**2. Methods and patients**

CF adolescents, regularly followed up at our CF Centre, were invited to participate in a 6-month program designed to offer online support during home IT and ACT. All patients in the age range 12–18 years were offered enrollment in the project.

The primary endpoint of the study was the feasibility of the online video call program and its acceptability. Feasibility was determined by percentage of adherence (more than 75% of eligible patients), acceptability by the number of contacts for planned calls (more than 50%), and dropout of enrolled patients (less than 20%).

A secondary endpoint was to assess its efficacy in improving patients' knowledge of therapies (preparation, sequences of IT/ACT) and autonomy in performing respiratory therapies and in cleaning devices, by means of score assigned during video monitoring.

Approval for conducting the study was received by the local ethics committee. Informed consent was obtained from subjects who agreed to participate and from their parents. All patients completed a Q1 questionnaire (see *Appendix*) to investigate their expectations toward the project.

Six touch screen tablets and internet connections were provided to adolescents who did not have access to one.

At the start, all subjects underwent their routine complete functional evaluation (spirometry, 6-minute walking test, MIP/MEP (muscle inspiratory and expiratory pressures)). All have their personalized therapeutic plan (IT and ACT), and during the 6-month program, they received a supervision of their physiotherapy program every 2 months at scheduled clinical visits.

A respiratory physiotherapist, via online video call, monitored, in the early afternoon, the adolescents' home program performances two times a week for 6 months, following each personal therapeutic plan. The scheduled time for each connection was 30–45 minutes; this time was available to monitor both IT and ACT, to answer questions and correct errors.

At the start and end of the study, the physiotherapist filled in a form for each subject, evaluating their independence and awareness during a session. Three issues were assessed, with a total of different items: (a) Does the patient know why, when, and with which drugs to perform IT (3 items)? (b) Does the patient know how to properly prepare the devices (9 items)? (c) Does the patient know to clean and disinfect used devices (2 items)? For each item, a score between 0 and 5 was

*Video Call Educational Program for Cystic Fibrosis Adolescents DOI: http://dx.doi.org/10.5772/intechopen.86074*

assigned (0, severely insufficient; 5, excellent). The scores (maximum, sufficient) for each issue were (a) 15, 9; (b) 45, 27; and (c) 10, 6 (see *Appendix*).

With regard to the question "How do you perform ACT?," the physiotherapist, after evaluation of each performance, gave a personalized educational intervention based on deficiencies identified during the video call, giving suggestions and advice and answering questions.

At the end of the study, a Q2 satisfaction questionnaire (see *Appendix*) was filled in by subjects, to evaluate agreement and acceptability of the project and to give their suggestions.

A descriptive analysis of the data collected was performed. A Student's t-test for paired data was performed to assess improvement in scores at the end of the study.

#### **3. Results**

adherence, it was suggested to identify social media tools for online support; some preliminary positive experiences have been reported with online educational video. The German Airway League made available video clips about "Correct Inhalation Therapy for Patients with Cystic Fibrosis." This gives the opportunity to CF adolescents to obtain, independently of time and location, autonomously, and in a

An educational video was recently made available to parents of babies who resulted positive at the newborn screening program for cystic fibrosis [6], as an adjunct to help with genetic counseling. This study demonstrated the effectiveness

CF adolescents, regularly followed up at our CF Centre, were invited to participate in a 6-month program designed to offer online support during home IT and ACT. All patients in the age range 12–18 years were offered enrollment in the

The primary endpoint of the study was the feasibility of the online video call program and its acceptability. Feasibility was determined by percentage of adherence (more than 75% of eligible patients), acceptability by the number of contacts for planned calls (more than 50%), and dropout of enrolled patients (less than 20%). A secondary endpoint was to assess its efficacy in improving patients' knowledge of therapies (preparation, sequences of IT/ACT) and autonomy in performing respiratory therapies and in cleaning devices, by means of score assigned during

Approval for conducting the study was received by the local ethics committee. Informed consent was obtained from subjects who agreed to participate and from their parents. All patients completed a Q1 questionnaire (see *Appendix*) to investi-

Six touch screen tablets and internet connections were provided to adolescents

At the start, all subjects underwent their routine complete functional evaluation (spirometry, 6-minute walking test, MIP/MEP (muscle inspiratory and expiratory pressures)). All have their personalized therapeutic plan (IT and ACT), and during the 6-month program, they received a supervision of their physiotherapy program

A respiratory physiotherapist, via online video call, monitored, in the early afternoon, the adolescents' home program performances two times a week for 6 months, following each personal therapeutic plan. The scheduled time for each connection was 30–45 minutes; this time was available to monitor both IT and ACT,

At the start and end of the study, the physiotherapist filled in a form for each subject, evaluating their independence and awareness during a session. Three issues were assessed, with a total of different items: (a) Does the patient know why, when, and with which drugs to perform IT (3 items)? (b) Does the patient know how to properly prepare the devices (9 items)? (c) Does the patient know to clean and disinfect used devices (2 items)? For each item, a score between 0 and 5 was

We employed a novel face-to-face monitoring of home inhalation therapy (IT) and airway clearance technique (ACT), with a video call survey and educational program, with the aim of assessing awareness of CF adolescents and helping them to improve their knowledge and adherence. Here we present our preliminary experience.

time-saving manner, information on correct inhalation treatment [5].

of an educational video in improving parents' knowledge.

*Cystic Fibrosis - Heterogeneity and Personalized Treatment*

**2. Methods and patients**

project.

**92**

video monitoring.

gate their expectations toward the project.

every 2 months at scheduled clinical visits.

to answer questions and correct errors.

who did not have access to one.

Thirty CF patients aged 12–18 years, regularly followed at our CF Centre, were eligible. Participation in the study was offered to all. All but one accepted to participate (97%), and 11 subjects (5 M) on a first arrived basis were enrolled.

The baseline characteristics of the study population are summarized in **Table 1**.


#### **Table 1.**

*Clinical characteristics of the study population at the baseline visit.*

All subjects have a confirmed CF, and all presented pancreatic insufficiency, age ranged between 11 and 16 years. Seven subjects had moderate respiratory disease (FEV1pp: 51–79%); four had normal function (FEV1pp: 94–104%). Chronic *Pseudomonas* infection was present in three. All presented a 6-minute walking test within the normal limits (range 557–720 meters).

**4. Discussion**

the planned calls.

agement of IT and ACT.

CF patients.

adherence.

ence.

**95**

respiratory physiotherapy in CF adolescents.

*DOI: http://dx.doi.org/10.5772/intechopen.86074*

*Video Call Educational Program for Cystic Fibrosis Adolescents*

the CF patient, differently by our program.

video call time coinciding with commitments to school.

or to be still present in the care of their teenage children.

implement educational programs on this aspect of care.

to prescribed therapies by the end of the project.

Our preliminary experience on a limited number of CF adolescents shows the possibility to perform an educational program by means of online video call. This program was designed to offer online support during home IT and ACT by a respiratory physiotherapist, with the aim of improving knowledge and adherence to

Recent reported experiences on an educational program on inhalation therapy [5] or newborn screening [6] with online video clips do not provide any kind of personal relationship between those who produced the media available online and

New technologies such as video call using smartphones or tablets are used on a daily basis by adolescents; thus we hypothesized that introducing educational programs in their life using these technologies might result in better outcomes. To the best of our knowledge, our study is the first educational program to use online video calls provided by an experienced physiotherapist to monitor IT/ACT. This program gave the opportunity to CF teenagers to develop personal contact with the respiratory therapist in their own homes, beyond the scheduled visits at the specialist center. Our work proved the feasibility of an educational video call program, where adolescents accepted online supervision for their daily IT/ACT and attended 75% of

The main problem we faced was the timing of the video calls, scheduled in the afternoon. In fact, 2 out of 11 patients had to abandon the project because of the

ACT monitoring and individualized educational interventions in the short term seem to lead to positive results, such as increased knowledge and better adherence

Patients agreed to receive video calls and maintain frequent contact with the physiotherapist, and the program seemed to improve their autonomy in the man-

disinfection of IT/ACT devices is not taken into account as a personal task by teenagers but is constantly referred to one of the parents (usually the mother). An explanation could be also the desire of parents to be sure of the adequacy of cleaning

Since the acquisition of personal autonomy also involves care (cleaning and disinfection) of the tools necessary for the execution of airway clearance, we will

willingness and capability of using modern technologies to communicate with young people and improvement in knowledge, self-management, and autonomy in

The main positive effects of this project were the CF care team showed both the

After the study ended, as a result of the project and in response to our patients' requests, video calls were made available during intravenous home therapy for pulmonary exacerbations, as patients recognized its usefulness in improving

Making additional resources available to patients outside the CF clinics, at their own home, resulted to be beneficial in reducing the feeling of loneliness during ACT daily performance and may, therefore, promote motivation and ameliorate adher-

This pilot study has some limitations, including the low number of patients and its short duration. It is well known that educational interventions must be repeated

With this study, we have also verified how an aspect of daily care, cleaning, and

Airway clearance technique consisted of the use of PEP Mask in all of them.

In the 6-month program, 301 educational video calls were performed, which is 75% of the scheduled calls.

Their mean duration was 45 min (range 30–60 min). Each subject received a video call at least twice a week.

During the study period, two subjects dropped out (n°9 and 10; 18%), because of school commitments in the afternoon.

Regarding questionnaires filled in by subjects at the start (Q1) and at the end (Q2) of the project, Q1 (filled by 11 subjects) shows that eight adolescents were pleased to participate in the project, considering it an opportunity to maintain frequent contact with physiotherapists (in four cases) and a way to monitor their home program (in five). Nine subjects adhered spontaneously, but four did it for pleasing parents, and only one boy was forced by them. All subjects considered ACT very important to maintain their health, and their main expectations were to improve technique and receive helpful advice (six subjects) and have the opportunity to demonstrate their independence (two of them).

The Q2 questionnaire (filled in by nine subjects) shows that ACT was considered important in spite of the effort it requires. All of them were pleased to be enrolled in the study as it was a good opportunity to monitor the way they perform ACT; they have received helpful advice (reported by five of them) or have maintained contact with physiotherapists (by four). Four of them felt emotionally supported.

#### **3.1 Results from forms filled by the physiotherapist**

**Issue A**. *Does the subject know why, when, and with which drugs to perform IT and ACT* (possible score for each patient: 0–15)? At the start, 4 out of 11 adolescents did not know the reason for which they must perform the IT/ACT, and they did not perform both the IT and the ACT correctly. At the end, the final scores showed a greater awareness of why airway clearance is important and have shown a better understanding of IT in all subjects but one (mean score at start 6.5 (range 2–13), mean score at end 9.6 (range 5–14), (P < 0.01)).

**Issue B***. Does the subject properly prepare his/her IT and device* (possible score for each patient: 0–45)? At the first evaluation, almost all were already able to prepare and assemble the devices; at the final one, all subjects were able to prepare and assemble the devices (mean score at start 29.5 (range 13–43), mean score at end 35.8 (range 25–43), (P < 0.01)).

**Issue C***. Does the subject clean and disinfect his/her devices after therapy* (possible score 0–10)? None but one subject was autonomous in device cleaning and disinfection, leaving this duty to parents, both at the start and end (mean score 2.2 in both evaluations, NS).

The initial assessment of appropriateness in the execution of IT/ACT shows that seven subjects kept a right posture during IT/ACT and respected the correct sequence of drugs, but after the educational intervention, all of them performed the entire sequence IT / ACT appropriately.
