van der Meer Victor, Bakker Moira J, van den Hout Wilbert B, Rabe Klaus F, Sterk Peter J, Kievit Job, Assendelft Willem J J, Sont Jacob K
Leiden University Medical Center, Leiden, The Netherlands.
Ann Intern Med. 2009 Jul 21;151(2):110-20. doi: 10.7326/0003-4819-151-2-200907210-00008.
The Internet may support patient self-management of chronic conditions, such as asthma.
To evaluate the effectiveness of Internet-based asthma self-management.
Randomized, controlled trial.
37 general practices and 1 academic outpatient department in the Netherlands.
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.
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.
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.
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.
The study was unblinded and lasted only 12 months.
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.
Netherlands Organization for Health Research and Development, ZonMw, and Netherlands Asthma Foundation.
互联网可能有助于慢性病患者的自我管理，如哮喘。
评估基于互联网的哮喘自我管理的有效性。
随机对照试验。
荷兰的37家全科诊所和1个学术门诊部。
200名成年哮喘患者，他们在上一年中接受吸入性糖皮质激素治疗3个月或更长时间，并且可以访问互联网。
12个月时的哮喘相关生活质量（7分制量表上最小临床显著差异为0.5）、哮喘控制情况、无症状天数、肺功能和病情加重情况。
使用计算机生成的置换区组方案将参与者随机分配到基于互联网的自我管理组（n = 101）或常规护理组（n = 99）。基于互联网的自我管理计划包括每周哮喘控制监测和治疗建议、在线和小组教育以及远程网络通信。
互联网组和常规护理组的哮喘相关生活质量分别提高了0.56分和0.18分（调整后的组间差异为0.38[95%CI，0.20至0.56]）。互联网组和常规护理组分别有54%和27%的患者改善了0.5分或更多（调整后的相对风险为2.00[CI，1.38至3.04]）。互联网组的哮喘控制改善程度大于常规护理组（调整后的差异为-0.47[CI，-0.64至-0.30]）。在12个月时，63%的互联网组患者和52%的常规护理组患者报告在前两周内有无症状天数（调整后的绝对差异为10.9%[CI，0.05%至21.3%]）。互联网组和常规护理组患者的支气管扩张剂前FEV1分别变化了0.24L和-0.01L（调整后的差异为0.25L[CI，0.03至0.46L]）。两组间病情加重情况无差异。
该研究未设盲，且仅持续了12个月。
基于互联网的自我管理可改善哮喘控制和肺功能，但并未减少病情加重情况，且哮喘相关生活质量的改善略低于临床显著水平。
荷兰卫生研究与发展组织、ZonMw和荷兰哮喘基金会。
