Author/Editor		Belisario, José S Marcano; Huckvale, Kit; Greenfield, Geva; Car, Josip; Gunn, Laura H
Title		Smartphone and tablet self management apps for asthma
Type		članek
Vol. and No.		, št. 11
Publication year		2013
ISSN		1469-493X - Cochrane database of systematic reviews (Online)
Language		eng
Abstract		BackgroundAsthma is one of the most common long-term conditions worldwide, which places considerable pressure on patients, communitiesand health systems. The major international clinical guidelines now recommend the inclusion of self management programmes inthe routine management of patients with asthma. These programmes have been associated with improved outcomes in patients withasthma. However, the implementation of self management programmes in clinical practice, and their uptake by patients, is still poor. Recent developments in mobile technology, such as smartphone and tablet computer apps, could help develop a platform for thedelivery of self management interventions that are highly customisable, low-cost and easily accessible. ObjectivesTo assess the effectiveness, cost-effectiveness and feasibility of using smartphone and tablet apps to facilitate the self management ofindividuals with asthma. Search methodsWe searched the Cochrane Airways Group Register (CAGR), the Cochrane Central Register of Controlled Trials (CENTRAL),MEDLINE, EMBASE, PsycINFO, CINAHL, GlobalHealth Library, Compendex/Inspec/Referex, IEEEXplore, ACMDigital Library,CiteSeerx and CAB abstracts via Web of Knowledge. We also searched registers of current and ongoing trials and the grey literature. We checked the reference lists of all primary studies and review articles for additional references. We searched for studies publishedfrom 2000 onwards. The latest search was run in June 2013.Selection criteriaWe included parallel randomised controlled trials (RCTs) that compared self management interventions for patients with cliniciandiagnosedasthma delivered via smartphone apps to self management interventions delivered via traditional methods (e.g. paper-basedasthma diaries).Data collection and analysisWe used standard methods expected by the Cochrane Collaboration. Our primary outcomes were symptom scores; frequency ofhealthcare visits due to asthma exacerbations or complications and health-related quality of life. Main resultsWe included two RCTs with a total of 408 participants. We found no cluster RCTs, controlled before and after studies or interruptedtime series studies that met the inclusion criteria for this systematic review. Both RCTs evaluated the effect of a mobile phone-basedasthma self management intervention on asthma control by comparing it to traditional, paper-based asthma self management. Onestudy allowed participants to keep daily entries of their asthma symptoms, asthma medication usage, peak flow readings and peak flowvariability on their mobile phone, from which their level of asthma control was calculated remotely and displayed together with thecorresponding asthma self management recommendations. In the other study, participants recorded the same readings twice daily, andthey received immediate selfmanagement feedback in the form of a three-colour traffic light display on their phones. Participants fallinginto the amber zone of their action plan twice, or into the red zone once, received a phone call from an asthma nurse who enquiredabout the reasons for their uncontrolled asthma. We did not conduct a meta-analysis of the data extracted due to the considerable degree of heterogeneity between these studies. Insteadwe adopted a narrative synthesis approach. Overall, the results were inconclusive and we judged the evidence to have a GRADE ratingof low quality because further evidence is very likely to have an important impact on our confidence in the estimate of effect and islikely to change the estimate. In addition, there was not enough information in one of the included studies to assess the risk of bias forthemajority of the domains. Although the other included study was methodologically rigorous, it was not possible to blind participantsor personnel in the study. Moreover, there are concerns in both studies in relation to attrition bias and other sources of bias. One study showed that the use of a smartphone app for the delivery of an asthma self management programme had no statisticallysignificant effect on asthma symptom scores (mean difference (MD) 0.01, 95% confidence interval (CI) -0.23 to 0.25), asthma-relatedquality of life (MD of mean scores 0.02, 95% CI -0.35 to 0.39), unscheduled visits to the emergency department (OR 7.20, 95% CI0.37 to 140.76) or frequency of hospital admissions (odds ratio (OR) 3.07, 95% CI 0.32 to 29.83). The other included study foundthat the use of a smartphone app resulted in higher asthma-related quality of life scores at six-month follow-up (MD5.50, 95%CI 1.48to 9.52 for the physical component score of the SF-12 questionnaire; MD 6.00, 95% CI 2.51 to 9.49 for the mental component scoreof the SF-12 questionnaire), improved lung function (PEFR) at four (MD 27.80, 95% CI 4.51 to 51.09), five (MD 31.40, 95% CI8.51 to 54.29) and six months (MD 39.20, 95% CI 16.58 to 61.82), and reduced visits to the emergency department due to asthmarelatedcomplications (OR 0.20, 95% CI 0.04 to 0.99). Both studies failed to find any statistical differences in terms of adherence tothe intervention and occurrence of other asthma-related complications.
Keywords		smartphone tablet self management asthma pametni telefon tablične aplikacije za upravljanje astma