一项试验性随机对照试验，比较基于短信收发和网络哮喘行动计划与书面行动计划对哮喘恶化的影响
2018/12/17
摘要
目的：我们比较了由自动短信服务（SMS）支持的电子哮喘行动计划（eAAP）和书面哮喘行动计划（AAP）在评估可接受性和哮喘控制改善方面的差异。我们推测，eAAP组的患者在生活质量、哮喘控制和哮喘恶化方面会有更多的改善。
方法：招募由医生诊断为哮喘，并在过去12个月中至少有一次哮喘恶化的患者。参与者接受个体化的行动计划，并被随机分成干预组（eAAP）和对照组（AAP）。干预组每周收到短信，触发哮喘控制评估和查看他们的eAAP。我们评估了远程健康平台在12个月内对哮喘恶化、哮喘控制和生活质量的适用性。
结果：106例患者入组（EAAP＝52，AAP＝54）。每周短信登记的累积响应率为68.4%。总的来说，28%的患者在干预期间检查了eAAP。与AAP组相比，eAAP组病情加重（18%）较少（RR=0.82[95%CI 0.49，1.36]），（P=0.44）。eAAP组与AAP组相比，哮喘控制和生活质量的平均得分更高，分别为4%(RR=1.04[95%CI 0.83，1.30])，(P=0.73)和5.5%(RR=1.06[95%CI 0.87，1.28])、(P=0.59)，但无统计学意义。
结论： 我们证明eAAP改善了哮喘控制效果，但正如预期的那样，样本量不足以显示出显著差异，但是基于这个试点研究，我们计划进行更大规模的效力更佳的随机对照试验（RCT）。
A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations.
Poureslami I PhD, Shum J MSc, Lester RT MD, Tavakoli H MD, MSc4, Dorscheid DR MD, PhD, FitzGerald JM MD.
Abstract
OBJECTIVE: We compared electronic asthma action plans (eAAP) supported by automated text messaging service (SMS) with written asthma action plans (AAP) on assessing acceptability and asthma control improvement. We hypothesized that the patients in eAAP group would have more improvements in their quality of life, asthma control and decreased asthma exacerbations.
METHODS: Patients with physician-diagnosed asthma having at least one asthma exacerbation in the previous 12 months were recruited. Participants received individualized action plans and were randomly assigned into either the intervention (eAAP) or control (AAP) group. Intervention participants received weekly SMS, triggering assessment of asthma control and viewing their eAAP. We assessed applicability of Telehealth platform on asthma exacerbations, asthma control, and quality of life over a 12-month period.
RESULTS: 106 patients were enrolled (eAAP = 52, AAP = 54). The cumulative response rate to all weekly SMS check-ins was 68.4%. Overall, 28% of patients checked into their eAAP during the intervention period. There were fewer exacerbations in the eAAP group (18%) compared to the AAP group (RR = 0.82 [95%CI 0.49, 1.36]), (P = 0.44). The mean scores for asthma control and quality of life were higher in the eAAP group compared to the AAP group by 4% (RR = 1.04 [95%CI 0.83, 1.30]), (P = 0.73) and 5.5% (RR = 1.06 [95%CI 0.87, 1.28]), (P = 0.59), respectively, but were not statistically significant.
CONCLUSIONS: We demonstrated that the eAAP presented improved asthma control outcomes, but as expected the sample size was inadequate to show a significant difference, but based on this pilot study we plan a larger appropriately powered randomized controlled trial (RCT).
目的：我们比较了由自动短信服务（SMS）支持的电子哮喘行动计划（eAAP）和书面哮喘行动计划（AAP）在评估可接受性和哮喘控制改善方面的差异。我们推测，eAAP组的患者在生活质量、哮喘控制和哮喘恶化方面会有更多的改善。
方法：招募由医生诊断为哮喘，并在过去12个月中至少有一次哮喘恶化的患者。参与者接受个体化的行动计划，并被随机分成干预组（eAAP）和对照组（AAP）。干预组每周收到短信，触发哮喘控制评估和查看他们的eAAP。我们评估了远程健康平台在12个月内对哮喘恶化、哮喘控制和生活质量的适用性。
结果：106例患者入组（EAAP＝52，AAP＝54）。每周短信登记的累积响应率为68.4%。总的来说，28%的患者在干预期间检查了eAAP。与AAP组相比，eAAP组病情加重（18%）较少（RR=0.82[95%CI 0.49，1.36]），（P=0.44）。eAAP组与AAP组相比，哮喘控制和生活质量的平均得分更高，分别为4%(RR=1.04[95%CI 0.83，1.30])，(P=0.73)和5.5%(RR=1.06[95%CI 0.87，1.28])、(P=0.59)，但无统计学意义。
结论： 我们证明eAAP改善了哮喘控制效果，但正如预期的那样，样本量不足以显示出显著差异，但是基于这个试点研究，我们计划进行更大规模的效力更佳的随机对照试验（RCT）。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(J Asthma. 2018 Oct 16:1-13. doi: 10.1080/02770903.2018.1500583.)
(J Asthma. 2018 Oct 16:1-13. doi: 10.1080/02770903.2018.1500583.)
A pilot randomized controlled trial on the impact of text messaging check-ins and a web-based asthma action plan versus a written action plan on asthma exacerbations.
Poureslami I PhD, Shum J MSc, Lester RT MD, Tavakoli H MD, MSc4, Dorscheid DR MD, PhD, FitzGerald JM MD.
Abstract
OBJECTIVE: We compared electronic asthma action plans (eAAP) supported by automated text messaging service (SMS) with written asthma action plans (AAP) on assessing acceptability and asthma control improvement. We hypothesized that the patients in eAAP group would have more improvements in their quality of life, asthma control and decreased asthma exacerbations.
METHODS: Patients with physician-diagnosed asthma having at least one asthma exacerbation in the previous 12 months were recruited. Participants received individualized action plans and were randomly assigned into either the intervention (eAAP) or control (AAP) group. Intervention participants received weekly SMS, triggering assessment of asthma control and viewing their eAAP. We assessed applicability of Telehealth platform on asthma exacerbations, asthma control, and quality of life over a 12-month period.
RESULTS: 106 patients were enrolled (eAAP = 52, AAP = 54). The cumulative response rate to all weekly SMS check-ins was 68.4%. Overall, 28% of patients checked into their eAAP during the intervention period. There were fewer exacerbations in the eAAP group (18%) compared to the AAP group (RR = 0.82 [95%CI 0.49, 1.36]), (P = 0.44). The mean scores for asthma control and quality of life were higher in the eAAP group compared to the AAP group by 4% (RR = 1.04 [95%CI 0.83, 1.30]), (P = 0.73) and 5.5% (RR = 1.06 [95%CI 0.87, 1.28]), (P = 0.59), respectively, but were not statistically significant.
CONCLUSIONS: We demonstrated that the eAAP presented improved asthma control outcomes, but as expected the sample size was inadequate to show a significant difference, but based on this pilot study we plan a larger appropriately powered randomized controlled trial (RCT).
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