Smartphone-guided self-prone positioning recommendations failed to promote adherence

Smartphone-guided recommendations and instructions for self-prone positioning failed to promote adherence among nonintubated patients with COVID-19, according to findings published in Chest.

“These results help to inform the use of self-guided prone positioning recommendations among nonintubated low acuity patients with COVID-19, inpatient smartphone-based interventions and self-prone positioning vs. assisted prone positioning in nonintubated patients,” Garrett Rampon, MD, pulmonologist at the University of Kansas Medical Center, and colleagues wrote.

APPEX-19 was a multicenter, randomized clinical trial of 293 participants with COVID-19 (mean age, 53 years; 39.9% women) who were not intubated but were receiving less than 6 L per minute of supplemental oxygen. Participants were randomly assigned to a smartphone-guided self-prone positioning intervention (n = 159) or usual care (n = 134). Participants in the intervention group received messages via their personal smartphone with an overview of the potential benefits of prone positioning for COVID-19; recommendations to prone position up to four times a day for 1 to 2 hours each session and nightly for a total of 12 hours; pictorial instructions for safe self-prone positioning; and instructions to track time spent in different body positions.

The primary outcome was the composite of respiratory deterioration or ICU transfer.

The APPEX-19 trial was stopped prematurely due to slow enrollment.

Of the 70 participants in the intervention group and 69 participants in the usual care group who self-reported body positioning, 71.4% in the intervention group and 59.4% in the usual care group attempted prone positioning.

Thirty-one participants assigned usual care and 32 participants assigned the self-prone positioning intervention experienced respiratory deterioration or ICU transfer. There was a 72.1% posterior probability of superiority for the intervention, which was less than the 95% threshold for superiority, according to the researchers..

Twenty-seven percent of participants assigned usual care and 11.9% of participants assigned the intervention reported adverse events. Overall, 8.8% of participants in the intervention group and 20.9% of participants in the usual care group reported being very uncomfortable with self-prone positioning, and 5.7% and 9%, respectively, reported loss of an IV catheter, and 0.6% in the intervention group reported loss of a urinary catheter.

The researchers concluded that this study “was underpowered to make conclusions concerning the effectiveness of self-prone positioning recommendations and instructions or self-prone positioning itself in reducing clinical deterioration.”