Vidatalk Communication Application: Usability, Acceptability and Efficacy Study

Not Applicable

Completed

Conditions: Nonverbal Communication
Critical Illness

Interventions: Device: Aim 3 - VidaTalk tablet app
Other: Aim 2 - VidaTalk - intubated
Other: Aim 3 - attention-control with non-VidaTalk tablet
Other: Aim 1 - VidaTalk - post-extubation

Registration Number: NCT02921776

Lead Sponsor: Ohio State University

Brief Summary: This Phase II Small Business Technology Transfer Research (STTR) will deliver a comprehensive patient communication solution for communication-impaired patients in the intensive care unit that may help decrease days in delirium, decrease anxiety levels, and reduce sedation exposure which are proximal outcomes known to be associated with decreased mechanical ventilation days, shorter lengths of ICU and hospital stay, and lower healthcare cost. The primary goal of this Phase II STTR proposal is to further define user requirements and product specifications and develop a prototype of VidaTalk, a patient-centric, touch pad communication software, to provide mechanically ventilated (MV) patients an evidence-based solution for effectively communicating their needs to care providers and family. A secondary goal is to test the impact of the VidaTalk on clinical outcomes. This study will use mixed methods including observations and interaction with hospitalized patients as they use the VidaTalk tool, surveys and medical record data extraction, product evaluation and brief interview, satisfaction surveys with family members of ICU patients, and focus groups with Registered Nurses.

Specific Aim 1. Develop a commercial prototype of VidaTalk that will include multilingual and customizable messages, compatibility with tablet devices, picture symbols, and integration with mobile communication devices.

Specific Aim 2. Demonstrate usability with iterative user assessment testing in a clinical setting.

Specific Aim 3. Test the clinical efficacy of VidaTalk via android application with MV patients by examining qualitative and quantitative endpoints in a clinical setting. Aim 3 hypothesis: MV patients using VidaTalk will demonstrate significant reductions in patient-reported communication difficulty and frustration, anxiety, sedation exposure, delirium/coma-free days, and improved patient and family satisfaction with ICU care compared to MV patients receiving attention-control (i.e., tablets with health education application).

Specific Aim 4. Validation of electronic visual analogue scale, versus current standard paper scale.

Specific Aim 5 a, b and c. Test the effect of the communication tablet (VidaTalk) on psychological symptoms in family caregivers.

Detailed Description: Treatment-induced communication impairment is one of the most common and distressful symptoms to mechanically ventilated intensive care unit (ICU) patients and is associated with anxiety, panic, anger, frustration, sleeplessness, and distress.This Phase II Small Business Technology Transfer Research (STTR) will deliver a comprehensive solution that may help decrease days in delirium, decrease anxiety levels, and reduce sedation exposure which are proximal outcomes known to be associated with decreased mechanical ventilation days, shorter lengths of ICU and hospital stay, and lower healthcare cost. The primary goal of this Phase II STTR proposal is to further define user requirements and product specifications and develop a prototype of VidaTalk (previously TouchTalk), a patient-centric, touch pad communication software, to provide mechanically ventilated (MV) patients an evidence-based solution for effectively communicating their needs to care providers and family. A secondary goal is to test the impact of the VidaTalk on clinical outcomes (e.g., patient-reported communication difficulty and frustration, anxiety, sedation exposure, delirium/coma-free days, and improved patient and family satisfaction with ICU care). This study will use mixed methods including observations and interaction with hospitalized patients as they use the VidaTalk communication tool, surveys and medical record data extraction, product evaluation and brief interview, satisfaction survey with family members of ICU patients and focus groups with Registered Nurses. Our Phase I STTR successfully delivered a beta prototype that met technical feasibility criteria; however, additional requirements emerged as a common theme from user testing and market analysis. The current study will meet the identified needs for VidaTalk to operate on android devices, be customizable to patients' unique message needs, use pictures symbols for communication, and be able to route patient requests to providers who are not present at the bedside.

Specific Aim 1 (Preliminary to Clinical Trial). Develop a commercial prototype of VidaTalk that will include multilingual and customizable messages, compatibility with tablet devices, picture symbols, and integration with mobile communication devices.

Specific Aim 2 (Preliminary to Clinical Trial). Demonstrate usability with iterative user assessment testing in a clinical setting.

Specific Aim 3. Test the clinical efficacy of VidaTalk via android application with MV patients by examining qualitative and quantitative endpoints in a clinical setting. Aim 3 hypothesis: MV patients using VidaTalk will demonstrate notable reductions in patient-reported frustration and communication difficulty, anxiety, sedation exposure, delirium/coma-free days, and improved patient and family satisfaction with ICU care compared to MV patients receiving attention-control.

Specific Aim 4. Validation of electronic visual analogue scale, versus current standard paper scale.

Specific Aim 5. Test the effect of the communication tablet (VidaTalk) on psychological symptoms in family caregivers.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 147

Inclusion Criteria

≥18 years old
Able to communicate in English
Awake alert, responding appropriately to commands.
Normal (aided or unaided) hearing and vision
Able to control head, arm and hand movements
Physiologically stable and in no acute distress (per nurse report)

Exclusion Criteria

Pre-existing communication impairments
Diagnosis of severe dementia or brain injury
CAM-ICU positive for delirium
unresponsiveness or inattention

Aim 2:

Inclusion Criteria:

≥18 years old
Able to communicate in English
Awake alert, responding appropriately to commands.
Normal (aided or unaided) hearing and vision
Able to control head, arm and hand movements
Physiologically stable and in no acute distress (per nurse report)
Intubated via oral endotracheal or tracheal tube without speaking valve, receiving mechanical ventilation

Exclusion Criteria:

Pre-existing communication impairments
Diagnosis of severe dementia or brain injury
CAM-ICU positive for delirium
unresponsiveness or inattention

Aim 3:

Inclusion Criteria:

≥18 years old
Able to communicate in English
Awake alert, responding appropriately to commands.
Normal (aided or unaided) hearing and vision
Able to control head, arm and hand movements
Physiologically stable and in no acute distress (per nurse report)
Intubated via oral endotracheal or tracheal tube without speaking valve, received mechanical ventilation during past 48 hours

Exclusion Criteria:

Pre-existing communication impairments
Diagnosis of severe dementia or brain injury
CAM-ICU positive for delirium
unresponsiveness or inattention

Aim 5

Inclusion Criteria:

Family caregivers of patient participants enrolled in Aim 3 as identified by the patient or self
>/=18 years old
Able to read and speak English
Non-professional, unpaid caregiver
Plans to visit at least 3 days/ week during ICU stay
Reliable telephone access (for follow-up assessment)

Exclusion Criteria:

Age under 18 years
Unable to read and speak English
Severe uncorrected hearing loss
Self-reported diagnosis of dementia or Alzheimer's
Self-reported psychiatric disorder (bipolar disorder, schizophrenia) or substance abuse requiring inpatient treatment within the last 12 months
Unreliable telephone access

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Aim 3 - VidaTalk tablet app	Aim 3 - VidaTalk tablet app	Test the clinical efficacy of VidaTalk with MV patients by examining qualitative and quantitative endpoints in a clinical setting. 35 intubated patients (oral endotracheal tube or tracheostomy) will be randomized to the intervention arm and will receive a protocolized instruction in the use of the VidaTalk application including patient return demonstration of key features, and review/ testing to competence conducted by a trained interventionist. When available, a family member may be included in surveys about the patients hospital stay, if patient agrees. The interventionist will visit patients briefly (5-10 minutes) each day to check user needs and concerns and will review or retrain on message options if needed. Intervention will be receipt of VidaTalk tablet application.
Aim 2 - VidaTalk intubated	Aim 2 - VidaTalk - intubated	Usability testing preliminary to Clinical Trial (Aim 3). Mechanically Ventilated patients will provide feedback on acceptability, will perform test messages with minimal errors, and will rate VidaTalk an overall average score of 4.5 or higher (Likert-type scale; 1 to 7) on usability questions. Prior to implementing these procedures, the company will perform further iterative design assessments and engineer a Vidatalk tablet application prototype. This prototype will be used with a final group of ten (10) intubated patients receiving mechanical ventilation support to field-test the prototype for functionality (human-device interaction factors, feasibility, and usability) and acceptability. Intervention is usability tasks with the VidaTalk app
Aim 3 - attention-control	Aim 3 - attention-control with non-VidaTalk tablet	35 intubated patients (oral endotracheal tube or tracheostomy) will receive the standard of care, which may include primarily writing tools (paper and pen) and, occasionally, picture or alphabet communication charts. Patients randomized to the control group will receive a protocolized introduction to the bedside Android device without the VidaTalk application, focusing instead on a common tablet application. Daily visits will be conducted with control group patients to query on use of the attention-control tablet. Interventions will be Aim 3 - attention-control with non-VidaTalk tablet.
Aim 1- VidaTalk post-extubation	Aim 1 - VidaTalk - post-extubation	Aim 1 is a two group iterative design preliminary to clinical trial. Group 1 and Group 2 will each consist of five previously mechanically ventilated patients who will be recruited from the ICUs at the OSUWMC (Ohio State University Wexner Medical Center), including discharged patients. Group 1 will use an initial android prototype of VidaTalk tablet application to be assessed for functionality (ergonomics, ease of use, ease of learning, simplicity, effectiveness and user interface) and usability on customizable communication, picture symbols, and integration with mobile communication devices. Group 2 will use an improved alpha prototype of VidaTalk tablet application version engineered from observations made during Group 1 sessions.

Primary Outcome Measures

Name	Time	Method
Mean Daily Patient-reported Communication Difficulty Rating Using Single Item 0-4 Rating Scale	Daily post-randomization until extubation or ICU discharge up to maximum of 28 days in the ICU	Aim 3 - Mean item score of daily by patient self report using a single item Likert-type scale from the Ease of Communication Scale (ECS) where scores range from 0 "not hard at all" to 4 "extremely hard"

Secondary Outcome Measures

Name	Time	Method
Mean Patient Frustration With Communication	Daily post-randomization until extubation or ICU discharge up to maximum of 28 days in the ICU	Aim 3 - This will be the calculated mean of the daily Communication Frustration scale - a single item scale reported by the patient, ranging from 0 "not frustrating" to 4 "extremely frustrating"
Family Satisfaction With Care in the Intensive Care Unit FS-ICU	One 10 minute survey will be given at patient's ICU discharge or extubation	(Aim3 )The Family Satisfaction with ICU Care (FS-ICU 24R) questionnaire overall satisfaction score is derived from questions 1 through 24 (26 items) and combines two subscale summary scores. The satisfaction with care summary score is derived from the questions numbered 1 through 14 (which consists of 16 questions because question 2 has parts a, b and c). The satisfaction with decision making summary score is derived from questions 15 through 24 (10 questions). All questions are coded as integers from 1 (worst) to 5 (best). Rescale the summary scores from 1 through 5 to 0 through 100 by subtracting 1 from the scores (so they can range from 0 to 4) and then multiplying each score by 25.
Mean Patient Reported Anxiety Score Using Visual Analogue Scale	Daily post-randomization until extubation or ICU discharge up to maximum of 28 days in the ICU	Aim 3 - Calculated mean of daily measure by patient mark (x) or point on the Visual Analogue Scale for anxiety, a 100 mm vertical line ranging from 0 ("not anxious at all") to 10 ("most anxious I've ever been").
Percentage of Patients Scoring in the "Calm" Range During Study Days on Richmond Agitation Sedation Score	Daily post-randomization until extubation or ICU discharge up to maximum of 28 days in the ICU	The Richmond Agitation Sedation Scale, a 10-level observational rating of agitation-sedation motor activity ranging from +4 'combative' to -5 unresponsive, with 0 as calm. Since this is a categorical measure, we compared proportion of patients with RASS in -1 to +1 (calm) range during study days.
Electronic Visual Analogue Scale-validation Measure	Only measured at baseline, order of administration randomized before or after paper version	(Aim4) visual analogue touch screen scale via android tablet with REDCap link. Not able to calculate because the touch screen scale was unreliable. Patients often needed assistance with the touch screen cursor for this experimental measure. We determined that pencil and paper analogue scale was superior for this patient population.
Family Member Anxiety	Baseline, patient extubation or discharge from ICU, 1-month, 3-month, 6-month post-discharge	(Aim 5) Hospital Anxiety and Depression Scale (HADS) Anxiety sub scale including 7 items each scored from 0-3 with total scores ranging from 0 - 21 with higher scores indicating higher levels of anxiety.
Family Member Depression	Baseline, patient extubation or discharge from ICU, 1-month, 3-month, 6-month post-discharge	(Aim 5). Hospital Anxiety and Depression Scale (HADS-D)- Depression Subscale including 7 items each scored from 0-3 with total scores ranging from 0 - 21 with higher scores indicating higher levels of depression symptoms.
Family Communication Difficulty	baseline and extubation or discharge from the ICU	Family Communication Survey administered to participant families. Sum of 9-items with each item rating 0 (not at all) to 4 (extremely difficult), resulting in a total summed score from 0 - 36. Higher scores indicate greater difficulty.
Communication Task Error Rate	Measured during 30-60 minute usability testing visit which occurs at study completion. This outcome applies only to Aim 1 & 2 arms.	Aims 1 \& 2 - count of the number of errors recorded by video screen capture for each of 8 communication tasks. Individual patients ranged from 0 to 9 errors, however this measure contains no upper range per task as it is a count of actual observed errors committed by patients.
Ease of Communication at Extubation /ICU Discharge	measured at Extubation /ICU Discharge	Ease of Communication Scale -10-item likert scale total score ranging from 0-40. Each item is 0-4 likert scale, total score is sum of all items with higher scores indicating greater communication difficulty.
Mean Daily Sedation Exposure	Daily post-randomization until extubation or ICU discharge up to maximum of 28 days in the ICU daily in ICU	Used in Aim 3 only. Calculation of benzodiazepine and morphine equivalents (for opiates) using hospital conversion charts (pharmacy conversion chart). All benzo IV doses were converted to Lorazepam IV doses. All opioid IV doses were converted to morphine IV doses. All benzo oral doses were converted to Lorazepam oral doses. All opioid oral doses were converted to morphine oral doses. Oral doses were converted to IV equivalents. Summed doses of Lorazepam IV and morphine IV were calculated for each study day for each patient. Doses were converted to milligrams per kilogram based on the patient's body weight. Higher numbers indicate greater sedation and/or opiate exposure.
Delirium/Coma -Free Days	Daily, from enrollment to 28 days post-enrollment	Aim 3 -Delirium/coma-free days is defined as the number of days alive and free of delirium and coma during the 28-day study period. Delirium will be coded as present when a patient displays both features 1 and 2, and either 3 or 4 of the CAM-ICU (Confusion Assessment Method). Coma is defined as a RASS (Richmond Agitation-Sedation Scale ) assessment score of -4 or -5.
Patient Satisfaction With Care	Measured at extubation or discharge from ICU which ever comes first	A 24-item survey with lower scores indicating greater satisfaction with care.
Post-traumatic Stress Symptoms: Impact of Events Scale-revised (IES-R)	1-month, 3-month, 6-month post-discharge	(Aim 5) Impact of Events Scale-revised. The IES-R is a 22-item self-report instrument with three subscales including intrusion (8 items), avoidance (8 items), and hyperarousal (6 items). The respondent is asked to report the degree of distress experienced for each item in the past 7 days. Each item is scored on a five-point Likert scale (0, not at all; 1, rarely; 2, occasionally; 3, fairly often; and 4, often) and total scores range from 0 to 88. Higher scores are representative of greater distress.
Patient Satisfaction With Communication Task Ease	Measured during 30-60 minute usability testing visit which occurs at study completion	Aims 1 \& 2 - a single item from the After Scenario Questionnaire (ASQ) of patient's self rating of satisfaction with the "ease of completing" each of 8 communication tasks on the usability test. Question asked of patients was "Overall, I am satisfied with the ease of completing this task". 1-strongly disagree 7-strongly agree. Higher scores indicated greater satisfaction with the ease of completing the task.
After-Scenario Questionnaire (ASQ) Score	Measured during 30-60 minute usability testing visit which occurs at study completion	Aims 1 \& 2. The After-Scenario Questionnaire (ASQ) is a 3-item likert-type scale used to assess how difficult a user perceived a task in a usability test. Responses range from 1-strongly disagree to 7- strongly agree. Total score is the sum of the 3 items, possible scores range from 3 to 21. Higher scores indicated better outcomes. This was not measured for each task as that was too burdensome for intubated patients. We measured once as an overall rating at the end of the session- 3-item ASQ.
Total Error Rate	Measured during 30-60 minute usability testing visit which occurs at study completion	Aims 1 \& 2 - calculated mean of the total number of errors recorded by video screen capture divided by the number of communication tasks completed (8 maximum) Aim 1 extubated patients. Using group 1 and group 2 summary data, 11 patients completed 82 tasks (6 were abandoned, 5 of these by one patient). Removing abandonments, total number of errors = 25/ 82 tasks = 0.30 error rate. Aim 2 intubated patients. 11 patients completed 69 tasks (18 were abandoned; 1 task was refused). Removing abandonments, total number of errors = 60/ 69 tasks = 0.87error rate.
Observed Task Completion Time (in Seconds)	Measured during 30-60 minute usability testing visit which occurs at study completion	Aims 1 \& 2 - This is the time, measured in seconds, on the screen capture recording beginning with the communication task command to patient completion of the communication task or message to patient completion of each of the 8 communication tasks on the usability test, calculated from the screen capture recordings
System Usability Scale (SUS) -Adapted	Measured during 30-60 minute usability testing visit which occurs at study completion	Aims 1 \& 2, System Usability Scale is 13-item likert type scale with item ratings of 1 'strongly agree' to 7 'strongly disagree' to obtain the patient's rating of overall usability of the VidaTalk application, total scores range from 13 to 91 Note: This is different from the standard 10-item SUS that uses a 5-point scale, with scores ranging 0-100.
Number of Participants That Responded "Yes" to Having Communication Difficulty at Extubation or ICU Discharge	measured at Extubation /ICU Discharge	Measured as a single item : Question asked was - "Presence of communication difficulty in the last few days?" with answers being Yes or No