Milne-Ives Madison, Lam Ching, Meinert Edward
Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom.
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom.
JMIR Pediatr Parent. 2021 Sep 17;4(3):e27999. doi: 10.2196/27999.
Inadequate pediatric asthma care has resulted in potentially avoidable unplanned hospital admissions and morbidity. A wide variety of digital technologies have been developed to monitor and support treatment adherence in children and adolescents with asthma. However, existing reviews need to be updated and expanded to provide an overview of the current state of research on these technologies and how they are being integrated into existing health care services and care pathways.
This study aims to provide an overview of the current research landscape and knowledge gaps regarding the use of digital technologies to support the care of children and adolescents with asthma.
This study was structured according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study frameworks. Five databases (PubMed, the Cochrane Central Register of Controlled Trials, Web of Science, Embase, and PsycINFO) were systematically searched for studies published in English from 2014 onward. Two reviewers independently screened the references and selected studies for inclusion based on the eligibility criteria. Data were systematically extracted per research question, which were synthesized in a descriptive analysis.
A wide variety of study characteristics, including the number and age of participants, study duration, and type of digital intervention, were identified. There was mixed evidence for the effectiveness of the interventions. Of the 10 studies that evaluated treatment adherence, 7 (70%) found improvements, but the evidence was inconsistent for asthma control (6/9, 67% of studies reported improvement or maintenance, but only 1 was significantly different between groups) and health outcome variables (5/9, 56% of studies found no evidence of effectiveness). The 6 studies that examined patient perceptions and assessments of acceptability and usability generally had positive findings.
A wide range of digital interventions are being developed and evaluated to support the monitoring and treatment adherence of children and adolescents with asthma. Meta-analyses are inhibited by the use of samples with a variety of overlapping age ranges; a theoretical framework for evaluating specific age groups would aid comparison between studies. Most studies found significant evidence for improved adherence to treatment or medications, but there was mixed evidence of the impact of the digital interventions on asthma control and other health outcomes. There are gaps in the literature relating to cost-effectiveness and integration with existing clinical care pathways. This study will be necessary to determine which digital interventions for children and young people with asthma are worth supporting and adopting in the clinical care pathways.
儿科哮喘护理不足导致了本可避免的非计划性住院和发病情况。人们已开发出各种各样的数字技术来监测并支持哮喘儿童和青少年的治疗依从性。然而，现有的综述需要更新和扩充，以概述这些技术的当前研究状况，以及它们如何被整合到现有的医疗服务和护理路径中。
本研究旨在概述关于使用数字技术支持哮喘儿童和青少年护理的当前研究概况和知识空白。
本研究按照PRISMA-ScR（系统评价与Meta分析扩展版的范围综述优先报告项目）以及人群、干预措施、对照、结局和研究框架进行构建。对五个数据库（PubMed、Cochrane对照试验中心注册库、科学网、Embase和PsycINFO）进行系统检索，以查找2014年以来发表的英文研究。两名评审员独立筛选参考文献，并根据纳入标准选择研究纳入。针对每个研究问题系统提取数据，并在描述性分析中进行综合。
确定了各种各样的研究特征，包括参与者数量和年龄、研究持续时间以及数字干预类型。干预措施有效性的证据不一。在评估治疗依从性的10项研究中，7项（70%）发现有改善，但哮喘控制方面的证据不一致（9项研究中的6项，67%报告有改善或维持，但组间只有1项有显著差异），健康结局变量方面也是如此（9项研究中的5项，56%的研究未发现有效性证据）。6项考察患者对可接受性和可用性的看法及评估的研究总体上有积极结果。
正在开发和评估多种数字干预措施，以支持哮喘儿童和青少年的监测及治疗依从性。由于使用了年龄范围有多种重叠的样本，Meta分析受到了限制；一个用于评估特定年龄组的理论框架将有助于研究间的比较。大多数研究发现有显著证据表明治疗或药物依从性有所改善，但关于数字干预对哮喘控制和其他健康结局影响的证据不一。在成本效益以及与现有临床护理路径整合方面，文献存在空白。有必要开展本研究，以确定哪些针对哮喘儿童和青少年的数字干预措施值得在临床护理路径中予以支持和采用。
