%0 Journal Article
%@ 1438-8871
%I JMIR Publications
%V 26
%N 
%P e50855
%T Digital Self-Management Platform for Adult Asthma: Randomized Attention-Placebo Controlled Trial
%A Kandola,Aaron
%A Edwards,Kyra
%A Straatman,Joris
%A Dührkoop,Bettina
%A Hein,Bettina
%A Hayes,Joseph
%+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7BN, United Kingdom, 44 2089288300, joseph.hayes@ucl.ac.uk
%K asthma
%K mobile health
%K self-management
%K randomized controlled trial
%K randomized
%K controlled trial
%K controlled trials
%K RCT
%K RCTs
%K respiratory
%K pulmonary
%K smartphone
%K platform
%K digital health
%K chronic
%K breathing
%K disease management
%K mHealth
%K mobile health
%K app
%K apps
%K application
%K applications
%K mobile phone
%D 2024
%7 29.4.2024
%9 Original Paper
%J J Med Internet Res
%G English
%X Background: Asthma is one of the most common chronic conditions worldwide, with a substantial individual and health care burden. Digital apps hold promise as a highly accessible, low-cost method of enhancing self-management in asthma, which is critical to effective asthma control. Objective: We conducted a fully remote randomized controlled trial (RCT) to assess the efficacy of juli, a commercially available smartphone self-management platform for asthma. Methods: We conducted a pragmatic single-blind, RCT of juli for asthma management. Our study included participants aged 18 years and older who self-identified as having asthma and had an Asthma Control Test (ACT) score of 19 or lower (indicating uncontrolled asthma) at the beginning of the trial. Participants were randomized (1:1 ratio) to receive juli for 8 weeks or a limited attention-placebo control version of the app. The primary outcome measure was the difference in ACT scores after 8 weeks. Secondary outcomes included remission (ACT score greater than 19), minimal clinically important difference (an improvement of 3 or more points on the ACT), worsening of asthma, and health-related quality of life. The primary analysis included participants using the app for 8 weeks (per-protocol analysis), and the secondary analysis used a modified intention-to-treat (ITT) analysis. Results: We randomized 411 participants between May 2021 and April 2023: a total of 152 (37%) participants engaged with the app for 8 weeks and were included in the per-protocol analysis, and 262 (63.7%) participants completed the week-2 outcome assessment and were included in the modified ITT analysis. Total attrition between baseline and week 8 was 259 (63%) individuals. In the per-protocol analysis, the intervention group had a higher mean ACT score (17.93, SD 4.72) than the control group (16.24, SD 5.78) by week 8 (baseline adjusted coefficient 1.91, 95% CI 0.31-3.51; P=.02). Participants using juli had greater odds of achieving or exceeding the minimal clinically important difference at 8 weeks (adjusted odds ratio 2.38, 95% CI 1.20-4.70; P=.01). There were no between group differences in the other secondary outcomes at 8 weeks. The results from the modified ITT analyses were similar. Conclusions: Users of juli had improved asthma symptom control over 8 weeks compared with users of a version of the app with limited functionality. These findings suggest that juli is an effective digital self-management platform that could augment existing care pathways for asthma. The retention of patients in RCTs and real-world use of digital health care apps is a major challenge. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry  ISRCTN87679686; https://www.isrctn.com/ISRCTN87679686 
%M 38684084
%R 10.2196/50855
%U https://www.jmir.org/2024/1/e50855
%U https://doi.org/10.2196/50855
%U http://www.ncbi.nlm.nih.gov/pubmed/38684084