. Overall, home spirometry was significantly lower than clinic spirometry (mean ΔFEV<sub>1clinic-home</sub> 0.13 L, 95% CI 0.10 to 0.19; mean ΔFVC<sub>clinic-home</sub> 0.20 L, 95% CI 0.14 to 0.25) and remained lower than clinic spirometry independent of age and experience. One-way ANOVA with post hoc comparisons showed significantly lower differences in clinic-home spirometry in adults than in children (Δmean 0.11, 95% CI -0.20 to -0.01) and teenagers (Δmean 0.14, 95% CI -0.25 to -0.02). For reproducibility analyses, 2669 unique measurement days of 311 individuals were included. Overall, 87.3% (2331/2669) of FEV<sub>1</sub> measurements and 74.3% (1985/2669) of FVC measurements met reproducibility criteria. Kruskal-Wallis with pairwise comparison demonstrated that for both FVC and FEV<sub>1</sub>, coefficient of variation was significantly lower in adults than in children and teenagers. A total of 5104 unique home measurements were graded. Grade E was given to 2435 tests as only one home measurement was performed. Of the remaining 2669 tests, 43.8% (1168/2669) and 43.6% (1163/2669) received grade A and B, respectively. The median percentage change in FEV<sub>1</sub> from baseline after initiation of ETI was 19.2% after 7-14 days and remained stable thereafter (n=33).</p><p><strong>Conclusions: </strong>Home spirometry is feasible but not equal to clinic spirometry. Home spirometry can confirm whether lung functions remain stable, but the context of measurement and personal trends are more relevant than absolute outcomes.</p>","PeriodicalId":16337,"journal":{"name":"Journal of Medical Internet Research","volume":"26 ","pages":"e60892"},"PeriodicalIF":5.8000,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653036/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Medical Internet Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2196/60892","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Portable spirometers are increasingly used to measure lung function at home, but doubts about the accuracy of these devices persist. These doubts stand in the way of the digital transition of chronic respiratory disease care, hence there is a need to address the accuracy of home spirometry in routine care across multiple settings and ages.
Objective: This study aimed to assess the accuracy, reproducibility, and responsiveness to the treatment of home spirometry in long-term pediatric and adult cystic fibrosis care.
Methods: This retrospective observational study was carried out in 5 Dutch cystic fibrosis centers. Home spirometry outcomes (forced expiratory volume in one second [FEV1], and forced vital capacity [FVC]) for 601 anonymized users were collected during 3 years. For 81 users, data on clinic spirometry and elexacaftor/tezacaftor/ivacaftor (ETI) use were available. Accuracy was assessed using Bland-Altman plots for paired clinic-home measurements on the same day and within 7 days of each other (nearest neighbor). Intratest reproducibility was assessed using the American Thoracic Society/European Respiratory Society repeatability criteria, the coefficient of variation, and spirometry quality grades. Responsiveness was measured by the percentage change in home spirometry outcomes after the start of ETI.
Results: Bland-Altman analysis was performed for 86 same-day clinic-home spirometry pairs and for 263 nearest neighbor clinic-home spirometry pairs (n=81). For both sets and for both FEV1 and FVC, no heteroscedasticity was present and hence the mean bias was expressed as an absolute value. Overall, home spirometry was significantly lower than clinic spirometry (mean ΔFEV1clinic-home 0.13 L, 95% CI 0.10 to 0.19; mean ΔFVCclinic-home 0.20 L, 95% CI 0.14 to 0.25) and remained lower than clinic spirometry independent of age and experience. One-way ANOVA with post hoc comparisons showed significantly lower differences in clinic-home spirometry in adults than in children (Δmean 0.11, 95% CI -0.20 to -0.01) and teenagers (Δmean 0.14, 95% CI -0.25 to -0.02). For reproducibility analyses, 2669 unique measurement days of 311 individuals were included. Overall, 87.3% (2331/2669) of FEV1 measurements and 74.3% (1985/2669) of FVC measurements met reproducibility criteria. Kruskal-Wallis with pairwise comparison demonstrated that for both FVC and FEV1, coefficient of variation was significantly lower in adults than in children and teenagers. A total of 5104 unique home measurements were graded. Grade E was given to 2435 tests as only one home measurement was performed. Of the remaining 2669 tests, 43.8% (1168/2669) and 43.6% (1163/2669) received grade A and B, respectively. The median percentage change in FEV1 from baseline after initiation of ETI was 19.2% after 7-14 days and remained stable thereafter (n=33).
Conclusions: Home spirometry is feasible but not equal to clinic spirometry. Home spirometry can confirm whether lung functions remain stable, but the context of measurement and personal trends are more relevant than absolute outcomes.
背景:便携式肺活量计越来越多地用于家庭测量肺功能,但对这些设备的准确性仍然存在怀疑。这些疑问阻碍了慢性呼吸道疾病护理的数字化转型,因此有必要解决家庭肺活量测定在多种环境和年龄的常规护理中的准确性问题。目的:本研究旨在评估家庭肺活量测定在儿童和成人囊性纤维化长期治疗中的准确性、可重复性和对治疗的反应性。方法:这项回顾性观察性研究在5个荷兰囊性纤维化中心进行。在3年内收集601名匿名用户的家庭肺活量测定结果(1秒用力呼气量[FEV1]和用力肺活量[FVC])。81名用户的临床肺活量测定和呼气呼气器/tezacaftor/ivacaftor (ETI)使用数据可用。使用Bland-Altman图对同一天和7天内的配对临床-家庭测量进行准确性评估(最近邻居)。使用美国胸科学会/欧洲呼吸学会可重复性标准、变异系数和肺活量测定质量等级评估试验的可重复性。反应性通过ETI开始后家庭肺活量测定结果的百分比变化来测量。结果:对86对当日临床-家庭肺活量测定对和263对最近邻居临床-家庭肺活量测定对(n=81)进行Bland-Altman分析。对于两组以及FEV1和FVC,均不存在异方差,因此平均偏差表示为绝对值。总体而言,家庭肺活量测定显著低于临床肺活量测定(平均ΔFEV1clinic-home 0.13 L, 95% CI 0.10至0.19;平均ΔFVCclinic-home 0.20 L, 95% CI 0.14至0.25),仍低于独立于年龄和经验的临床肺活量测定。事后比较的单因素方差分析显示,成人临床-家庭肺量测定的差异显著低于儿童(Δmean 0.11, 95% CI -0.20至-0.01)和青少年(Δmean 0.14, 95% CI -0.25至-0.02)。为了进行重复性分析,纳入311个个体的2669个唯一测量日。总体而言,87.3%(2331/2669)的FEV1测量值和74.3%(1985/2669)的FVC测量值符合重复性标准。Kruskal-Wallis两两比较表明,成人FVC和FEV1的变异系数显著低于儿童和青少年。共有5104个独特的家庭测量被分级。2435次测试被评为E级,因为只有一次家庭测量。在剩下的2669次测试中,分别有43.8%(1168/2669)和43.6%(1163/2669)获得A级和B级。ETI开始后7-14天FEV1较基线变化的中位数百分比为19.2%,此后保持稳定(n=33)。结论:家庭肺活量测定是可行的,但不等同于临床肺活量测定。家庭肺活量测定可以确认肺功能是否保持稳定,但测量的背景和个人趋势比绝对结果更相关。
期刊介绍:
The Journal of Medical Internet Research (JMIR) is a highly respected publication in the field of health informatics and health services. With a founding date in 1999, JMIR has been a pioneer in the field for over two decades.
As a leader in the industry, the journal focuses on digital health, data science, health informatics, and emerging technologies for health, medicine, and biomedical research. It is recognized as a top publication in these disciplines, ranking in the first quartile (Q1) by Impact Factor.
Notably, JMIR holds the prestigious position of being ranked #1 on Google Scholar within the "Medical Informatics" discipline.