Raywood, Emma;
(2024)
Remote monitoring of airway clearance techniques in children and young people with cystic fibrosis to understand impact on clinical outcomes.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
People with cystic fibrosis (CF) are prescribed daily airway clearance techniques (ACTs) to mitigate lung damage. The long-term evidence to guide ACT practice or optimise technique is limited, and how treatments are undertaken each day is unclear. The overall aims of this thesis were to: 1) Use remote monitoring to record and describe longitudinal patterns of ACT in children and young people with CF (CYPwCF) using positive expiratory pressure (PEP) devices. 2) Assess adherence to recommendations and personalised ACT prescriptions, 3) Assess the impact of app based breath-count feedback and gaming, 4) Identify any associations between ACT patterns and clinical outcomes. CYPwCF aged 6-16 years using PEP devices for ACT, were recruited and provided with a bespoke sensor and app to record usual daily ACTs for 16 months. An app also provided breath count feedback and ACT gaming in an interrupted time series design. Over 55,000 ACT treatments (5,000,000 breaths) were recorded by 144 CYPwCF. Recorded breath profiles varied between participants and related strongly to ACT device. Most treatments recorded (75%) contained the prescribed breath number but breath profiles were not in line with recommendations. Most participants had low adherence to the recommended technique. ACT driven gaming improved ACT breath profiles in line with recommendations. Linear mixed effects models demonstrated that doing more treatments was not associated with improved clinical outcomes alone. However, doing ACTs as recommended in guidelines was associated with improved lung function (FEV₁ %predicted), more good quality treatments had a larger effect. Performing ACTs outside of recommendations was comparable to not participating in treatments at all. This is the first time longitudinal breath-by-breath ACT data has been recorded and the impact of ACT technique on clinical outcomes explored. This evidence can guide ACT prescription, training, monitoring and be used to improve outcomes for CYPwCF.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | Remote monitoring of airway clearance techniques in children and young people with cystic fibrosis to understand impact on clinical outcomes |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2024. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10197316 |
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