Measuring the impact of ambulatory red blood cell transfusion on home functional status: Study protocol for a pilot randomized controlled trial

Dennis H. Murphree, Theresa N. Kinard, Nandita D Khera, Curtis Storlie, Che Ngufor, Sudhindra Upadhyaya, Jyotishman Pathak, Emma Fortune, Eapen K. Jacob, Rickey E. Carter, Karl A. Poterack, Daryl J Kor

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Red blood cell (RBC) transfusion is frequently employed in both ambulatory and hospital environments with the aim of improving patient functional status. In the ambulatory setting, this practice is particularly common in patients with malignancy due to anemia associated with their cancer therapy. Increasingly, the efficacy of this US$10.5 billion per year practice has been called into question. While it is often standard of care for patients with chemotherapy-induced anemia to receive ambulatory RBC transfusions, it is unclear to what extent such transfusions affect home functional status. It is also unclear whether or not changes in functional status in this population can be objectively quantified using wearable activity monitors. We propose to directly measure the impact of outpatient RBC transfusions on at-home functional status by recording several physiological parameters and quantifiable physical activity metrics, e.g., daily energy expenditure and daily total step count, using the ActiGraph wGT3X-BT. This device is an accelerometer-based wearable activity monitor similar in size to a small watch and is worn at the waist. Study participants will wear the device during the course of their daily activities giving us quantifiable insight into activity levels in the home environment. Methods/design: This will be a randomized crossover pilot clinical trial with a participant study duration of 28â days. The crossover nature allows each patient to serve as their own control. Briefly, patients presenting at a tertiary medical center's Ambulatory Infusion Center (AIC) will be randomized to either: (1) receive an RBC transfusion as scheduled (transfusion) or (2) abstain from the scheduled transfusion (no transfusion). After an appropriate washout period, participants will crossover from the transfusion arm to the no-transfusion arm or vice versa. Activity levels will be recorded continuously throughout the study using an accelerometry monitor. In addition to device data, functional status and health outcomes will be collected via a weekly telephone interview. The primary outcome measure will be daily energy expenditure. Performance metrics, such as step count changes, will also be evaluated. Additional secondary outcome measures will include daily sedentary time and Patient-reported Outcomes Measurement Information System (PROMIS) Global 10 Survey scores. Discussion: This trial will provide important information on the feasibility and utility of using accelerometry monitors to directly assess the impact of RBC transfusion on patients' functional status. The results of the study will inform the merit and methods of a more definitive future trial evaluating the impact of ambulatory RBC transfusions in the target population. Trial registration: ClinicalTrials.gov, identifier: NCT02835937. Registered on 15 July 2016.

Original languageEnglish (US)
Article number153
JournalTrials
Volume18
Issue number1
DOIs
StatePublished - Mar 31 2017

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Erythrocyte Transfusion
Randomized Controlled Trials
Accelerometry
Equipment and Supplies
Energy Metabolism
Anemia
Outcome Assessment (Health Care)
Health Services Needs and Demand
Standard of Care
Information Systems
Health Status
Neoplasms
Outpatients
Clinical Trials
Interviews
Exercise
Drug Therapy
Population

Keywords

  • Clinical trial
  • Functional status
  • Outpatient
  • Transfusion

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology (medical)

Cite this

Measuring the impact of ambulatory red blood cell transfusion on home functional status : Study protocol for a pilot randomized controlled trial. / Murphree, Dennis H.; Kinard, Theresa N.; Khera, Nandita D; Storlie, Curtis; Ngufor, Che; Upadhyaya, Sudhindra; Pathak, Jyotishman; Fortune, Emma; Jacob, Eapen K.; Carter, Rickey E.; Poterack, Karl A.; Kor, Daryl J.

In: Trials, Vol. 18, No. 1, 153, 31.03.2017.

Research output: Contribution to journalArticle

Murphree, Dennis H. ; Kinard, Theresa N. ; Khera, Nandita D ; Storlie, Curtis ; Ngufor, Che ; Upadhyaya, Sudhindra ; Pathak, Jyotishman ; Fortune, Emma ; Jacob, Eapen K. ; Carter, Rickey E. ; Poterack, Karl A. ; Kor, Daryl J. / Measuring the impact of ambulatory red blood cell transfusion on home functional status : Study protocol for a pilot randomized controlled trial. In: Trials. 2017 ; Vol. 18, No. 1.
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AU - Kinard, Theresa N.

AU - Khera, Nandita D

AU - Storlie, Curtis

AU - Ngufor, Che

AU - Upadhyaya, Sudhindra

AU - Pathak, Jyotishman

AU - Fortune, Emma

AU - Jacob, Eapen K.

AU - Carter, Rickey E.

AU - Poterack, Karl A.

AU - Kor, Daryl J

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N2 - Background: Red blood cell (RBC) transfusion is frequently employed in both ambulatory and hospital environments with the aim of improving patient functional status. In the ambulatory setting, this practice is particularly common in patients with malignancy due to anemia associated with their cancer therapy. Increasingly, the efficacy of this US$10.5 billion per year practice has been called into question. While it is often standard of care for patients with chemotherapy-induced anemia to receive ambulatory RBC transfusions, it is unclear to what extent such transfusions affect home functional status. It is also unclear whether or not changes in functional status in this population can be objectively quantified using wearable activity monitors. We propose to directly measure the impact of outpatient RBC transfusions on at-home functional status by recording several physiological parameters and quantifiable physical activity metrics, e.g., daily energy expenditure and daily total step count, using the ActiGraph wGT3X-BT. This device is an accelerometer-based wearable activity monitor similar in size to a small watch and is worn at the waist. Study participants will wear the device during the course of their daily activities giving us quantifiable insight into activity levels in the home environment. Methods/design: This will be a randomized crossover pilot clinical trial with a participant study duration of 28â days. The crossover nature allows each patient to serve as their own control. Briefly, patients presenting at a tertiary medical center's Ambulatory Infusion Center (AIC) will be randomized to either: (1) receive an RBC transfusion as scheduled (transfusion) or (2) abstain from the scheduled transfusion (no transfusion). After an appropriate washout period, participants will crossover from the transfusion arm to the no-transfusion arm or vice versa. Activity levels will be recorded continuously throughout the study using an accelerometry monitor. In addition to device data, functional status and health outcomes will be collected via a weekly telephone interview. The primary outcome measure will be daily energy expenditure. Performance metrics, such as step count changes, will also be evaluated. Additional secondary outcome measures will include daily sedentary time and Patient-reported Outcomes Measurement Information System (PROMIS) Global 10 Survey scores. Discussion: This trial will provide important information on the feasibility and utility of using accelerometry monitors to directly assess the impact of RBC transfusion on patients' functional status. The results of the study will inform the merit and methods of a more definitive future trial evaluating the impact of ambulatory RBC transfusions in the target population. Trial registration: ClinicalTrials.gov, identifier: NCT02835937. Registered on 15 July 2016.

AB - Background: Red blood cell (RBC) transfusion is frequently employed in both ambulatory and hospital environments with the aim of improving patient functional status. In the ambulatory setting, this practice is particularly common in patients with malignancy due to anemia associated with their cancer therapy. Increasingly, the efficacy of this US$10.5 billion per year practice has been called into question. While it is often standard of care for patients with chemotherapy-induced anemia to receive ambulatory RBC transfusions, it is unclear to what extent such transfusions affect home functional status. It is also unclear whether or not changes in functional status in this population can be objectively quantified using wearable activity monitors. We propose to directly measure the impact of outpatient RBC transfusions on at-home functional status by recording several physiological parameters and quantifiable physical activity metrics, e.g., daily energy expenditure and daily total step count, using the ActiGraph wGT3X-BT. This device is an accelerometer-based wearable activity monitor similar in size to a small watch and is worn at the waist. Study participants will wear the device during the course of their daily activities giving us quantifiable insight into activity levels in the home environment. Methods/design: This will be a randomized crossover pilot clinical trial with a participant study duration of 28â days. The crossover nature allows each patient to serve as their own control. Briefly, patients presenting at a tertiary medical center's Ambulatory Infusion Center (AIC) will be randomized to either: (1) receive an RBC transfusion as scheduled (transfusion) or (2) abstain from the scheduled transfusion (no transfusion). After an appropriate washout period, participants will crossover from the transfusion arm to the no-transfusion arm or vice versa. Activity levels will be recorded continuously throughout the study using an accelerometry monitor. In addition to device data, functional status and health outcomes will be collected via a weekly telephone interview. The primary outcome measure will be daily energy expenditure. Performance metrics, such as step count changes, will also be evaluated. Additional secondary outcome measures will include daily sedentary time and Patient-reported Outcomes Measurement Information System (PROMIS) Global 10 Survey scores. Discussion: This trial will provide important information on the feasibility and utility of using accelerometry monitors to directly assess the impact of RBC transfusion on patients' functional status. The results of the study will inform the merit and methods of a more definitive future trial evaluating the impact of ambulatory RBC transfusions in the target population. Trial registration: ClinicalTrials.gov, identifier: NCT02835937. Registered on 15 July 2016.

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KW - Functional status

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