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Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials
Santer, Miriam Muller, Ingrid Becque, Taeko Stuart, Beth Hooper, Julie Steele, Mary Wilczynska, Sylvia Sach, Tracey H Ridd, Matthew J Roberts, Amanda
Santer, Miriam
Muller, Ingrid
Becque, Taeko
Stuart, Beth
Hooper, Julie
Steele, Mary
Wilczynska, Sylvia
Sach, Tracey H
Ridd, Matthew J
Roberts, Amanda
Abstract
Objective
To determine the effectiveness of two online
behavioural interventions, one for parents and carers
and one for young people, to support eczema self-management.
Design
Two independent, pragmatic, parallel group,
unmasked, randomised controlled trials.
Setting
98 general practices in England.
Participants
Parents and carers of children (0-12 years) with
eczema (trial 1) and young people (13-25 years) with
eczema (trial 2), excluding people with inactive or
very mild eczema (≤5 on POEM, the Patient-Oriented
Eczema Measure).
Interventions
Participants were randomised (1:1) using online
software to receive usual eczema care or an online
(www.EczemaCareOnline.org.uk) behavioural
intervention for eczema plus usual care.
Main outcome measures
Primary outcome was eczema symptoms rated using
POEM (range 0-28, with 28 being very severe) every
four weeks over 24 weeks. Outcomes were reported
by parents or carers for children and by self-report for
young people. Secondary outcomes included POEM
score every four weeks over 52 weeks, quality of life,
eczema control, itch intensity (young people only),
patient enablement, treatment use, perceived barriers
to treatment use, and intervention use. Analyses were
carried out separately for the two trials and according
to intention-to-treat principles.
Results
340 parents or carers of children (169 usual care;
171 intervention) and 337 young people (169 usual
care; 168 intervention) were randomised. The mean
baseline POEM score was 12.8 (standard deviation
5.3) for parents and carers and 15.2 (5.4) for young
people. Three young people withdrew from follow-up but did not withdraw their data. All randomised
participants were included in the analyses. At 24
weeks, follow-up rates were 91.5% (311/340) for
parents or carers and 90.2% (304/337) for young
people. After controlling for baseline eczema severity
and confounders, compared with usual care groups
over 24 weeks, eczema severity improved in the
intervention groups: mean difference in POEM
score −1.5 (95% confidence interval −2.5 to −0.6;
P=0.002) for parents or carers and −1.9 (−3.0 to
−0.8; P<0.001) for young people. The number needed
to treat to achieve a 2.5 difference in POEM score at
24 weeks was 6 in both trials. Improvements were
sustained to 52 weeks in both trials. Enablement
showed a statistically significant difference favouring
the intervention group in both trials: adjusted mean
difference at 24 weeks −0.7 (95% confidence interval
−1.0 to −0.4) for parents or carers and −0.9 (−1.3 to
−0.6) for young people. No harms were identified in
either group.
Conclusions
Two online interventions for self-management of
eczema aimed at parents or carers of children with
eczema and at young people with eczema provide a
useful, sustained benefit in managing eczema severity
in children and young people when offered in addition
to usual eczema care.
MIDER Authors
Citations
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Date
2022-12
Type
Article
Subject
Eczema, Primary care, World wide web technology
Collections
Citation
BMJ2022;379:e072007