Comparing approaches to teaching patients how to use an app-based home spirometer: A randomised controlled trial

Morgan, Caitlin; Higbee, Daniel; Dixon, Catherine; Buckroyd, Emma; Adamali, Huzaifa; Barratt, Shaney; Shrimanker, Rahul; Hyams, Catherine; White, Paul; Dodd, James

Abstract

Background
Bluetooth enabled, app-based home spirometry has been validated for use in the diagnosis and monitoring of respiratory disease. Remote teaching (virtual or self-directed) 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 virtual or self-directed teaching were valid methods 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. Bland-Altman analysis between hospital and home FEV1 measurements in group A showed a mean difference 0.108L (95%CI: 0.040, 0.177), LoA -0.331L to 0.548L, Group B 0.152L (95%CI:0.076, 0.228), LoA -0.358L to 0.661L and Group C 0.153L (95%CI:0.077, 0.229), LoA -0.358L to 0.661L. FVC measurements in Group A showed a mean difference 0.123L (95%CI: 0.015, 0.231), LoA -0.402L to 0.648L, Group B 0.249L (95%CI: 0.143, 0.355), LoA -0.297L to 0.795L and Group C 0.340 (95%CI: 0.154, 0.525), LoA -0.556L to 1.235L. The difference in means between randomised arms does not differ in FEV1 measurements (F(2, 76) = 0.894, MSE=1.348, p=0.413) and FVC (F(2,78) = 0.177, MSE=2.082, p=0.838). 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 (virtual or self-directed) 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 virtual or self-directed 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.

Trial Registration: ISRCTN:18299685

Key Words: Home spirometry; disease monitoring; medical education

• Journal Article Type: Article
• Acceptance Date: Jul 9, 2025
• Deposit Date: Jul 9, 2025
• Print ISSN: 2561-326X
• Electronic ISSN: 2561-326X
• Publisher: JMIR Publications
• Peer Reviewed: Peer Reviewed
• Public URL: https://uwe-repository.worktribe.com/output/14686224
• Publisher URL: https://formative.jmir.org