电子健康智能手机应用对银屑病患者心理健康的影响：前瞻性随机对照干预研究。
Impact of an eHealth Smartphone App on the Mental Health of Patients With Psoriasis: Prospective Randomized Controlled Intervention Study.
机构信息
Department of Dermatology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
出版信息
JMIR Mhealth Uhealth. 2021 Oct 25;9(10):e28149. doi: 10.2196/28149.
BACKGROUND
Psoriasis has a negative impact on patients' physical and mental health and can lead to anxiety and depression. Disease management strategies, including educational programs and eHealth devices, have been shown to improve health care for several chronic diseases. However, such disease management strategies are lacking in the routine care of patients with psoriasis.
OBJECTIVE
This study aims to study the impact of a novel intervention that combines an educational program with a disease management smartphone app on the mental health of patients with psoriasis.
METHODS
Patients with psoriasis in the intervention group received an educational program; attended visits on weeks 0, 12, 24, 36, and 60; and had access to the study app. Patients in the control group only attended the visits. The primary endpoint was a significant reduction of scores on the Hospital Anxiety and Depression Scale (HADS). Secondary end points were reductions in Dermatology Life Quality Index score, Psoriasis Area and Severity Index score, pruritus, and pain, as well as improvements in mood and daily activities. In addition, modulating effects of sex, age, disease duration, and app use frequency were evaluated.
RESULTS
A total of 107 patients were included in the study and randomized into the control group (53/107, 49.5%) or intervention group (54/107, 50.5%). Approximately 71.9% (77/107) of the patients completed the study. A significant reduction in HADS-Depression (HADS-D) in the intervention group was found at weeks 12 (P=.04) and 24 (P=.005) but not at weeks 36 (P=.12) and 60 (P=.32). Patient stratification according to app use frequency showed a significant improvement in HADS-D score at weeks 36 (P=.004) and 60 (P=.04) and in HADS-Anxiety (HADS-A) score at weeks 36 (P=.04) and 60 (P=.05) in the group using the app less than once every 5 weeks. However, in patients using the app more than once every 5 weeks, no significant reduction in HADS-D (P=.84) or HADS-A (P=.20) score was observed over the 60-week study period compared with that observed in patients in the control group. All findings were independent of sex, age, and disease duration.
CONCLUSIONS
These findings support the use of a disease management smartphone app as a valid tool to achieve long-term improvement in the mental health of patients with psoriasis if it is not used too frequently. Further studies are needed to analyze the newly observed influence of app use frequency.
TRIAL REGISTRATION
Deutsches Register Klinischer Studien DRKS00020755; https://tinyurl.com/nyzjyvvk.
背景
银屑病会对患者的身心健康产生负面影响，导致焦虑和抑郁。疾病管理策略，包括教育计划和电子健康设备，已被证明可改善多种慢性病的医疗保健。然而，在银屑病患者的常规护理中，缺乏这种疾病管理策略。
目的
本研究旨在研究一种新的干预措施，该措施将教育计划与疾病管理智能手机应用程序相结合，对银屑病患者的心理健康产生影响。
方法
干预组的银屑病患者接受教育计划；在第 0、12、24、36 和 60 周就诊；并可使用研究应用程序。对照组的患者仅就诊。主要终点是医院焦虑和抑郁量表（HADS）评分显著降低。次要终点是降低皮肤病生活质量指数评分、银屑病面积和严重程度指数评分、瘙痒和疼痛，以及改善情绪和日常活动。此外，还评估了性别的调节作用、年龄、疾病持续时间和应用程序使用频率。
结果
共有 107 名患者入组并随机分为对照组（53/107，49.5%）或干预组（54/107，50.5%）。大约 71.9%（77/107）的患者完成了研究。干预组在第 12 周（P=.04）和第 24 周（P=.005）时 HADS-抑郁（HADS-D）评分显著降低，但在第 36 周（P=.12）和第 60 周（P=.32）时未降低。根据应用程序使用频率对患者进行分层显示，在第 36 周（P=.004）和第 60 周（P=.04）时 HADS-D 评分以及第 36 周（P=.04）和第 60 周（P=.05）时 HADS-焦虑（HADS-A）评分均有显著改善，在每 5 周使用应用程序少于一次的组中。然而，在每 5 周使用应用程序超过一次的患者中，与对照组相比，HADS-D（P=.84）或 HADS-A（P=.20）评分在 60 周的研究期间没有显著降低。所有发现均独立于性别、年龄和疾病持续时间。
结论
这些发现支持使用疾病管理智能手机应用程序作为一种有效的工具，如果使用频率不高，则可以长期改善银屑病患者的心理健康。需要进一步的研究来分析应用程序使用频率的新发现影响。
试验注册
德国临床试验注册中心 DRKS00020755；https://tinyurl.com/nyzjyvvk。
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