Pilot study of a randomized trial to evaluate a Web-based intervention targeting adolescents presenting to the emergency department with acute asthma

Abstract

BackgroundLow-income African-American adolescents use preventive medical services less frequently than their White counterparts, indicating a need for effective interventions targeting this group. Puff City is a Web-based, asthma management program for urban adolescents that has been evaluated in high school settings with promising results. The objective of this pilot was to assess the feasibility of initiating Puff City (treatment) in an emergency department setting, thereby informing the conduct of an individual randomized trial to evaluate its effectiveness compared to a generic, Web-based program (control) in preventing subsequent emergency department (ED) visits.MethodsTeens aged 13–19 years presenting with acute asthma to two urban EDs within the study period were eligible. Subsequent ED visits were collected using the electronic medical record. A priori indication of a potential intervention effect was p < 0.20.ResultsOf the 121 teens randomized (65 treatment, 56 control), 86.0% were African-American and 44.6% male, with the mean age = 15.4 years. Computer ownership was reported by 76.8% of teens. Overall, 64.5% of teens completed >3 of 4 sessions and 90% completed the 12-month survey. At 12 months, the treatment group showed a trend toward fewer ED visits than controls (33.8 versus 46.4%), p = 0.15.ConclusionsResults indicate the feasibility of enrolling at-risk adolescents in ED settings and set the stage for a large, pragmatic trial using a technology-based intervention to reduce the burden of pediatric asthma.Trial registrationClinicalTrials.gov, NCT01695031

The effectiveness of interventions to improve self‐management for adolescents and young adults with allergic conditions: A systematic review

“…Interventions consisted of the use of computer web‐based applications, 31,33,35,36 telecommunication compressed videos 32,34 or the use of mobile applications 29,30 . Bynum et al 32 designed an experimental study with random assignment of participants to a telepharmacy counselling group or control group.…”

“…All studies were randomized controlled trials, although three were just pilot studies 29‐31 . Participants were recruited from rural and suburban paediatric clinics or outpatients, 29‐34 emergency departments 35 or high schools 36 …”

“…Clinical outcomes such as asthma symptoms, hospital visits, adherence, device technique and asthma knowledge were also shown to improve. Velsor‐Friedrich et al's 24 coping‐skills training intervention, Bignall et al's 46 breathing re‐training intervention, Joseph et al's 35 computer‐tailored intervention and an educational intervention by van Es et al 39 reported no differences, with both intervention and control groups improving over time. This may be due to the participants and setting for Velsor‐Friedrich et al 24 (low‐income urban adolescents in a community setting) and to the low participant numbers for the other studies.…”

“…29,30 Bynum et al 32 Internet-based self-management 33 and the Puff-city-web-based computer-tailored intervention. 35,36 One of the pilot studies was a block-randomized controlled study to assess the impact of a personal health application-web-based system called MyMediHealth which sent medication reminders via text. 29 Across studies, control groups either received usual care, 29,33,34 written instructions 30,32 or education sessions (eg sessions link to asthma website or a sham CD ROM).…”

A Prototype Exercise–Empowerment Mobile Video Game for Children With Cancer, and Its Usability Assessment: Developing Digital Empowerment Interventions for Pediatric Diseases

“…In children with asthma, adherence to treatment programs is challenging ( 69 , 70 ). Web-based programs have shown efficacy in promoting asthma treatment adherence ( 71 , 72 ). Although a potential trigger for asthma symptom exacerbation, exercise can improve disease symptoms and psychosocial adjustment ( 73 , 74 ).…”