Internet-Based Self-management Plus Education Compared With Usual Care in Asthma: A Randomized Trial
Abstract
Background: The Internet may support patient self-management of chronic conditions, such as asthma. Objective: To evaluate the effectiveness of Internet-based asthma self-management. Design: Randomized, controlled trial. Setting: 37 general practices and 1 academic outpatient department in the Netherlands. Patients: 200 adults with asthma who were treated with inhaled corticosteroids for 3 months or more during the previous year and had access to the Internet. Measurements: Asthma-related quality of life at 12 months (minimal clinically significant difference of 0.5 on the 7-point scale), asthma control, symptom-free days, lung function, and exacerbations. Intervention: Participants were randomly assigned by using a computer-generated permuted block scheme to Internet-based self-management (n = 101) or usual care (n = 99). The Internet-based self-management program included weekly asthma control monitoring and treatment advice, online and group education, and remote Web communications. Results: Asthma-related quality of life improved by 0.56 and 0.18 points in the Internet and usual care groups, respectively (adjusted between-group difference, 0.38 [95% CI, 0.20 to 0.56]). An improvement of 0.5 point or more occurred in 54% and 27% of Internet and usual care patients, respectively (adjusted relative risk, 2.00 [CI, 1.38 to 3.04]). Asthma control improved more in the Internet group than in the usual care group (adjusted difference, −0.47 [CI, −0.64 to −0.30]). At 12 months, 63% of Internet patients and 52% of usual care patients reported symptom-free days in the previous 2 weeks (adjusted absolute difference, 10.9% [CI, 0.05% to 21.3%]). Prebronchodilator FEV1 changed with 0.24 L and −0.01 L for Internet and usual care patients, respectively (adjusted difference, 0.25 L [CI, 0.03 to 0.46 L]). Exacerbations did not differ between groups. Limitation: The study was unblinded and lasted only 12 months. Conclusion: Internet-based self-management resulted in improvements in asthma control and lung function but did not reduce exacerbations, and improvement in asthma-related quality of life was slightly less than clinically significant. Primary Funding Source: Netherlands Organization for Health Research and Development, ZonMw, and Netherlands Asthma Foundation.
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The sensitivity analysis confirmed that the heterogeneity was likely attributable to 1 study, possibly because the reported values were derived from model estimates.
“Our sensitivity analysis confirmed that the heterogeneity was likely attributable to 1 study, possibly because the reported values were derived from model estimates [74].”
From Effectiveness and Acceptability of Asynchronous Digital Health in Asthma Care: Mixed Methods Systematic Review (2024) · cites this paper as [74]
For the van der Meer 2009 trial, the risk of bias from blinding of outcome assessment was high because there was no blinding of intervention, outcome assessor, or data analyser.
“No blinding of intervention, outcome assessor or data analyser”
From Home telemonitoring and remote feedback between clinic visits for asthma (2016) · cites this paper as van der Meer 2009
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- Authors
- van der Meer, V., Bakker, M. J., van den Hout, W. B., Rabe, K. F., Sterk, P. J., Kievit, J., Assendelft, W. J. J., Sont, J. K., & for the SMASHING (Self-Management in Asthma Supported by Hospitals, I.
- Affiliations
- From Leiden University Medical Center, Leiden, and University of Amsterdam, Amsterdam, the Netherlands.
- Leiden University Medical Center (NL)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2009-07-21
- Volume
- 151
- Issue
- 2
- Pages
- 110-120
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W1485871038
- Cited by
- 6
- References
- 32
- Citations by year
- 2022: 1 · 2018: 1 · 2013: 2
- FWCI
- 0.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- asthma, patient education, asthma control, asthma quality of life, lung function, asthma exacerbations, inhaled corticosteroids, online health education, adult asthma, usual care comparison, general practitioner care, outpatient care, symptom-free days, FEV1, online intervention, chronic disease self-management, telemedicine
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