Abstract
BackgroundTo identify, summarise and synthesise the evidence for using interactive digital interventions to support patient self-management of asthma, and determine their impact.MethodsSystematic review with meta-analysis. We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Library, DoPHER, TROPHI, Social Science Citation Index and Science Citation Index. The selection criteria requirement was studies of adults (16 years and over) with asthma, interventions that were interactive digital interventions and the comparator was usual care. Outcomes were change in clinical outcomes, cost effectiveness and patient-reported measures of wellbeing or quality of life. Only Randomised Controlled Trials published in peer-reviewed journals in English were eligible.Potential studies were screened and study characteristics and outcomes were extracted from eligible papers independently by two researchers. Where data allowed, meta-analysis was performed using a random effects model.ResultsEight papers describing 5 trials with 593 participants were included, but only three studies were eligible for inclusion for meta-analysis. Of these, two aimed to improve asthma control and the third aimed to reduce the total dose of oral prednisolone without worsening control. Analyses with data from all three studies showed no significant differences and extremely high heterogeneity for both Asthma Quality of Life (AQLQ) (Standardised Mean Difference (SMD) 0.05; 95 % Confidence Interval (CI) 0.32 to −0.22: I2 96.8) and asthma control (SMD 0.21; 95 % CI −0.05 to .42; I2 = 87.4). The removal of the third study reduced heterogeneity and indicated significant improvement for both AQLQ (SMD 0.45; 95 % CI 0.13 to 0.77: I2 = 0.34) and asthma control (SMD 0.54; 95 % CI 0.22 to 0.86: I2 = 0.11). No evidence of harm was identified.ConclusionDigital self-management interventions for adults with asthma show promise, with some evidence of small beneficial effects on asthma control. Overall, the evidence base remains weak due to the lack of large, robust trials.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0248-7) contains supplementary material, which is available to authorized users.
Highlights
To identify, summarise and synthesise the evidence for using interactive digital interventions to support patient self-management of asthma, and determine their impact
One potential method for improving self-management is through the use of interactive digital interventions (IDIs), which offer the possibility of enabling patients to self-manage long-term conditions such as asthma and improve outcomes [10,11,12]
The intervention was an interactive digital intervention; the comparator was usual care; outcomes were objectively measured change in clinical outcomes and / or patient-reported outcomes of wellbeing or quality of life; and the study type was Randomised Controlled Trials (RCTs) as they present the strongest level of evidence
Summary
Summarise and synthesise the evidence for using interactive digital interventions to support patient self-management of asthma, and determine their impact. Primary care support for self-management in asthma can be sub-optimal [9]. IDIs are packages that can combine health information with decision support to help inform behaviour change in patients, and are typically delivered through the internet or via smart phones. They offer the potential to improve the lives of people with asthma through automating and personalising routine aspects of education, monitoring and support, whilst at the same time giving patients convenient 24 h access to detailed, personalised feedback [13, 14]. There is evidence that well-designed IDIs can change patient health-related behaviour, improve patient knowledge and increase confidence for self-management of health problems [10, 11, 15]
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