Outcome measures of efficacy associated with a Web-enabled asthma self-management programme - Findings from a quasi-experiment

Objective: To assess the efficacy of a World Wide Web-enabled asthma selfma nagement intervention on quality-of-life indicators among self-selected par ticipants with asthma. Design: A quasi-experimental design was used in which quality-of-life outco me indicators were derived from the Mini Asthma Quality of Life Questionnai re (MiniAQLQ); this self-administered instrument includes a global score an d 4 domain scores (emotional status, environmental triggers, symptoms and a ctivity restrictions). Baseline and re-measure scores were statistically te sted for change over a 6-month period of engaged participation. Intervention: The web-enabled interactive MyAsthma(TM) intervention which b uilds on patient-centred self-management skills based on education, appropr iate medication usage and symptom control. Participants: A national sample of 437 patients with self-reported symptoms of mild intermittent to severe asthma who registered as participants in My Asthma(TM) Engaged use of the Internet for building asthma self-management skills was examined as a construct of participation in the intervention. Main outcome measures and results: Based on participants' self-reported res ponses, high volume users of the web-enabled intervention reported improved quality-of-life scores that were both statistically and clinically signifi cant. Participants with a documented number of site visits greater than the group median (17 or more visits over the 6-month period of observation) were 1.6 times more likely to report an improvement in their global MiniAQLQ score compared with participants with less than the median number of visits [adju sted odds ratio (OR) = 1.60, 95% confidence interval (CI) 1.03, 2.48]. A si milar effect associated with website visit frequency was observed with resp ect to participants' emotional subscales scores (adjusted OR = 1.76, 95% CI 1.09, 2.85) and activity subscale scores (adjusted OR = 1.64, 95% CI 1.06, 2.55). Conclusions: Based on pre-/post-test measures derived from a standardised a nd validated instrument, the web-enabled MyAsthma(TM) self-management progr amme was associated with a positive change in patient reported scores of qu ality of life. Although these results are preliminary and not derived from rigorously controlled clinical trials, the strength of this evidence is not eworthy nonetheless. We acknowledge that self-selection bias in observation al studies is a threat to both internal and external validity. Research bas ed on randomised clinical trials is needed to further document the effects of web-enabled disease management interventions targeting patients with ast hma.