**Abstract**

Airway clearance technique (ACT) and inhalation therapy (IT) are essential in cystic fibrosis (CF) lung disease management. We here present our experience with a video-call educational program, which could maintain or improve adherence in adolescents. A 6-month program was offered to adolescents: a physiotherapist would monitor their ACT and IT home program via scheduled video-calls. A structured form evaluating patients' independence and awareness during a session would be filled in at the start and after 6 months. After informed consent was obtained, subjects filled in a questionnaire about their expectations and a satisfaction questionnaire at the end of the program. Student's t-test for paired data was performed for quantitative evaluation of the variables considered in forms filled during video calls. Eleven CF subjects were enrolled; most of them adhered spontaneously, as they expected to improve technique and receive helpful advice. About 301 educational video-calls were performed, 75% being the scheduled calls. Two patients dropped out. In the end, better awareness and self-management in ACT and IT was evident, and patients showed better performances (P < 0.01), reporting they received helpful advice. Video-call education is a simple and feasible tool which could be useful to support adherence to ACT and IT in CF adolescents.

**Keywords:** adherence, patient education, telemedicine

#### **1. Introduction**

Adherence to "time-consuming" therapies in chronic patients is a wellrecognized issue to overcome.

Low adherence has been described in adolescents suffering from diabetes mellitus [1] and reported in almost 50% of patient prescriptions for respiratory physiotherapy in cystic fibrosis (CF) [2] as well as more recently in prescriptions for drugs targeting cystic fibrosis transmembrane regulator (CFTR) protein function [3].

CF patients from adolescence to adulthood are at risk of their clinical condition worsening, due to several issues: a claim of autonomy (self-management), refusing therapies or parents' authority, and a misunderstanding or low perception of the treatment necessity and efficacy.

It is imperative for CF Centres to ensure awareness, knowledge, and autonomy in adolescents.

A recent review [4] focused on the existing evidence base regarding adherence interventions in adolescents with CF. Among potential strategies to improve

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

assigned (0, severely insufficient; 5, excellent). The scores (maximum, sufficient)

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

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

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.

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 partic-

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

**Age FEV1% Mip% Mep**

*Staphylococcus aureus* 13 72 54 58 690

*Staphylococcus aureus* 13 104 66 63 720

*Staphylococcus aureus* 11 94 91 98 605

*Staphylococcus aureus* 16 69 78 54 591

*Staphylococcus aureus* 11 98 136 114 690

*Staphylococcus aureus* 12 79 118 96 695

**%**

15 51 86 72 720

16 94 108 83 660

16 69 151 149 570

16 56 128 87 Not done

13 61 167 95 557

**6**<sup>0</sup> **walking test (m)**

ipate (97%), and 11 subjects (5 M) on a first arrived basis were enrolled.

**microbiology**

*Pseudomonas aeruginosa*

*Staphylococcus aureus Pseudomonas aeruginosa*

> *Pseudomonas aeruginosa*

*Non-tuberculous Mycobacterium*

*Achromobacter xyl. Staphylococcus aureus*

**Mean 13.82 77.00 107.55 88.09 649.80 SD 2.04 18.11 36.01 27.52 62.96**

**Patients Sex Genotype Respiratory**

G542X

G542X

N1303K

del

del

1898 + 1GA

R785X

N1303K

del

G673X

W1282X

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

1 M F508 del/

2 M F508 del/

3 M 1717-1G > A/

4 F F508 del/F508

5 M F508del/F508

6 M F508del/

7 F W1282X/

8 F F508del/

9 F F508 del/F508

10 F F508del/

11 F F508del/

**Table 1.**

**93**

for each issue were (a) 15, 9; (b) 45, 27; and (c) 10, 6 (see *Appendix*).

*Video Call Educational Program for Cystic Fibrosis Adolescents*

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

and answering questions.

their suggestions.

**3. Results**

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 of an educational video in improving parents' knowledge.

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.
