Department of Rheumatology and Immunology, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, Sichuan, China.
School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China.
JMIR Mhealth Uhealth. 2024 Apr 11;12:e47012. doi: 10.2196/47012.
In patients with gout, suboptimal management refers to a lack of disease knowledge, low treatment compliance, and inadequate control of serum uric acid (SUA) levels. Several studies have shown that continuous care is recommended for disease management in patients with gout. However, in China, the continuous care model commonly used for patients with gout requires significant labor and time costs, and its efficiency and coverage remain low. Mobile health (mHealth) may be able to address these issues.
This study aimed to explore the impact of mHealth-based continuous care on improving gout knowledge and treatment compliance and reducing SUA levels.
This study was a single-center, single-blind, and parallel-group randomized controlled trial. Participants were recruited at the West China Hospital of Sichuan University in Chengdu, China, between February 2021 and July 2021 and were randomly assigned to the intervention and control groups. The intervention group received continuous care via an mHealth app, which includes modules for health records, 24 weeks of gout-related health education materials, and interactive support. The control group received routine continuous care, including face-to-face health education, paper-based health education materials consistent with the content for the intervention group, and telephone consultations initiated by the patient. Follow-up was conducted at 6 months. Participants' gout knowledge levels and treatment compliance were measured at baseline and the 12th and 24th weeks, and participants' SUA levels were measured at baseline and the 24th week. The intention-to-treat principle and a generalized estimating equation model were used to test the effect of the intervention.
Overall, 258 potential participants underwent eligibility assessments, and 120 were recruited and randomized into the intervention (n=60, 50%) and control (n=60, 50%) groups. Of the 120 participants, 93 (77.5%) completed the 24-week study. The 2 groups had no significant differences in sociodemographic or clinical characteristics, and the baseline measurements were comparable (all P>.05). Compared with the control group, the intervention group exhibited a significant improvement in gout knowledge levels over time (β=0.617, 95% CI 0.104-1.129; P=.02 and β=1.300, 95% CI 0.669-1.931; P<.001 at the 12th and 24th weeks, respectively). There was no significant difference in treatment adherence between the 2 groups at the 12th week (β=1.667, 95% CI -3.283 to 6.617; P=.51), while a statistical difference was observed at the 24th week (β=6.287, 95% CI 1.357-11.216; P=.01). At the 24th week, SUA levels in both the intervention and control groups were below baseline, but there was no significant difference in SUA changes between the 2 groups (P=.43).
Continuous care based on the mHealth app improved knowledge levels and treatment compliance among patients with gout. We suggest incorporating this intervention modality into standard continuous care for patients with gout.
在痛风患者中，管理欠佳是指缺乏疾病知识、治疗依从性低以及血尿酸（SUA）水平控制不佳。多项研究表明，痛风患者的疾病管理需要持续护理。然而，在中国，痛风患者常用的连续护理模式需要大量的人力和时间成本，其效率和覆盖面仍然较低。移动医疗（mHealth）或许可以解决这些问题。
本研究旨在探讨基于 mHealth 的连续护理对提高痛风知识和治疗依从性以及降低 SUA 水平的影响。
本研究是一项单中心、单盲、平行组随机对照试验。参与者于 2021 年 2 月至 7 月在四川大学华西医院招募，并随机分为干预组和对照组。干预组通过 mHealth 应用程序接受连续护理，其中包括健康记录模块、24 周的痛风相关健康教育材料以及互动支持。对照组接受常规连续护理，包括面对面的健康教育、与干预组内容一致的纸质健康教育材料以及患者发起的电话咨询。随访时间为 6 个月。参与者在基线和第 12 周、第 24 周时测量痛风知识水平和治疗依从性，在基线和第 24 周时测量 SUA 水平。采用意向治疗原则和广义估计方程模型检验干预效果。
共有 258 名潜在参与者接受了资格评估，120 名被招募并随机分为干预组（n=60，50%）和对照组（n=60，50%）。在 120 名参与者中，93 名（77.5%）完成了 24 周的研究。两组在社会人口统计学或临床特征方面无显著差异，基线测量结果相当（均 P>.05）。与对照组相比，干预组的痛风知识水平随时间呈显著改善（β=0.617，95%CI 0.104-1.129；P=.02 和β=1.300，95%CI 0.669-1.931；P<.001，分别在第 12 周和第 24 周）。两组在第 12 周的治疗依从性无显著差异（β=1.667，95%CI-3.283 至 6.617；P=.51），而在第 24 周则存在统计学差异（β=6.287，95%CI 1.357-11.216；P=.01）。在第 24 周，干预组和对照组的 SUA 水平均低于基线，但两组间 SUA 变化无显著差异（P=.43）。
基于 mHealth 应用程序的连续护理提高了痛风患者的知识水平和治疗依从性。我们建议将这种干预模式纳入痛风患者的标准连续护理中。
