Accepted for/Published in: JMIR Formative Research
Date Submitted: Mar 18, 2025
Date Accepted: Jul 9, 2025
Comparing approaches to teaching patients how to use an app-based home spirometer: A randomised controlled trial
ABSTRACT
Background:
Bluetooth enabled, app-based home spirometry has been validated for use in the diagnosis and monitoring of respiratory disease. Remote teaching offers the opportunity to deliver diagnostics safely and at scale. The most appropriate method of teaching home spirometry to patients is unknown.
Objective:
The aim of this pragmatic study undertaken during the COVID-19 pandemic was to determine whether remote teaching was a valid method of deploying home spirometry to patients referred for outpatient lung physiology testing.
Methods:
REACH-SPIRO was a single centre, unblinded, randomised controlled trial of adults referred for spirometry. Participants were randomised (1:1:1) to be taught to use a bluetooth, app-based spirometer either face to face (A), virtually (live video conferencing) (B), or self-directed (C). Forced vital capacity (FVC) and Forced expiratory volume in 1 second (FEV1) were recorded. Home spirometry readings (Spirobank Smart Spirometer) were compared to each teaching method and hospital measurements (VyaireMedical) using Bland-Altman and two-way ANOVA. Patients feedback questionnaires on acceptability and adherence were collected.
Results:
At total of 106 participants were randomised. No significant difference was noted between spirometry measures across the different teaching methods. Home and hospital spirometry were highly correlated. In all groups, FVC (mean difference 0.238L, p<0.001, 95% CI 0.160-0.315) measurements were higher in hospital vs home spirometry. FEV1 measurements showed a mean difference of 0.138L (p<0.001, 95% CI 0.097-0.180), remaining within ATS/ERS reproducibility criteria. Patient feedback indicated a preference for virtual or face-to-face instruction over self-directed learning due to difficulties using the app or frustration over lack of feedback.
Conclusions:
There was no meaningful difference in spirometry results between patients taught to use a home spirometer remotely or face-to-face. Spirometry values were statistically significantly lower at home than in hospital in all groups. Patients feedback indicated a preference for virtual or face to face support rather than self-directed methods. This study supports the use of remote teaching of home spirometry for the monitoring of respiratory disease. In doing so, we can improve access to spirometry in hard-to-reach and vulnerable populations. Clinical Trial: ISRCTN:18299685
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