J. Med. Internet Res. - Long-term outcomes of internet-based self-management support in adults with asthma: randomized controlled trial.


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CKGROUND: Long-term asthma management falls short of the goals set by international guidelines. The Internet is proposed as an attractive medium to support guided self-management in asthma. Recently, in a multicenter, pragmatic randomized controlled parallel trial with a follow-up period of 1 year, patients were allocated Internet-based self-management (IBSM) support (Internet group [IG]) or usual care (UC) alone. IBSM support was automatically terminated after 12 months of follow-up. In this study, IBSM support has been demonstrated to improve asthma-related quality of life, asthma control, lung function, and the number of symptom-free days as compared to UC. IBSM support was based on known key components for effective self-management and included weekly asthma control monitoring and treatment advice, online and group education, and communication (both online and offline) with a respiratory nurse.OBJECTIVE: The objective of the study was to assess the long-term effects of providing patients 1 year of IBSM support as compared to UC alone.METHODS: Two hundred adults with physician-diagnosed asthma (3 or more months of inhaled corticosteroids prescribed in the past year) from 37 general practices and 1 academic outpatient department who previously participated were invited by letter for additional follow-up at 1.5 years after finishing the study. The Asthma Control Questionnaire (ACQ) and the Asthma Quality of Life Questionnaire (AQLQ) were completed by 107 participants (60 UC participants and 47 IG participants). A minimal clinical important difference in both questionnaires is 0.5 on a 7-point scale.RESULTS: At 30 months after baseline, a sustained and significant difference in terms of asthma-related quality of life of 0.29 (95% CI 0.01-0.57) and asthma control of -0.33 (95% CI -0.61 to -0.05) was found in favor of the IBSM group. No such differences were found for inhaled corticosteroid dosage or for lung function, measured as forced expiratory volume in 1 second.CONCLUSIONS: Improvements in asthma-related quality of life and asthma control were sustained in patients who received IBSM support for 1 year, even up to 1.5 years after terminating support. Future research should be focused on implementation of IBSM on a wider scale within routine asthma care.TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number (ISRCTN): 79864465; http://www.controlled-trials.com/ISRCTN79864465 (Archived by WebCite at http://www.webcitation.org/6J4VHhPk4).

Resumo Limpo

ckground longterm asthma manag fall short goal set intern guidelin internet propos attract medium support guid selfmanag asthma recent multicent pragmat random control parallel trial followup period year patient alloc internetbas selfmanag ibsm support internet group ig usual care uc alon ibsm support automat termin month followup studi ibsm support demonstr improv asthmarel qualiti life asthma control lung function number symptomfre day compar uc ibsm support base known key compon effect selfmanag includ week asthma control monitor treatment advic onlin group educ communic onlin offlin respiratori nurseobject object studi assess longterm effect provid patient year ibsm support compar uc alonemethod two hundr adult physiciandiagnos asthma month inhal corticosteroid prescrib past year general practic academ outpati depart previous particip invit letter addit followup year finish studi asthma control questionnair acq asthma qualiti life questionnair aqlq complet particip uc particip ig particip minim clinic import differ questionnair point scaleresult month baselin sustain signific differ term asthmarel qualiti life ci asthma control ci found favor ibsm group differ found inhal corticosteroid dosag lung function measur forc expiratori volum secondconclus improv asthmarel qualiti life asthma control sustain patient receiv ibsm support year even year termin support futur research focus implement ibsm wider scale within routin asthma caretri registr intern standard random control trial number isrctn httpwwwcontrolledtrialscomisrctn archiv webcit httpwwwwebcitationorgjvhhpk

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