Background Psoriasis has a negative impact on patients’ physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis. Objective This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis. Methods Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated. Results A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5%) or intervention group (54/107, 50.5%). Approximately 71.9% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration. Conclusions These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency. Trial Registration Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk
BACKGROUND Psoriasis has a negative impact on patients’ mental and physical health. Disease management strategies including educational programs and eHealth devices can improve health care in chronic diseases. OBJECTIVE Combining an educational program with a disease management smartphone application has been shown to reduce depressive symptoms in psoriasis patients over 24 weeks. Here, we present results of the 60-week long-term study period. METHODS Psoriasis patients of the intervention group received an educational program, visits on week 0, 12, 24, 36, and 60, and access to the study-app. The control group attended the visits, only. Additionally, effects of the app usage frequency were assessed. Primary endpoints were a significant reduction of the Hospital Anxiety and Depression Score (HADS-A/-D). RESULTS 107 patients were included in the study and randomized into the control (n = 53) or intervention group (n = 54). 77 patients completed the study. A significant reduction in HADS D in the intervention group was found in week 12 (P = .04) and 24 (P = .005), but not in week 36 (P = .12) and 60 (P = .32). Patient stratification according to their app usage frequency showed a significant improvement of the HADS-D at week 36 (P = .004) and 60 (P = .04) and in the HADS-A at week 36 (P = .04) and 60 (P = .05) in the group using the app less than once a month. CONCLUSIONS These findings support the usage of a disease management smartphone application as a valid tool to achieve a long-term improvement of psoriasis patients’ mental health, if not used too frequently. CLINICALTRIAL Drks.de DRKS00020755 (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020755)
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