The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial

Abstract

BackgroundWhether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.ObjectiveThe aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.MethodsA multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.ResultsA total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI –0.12 to 1.05) and 9 months (mean change 0.39, 95% CI –0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.ConclusionsThis study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals’ knowledge and self-management skills improve may result in long-term gains in asthma control.ClinicalTrialInternational Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).

Theory-Based Digital Interventions to Improve Asthma Self-Management Outcomes: Systematic Review (Preprint)

“…1). Of these 16 studies, 11 (69%) reported on randomised controlled trials (RCT) (10 two-arm RCTs [50][51][52][53][54][55][56][57][58][59], one three-arm RCT [60]) and 5 (31%) were feasibility studies employing a pre-post design [61][62][63][64][65] (Multimedia Apendix 2). Two of the RCTs reported on the same intervention [51,59], however, as they reported on different outcomes, and different uses of theory, we have considered them as separate interventions.…”

“…Most studies were undertaken in the United States (75%; n=12; [51-56, 59-61, 63-65]), followed by Australia (n=2; [57,62]), Canada (n=1; [50]) and New Zealand (n=1; [58]). Studies included a range of ages: children (44%; n=7; [51, 53, 59-61, 64, 65]), adolescents (13%; n=2; [54,55]), adults (38%; n=6; [50,52,57,58,62,63]) and mixed sample (6%; n=1; [56]). Between 35-82% of the samples were female.…”

“…Table 2 shows the study characteristics in terms of adherence and self-management (including self-management efficacy, beliefs and behaviours) outcomes. Five studies (31%) did not report on behavioural outcomes [50,53,55,57,63].…”

“…Five studies (31%; 3 RCTs and 2 pre-post studies) reported on asthma control, measured by the Asthma Control Questionnaire (ACQ) (n=1; [57]); the Asthma Control Test (n=3; [50,52,63]); and the Royal College of Physicians 3-questions screening tool (n=1; [62]). Only the two pre-post studies [62,63] reported a significant effect of the intervention on asthma control.…”

“…Validated measures included the Asthma Quality of Life Questionnaire (AQLQ) (n= 2; [52,63]), the Paediatric Quality of Life Questionnaire (PQLQ) (n=3; [53,56,64]), the Functional Status measure (FS II R) (n=1; [51]), and the mini AQLQ (n=1; [50]). Two studies developed a quality of life measure specific to their study [54,62].…”