Miller Lisa, Schüz Benjamin, Walters Julia, Walters E Haydn
School of Medicine, Psychology, University of Tasmania, Hobart, Australia.
University of Tasmania, Hobart, Australia.
JMIR Mhealth Uhealth. 2017 May 2;5(5):e57. doi: 10.2196/mhealth.7168.
Mobile technology interventions (MTI) are becoming increasingly popular in the management of chronic health behaviors. Most MTI allow individuals to monitor medication use, record symptoms, or store and activate disease-management action plans. Therefore, MTI may have the potential to improve low adherence to medication and action plans for individuals with asthma, which is associated with poor clinical outcomes.
A systematic review and meta-analysis were conducted to evaluate the efficacy of MTI on clinical outcomes as well as adherence in individuals with asthma. As the use of evidence-based behavior change techniques (BCT) has been shown to improve intervention effects, we also conducted exploratory analyses to determine the role of BCT and engagement with MTI as moderators of MTI efficacy.
We searched electronic databases for randomized controlled trials up until June 2016. Random effect models were used to assess the effect of MTI on clinical outcomes as well as adherence to preventer medication or symptom monitoring. Mixed effects models assessed whether the features of the MTI (ie, use of BCT) and how often a person engaged with MTI moderated the effects of MTI.
The literature search located 11 studies meeting the inclusion criteria, with 9 providing satisfactory data for meta-analysis. Compared with standard treatment, MTI had moderate to large effect sizes (Hedges g) on medication adherence and clinical outcomes. MTI had no additional effects on adherence or clinical outcomes when compared with paper-based monitoring. No moderator effects were found, and the number of studies was small. A narrative review of the two studies, which are not included in the meta-analysis, found similar results.
This review indicated the efficacy of MTI for self-management in individuals with asthma and also indicated that MTI appears to be as efficacious as paper-based monitoring. This review also suggested a need for robust studies to examine the effects of BCT use and engagement on MTI efficacy to inform the evidence base for MTI in individuals with asthma.
移动技术干预（MTI）在慢性健康行为管理中越来越受欢迎。大多数MTI允许个人监测药物使用情况、记录症状或存储并启动疾病管理行动计划。因此，MTI可能有潜力改善哮喘患者对药物和行动计划的低依从性，而这种低依从性与不良临床结局相关。
进行一项系统评价和荟萃分析，以评估MTI对哮喘患者临床结局及依从性的疗效。由于已证明使用基于证据的行为改变技术（BCT）可改善干预效果，我们还进行了探索性分析，以确定BCT的作用以及与MTI的互动作为MTI疗效调节因素的作用。
我们检索电子数据库，查找截至2016年6月的随机对照试验。采用随机效应模型评估MTI对临床结局以及预防用药依从性或症状监测的影响。混合效应模型评估MTI的特征（即BCT的使用）以及个人与MTI互动的频率是否调节了MTI的效果。
文献检索找到11项符合纳入标准的研究，其中9项提供了可用于荟萃分析的满意数据。与标准治疗相比，MTI对药物依从性和临床结局有中度至较大的效应量（Hedges g）。与纸质监测相比，MTI对依从性或临床结局没有额外影响。未发现调节因素效应，且研究数量较少。对两项未纳入荟萃分析的研究进行的叙述性综述发现了类似结果。
本综述表明MTI对哮喘患者自我管理有效，并且MTI似乎与纸质监测一样有效。本综述还建议需要进行有力研究，以检验BCT的使用和互动对MTI疗效的影响，为哮喘患者MTI的证据基础提供信息。
