The effect of SMART care model on physical and psychological adaptation of patients with liver cirrhosis: randomized controlled trial

Objective: The objective of this study was to develop and evaluate the effect of Self-Management with APP and Reminder Technology (SMART) care model on the improvement of physical and psychological adaptation in patients with moderate to severe liver cirrhosis. Methods: A randomized controlled trial was conducted to examine the effectiveness of SMART care model on the physical and psychological adaptation. SMART care model was used to conduct individual managements by a self-management APP of liver cirrhosis which provides symptoms monitoring and immediate feedbacks. Outcome measurements were pre-test, after intervention, and at the three and six month after intervention. The instruments included multidimensional symptoms questionnaire, frequency of emergency and outpatient department visit, hospital anxiety and depression scale, and short-form Chinese health-promoting lifestyle profile. GEE models were used to identify the effectiveness of SMART care model using application of selfmanagement on improving physical and psychological adaptation. Results: A total of 20 patients with moderate to severe liver cirrhosis randomly assigned to SMART care group or control group receiving usual care. GEE model demonstrated that SMART can benefit patients with moderate to severe liver cirrhosis to improve depressive symptoms and increase healthpromoting behaviors; however, the effect of SMART on decreasing symptoms distress was not significant. Conclusions: The results confirmed that SMART care model was effective to improve depressive symptoms and increase health-promoting lifestyles in patients with moderate to severe liver cirrhosis. Further studies adding contents related to the improvement of symptoms distress should be considered.