This study is part of a larger project aimed at understanding how the use of a new self-monitoring device (comprising connected objects and smartphone applications) transforms the care of patients with CF in France. Specifically, we explored the changes in the management and monitoring of the pathology by physiotherapists.
A triangulation of different qualitative methodologies was employed, including eight semi-structured interviews, participant observation, and a literature review. An interview guide was developed for the interviews. All semi-structured interviews were transcribed, and an in-depth thematic analysis based on grounded theory was conducted.
The results first highlight the complexity of caring for patients with CF, as reported by the interviewed physiotherapists. This care requires significant “monitoring work,” shared between the patient (observation of criteria, retrospective and reflective work) and the physiotherapist (observation of clinical signs, clinical reasoning). The use of a self-monitoring device leads to unprecedented patient empowerment but also poses risks, such as rejecting autonomy and pathologizing everyday life. Furthermore, self-monitoring devices alter the nature of monitoring work. They transform the roles involved in monitoring (e.g., delegating tasks to patients), the spaces where monitoring occurs (e.g., measurements taken at the patient’s home), and the temporal aspects of monitoring (e.g., faster and continuous measurements). These devices also facilitate the quantification of monitoring work (e.g., improved traceability in the application). However, there are barriers and reasons for discontinuing their uses, including the complexity of the device, age-related challenges, additional workload, and cost.
The process of quantification and standardization enabled by these devices is questionable, as it generates diffuse forms of control over patients. Clear objectives for the use of these devices by physiotherapists working with CF patients should be defined collaboratively.
The concept of “monitoring work” could also be applied to the management of other chronic conditions requiring increased monitoring in physiotherapy. The findings prompt us to reconsider how these digital devices are introduced and utilized in physiotherapy care practices.
digital health
self-monitoring
