A mHealth-based care model for improving hypertension control in stroke survivors

Pilot RCT

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794). Methods: We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses. Results: Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, “I thought the system was easy to use” mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5–6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50% in IA and CA. At study completion, HTN was controlled in 82% (23/28) of IA and 64% (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89% (23/26) of IA and 58% (14/24) of CA, (p = 0.015). Conclusion: A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors. Clinical Trial.gov: NCT01875094

Original languageEnglish (US)
Pages (from-to)24-34
Number of pages11
JournalContemporary Clinical Trials
Volume70
DOIs
StatePublished - Jul 1 2018

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Telemedicine
Stroke
Hypertension
Research Personnel
Clinical Trials
Databases
Physicians

Keywords

  • Hypertension
  • MHealth
  • Self-management
  • Stroke survivors

PubMed: MeSH publication types

  • Journal Article
  • Research Support, U.S. Gov't, P.H.S.

Cite this

@article{4da709a6d50a4995a493e45e40e32df6,
title = "A mHealth-based care model for improving hypertension control in stroke survivors: Pilot RCT",
abstract = "Purpose: Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794). Methods: We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses. Results: Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, “I thought the system was easy to use” mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5–6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50{\%} in IA and CA. At study completion, HTN was controlled in 82{\%} (23/28) of IA and 64{\%} (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89{\%} (23/26) of IA and 58{\%} (14/24) of CA, (p = 0.015). Conclusion: A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors. Clinical Trial.gov: NCT01875094",
keywords = "Hypertension, MHealth, Self-management, Stroke survivors",
author = "Kamakshi Lakshminarayan and Westberg, {Sarah M} and Carin Northuis and Fuller, {Candace C.} and Ikramuddin, {Farha S} and Mustapha Ezzeddine and Julie Scherber and Speedie, {Stuart M}",
year = "2018",
month = "7",
day = "1",
doi = "10.1016/j.cct.2018.05.005",
language = "English (US)",
volume = "70",
pages = "24--34",
journal = "Contemporary Clinical Trials",
issn = "1551-7144",
publisher = "Elsevier Inc.",

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TY - JOUR

T1 - A mHealth-based care model for improving hypertension control in stroke survivors

T2 - Pilot RCT

AU - Lakshminarayan, Kamakshi

AU - Westberg, Sarah M

AU - Northuis, Carin

AU - Fuller, Candace C.

AU - Ikramuddin, Farha S

AU - Ezzeddine, Mustapha

AU - Scherber, Julie

AU - Speedie, Stuart M

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Purpose: Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794). Methods: We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses. Results: Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, “I thought the system was easy to use” mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5–6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50% in IA and CA. At study completion, HTN was controlled in 82% (23/28) of IA and 64% (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89% (23/26) of IA and 58% (14/24) of CA, (p = 0.015). Conclusion: A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors. Clinical Trial.gov: NCT01875094

AB - Purpose: Hypertension (HTN) is significantly under-treated in stroke survivors. We examined usability and efficacy of a mHealth -based care model for improving post-stroke HTN control (Funding: AHRQ R21HS021794). Methods: We used a RCT design. Planned study duration was 90 days. Intervention arm (IA) participants measured their BP daily using a smart phone and wireless BP monitor. This was transmitted automatically to the study database. Investigators (Physician + PharmD) made bi-weekly medication adjustments to achieve the BP goal. Control arm (CA) participants received a digital BP monitor and usual care. We examined Usability (measured with Marshfield System Usability Survey) and HTN control efficacy using an ITT (intent-to-treat) and as-treated (AT) analyses. Results: Fifty participants (IA = 28; CA = 22) completed the study. The Marshfield survey question, “I thought the system was easy to use” mean score was 4.6, (5 = strongly agree). Mean SBP declined significantly between enrollment and study completion in the IA. In ITT, IA SBP declined 9.88 mm, p = 0.005. In AT, IA SBP declined 10.81 mm, p = 0.0036. CA SBP decline was 5–6 mm Hg (not significant). In the ITT, baseline HTN control (SBP < 140 mm Hg) was 50% in IA and CA. At study completion, HTN was controlled in 82% (23/28) of IA and 64% (14/22) of CA (p = 0.14). In the AT, HTN was controlled in 89% (23/26) of IA and 58% (14/24) of CA, (p = 0.015). Conclusion: A mHealth-based HTN care model had excellent usability and provided better HTN control than usual care in stroke survivors. Clinical Trial.gov: NCT01875094

KW - Hypertension

KW - MHealth

KW - Self-management

KW - Stroke survivors

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