基于移动互联网技术儿童哮喘自我管理工具的构建与应用研究
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摘要
目的研发基于移动互联网技术的儿童哮喘自我管理工具并予以临床应用实践,初步探索移动互联网技术应用于儿童哮喘自我管理的临床价值。方法根据儿童哮喘管理的基本要素,研发基于Android手机操作系统的儿童轻松呼吸远程管理APP,测试并优化APP的使用功能。选取2016年2—6月在首都医科大学附属北京儿童医院过敏反应科就诊并确诊的64例支气管哮喘患儿,根据患儿监护人的意愿,分为APP管理组28例和传统日记卡管理组36例。APP管理组采用智能手机下载APP,远程管理哮喘患儿;传统日记卡管理组采用传统纸质版日记卡记录哮喘患儿症状、用药等情况。比较管理前和随访1个月后两组患儿的哮喘控制率、儿童哮喘控制测试(C-ACT)得分,随访1个月后两组患儿用药依从性、自我管理执行情况[记录症状天数和记录峰值呼气流速(PEFR)天数],并评估患儿监护人对APP管理的满意度和认可度。结果完成1个月随访的APP管理组患儿18例,传统日记卡管理组患儿33例。管理前和管理1个月后,两组患者支气管哮喘控制率、C-ACT得分比较,差异均无统计学意义(P>0.05);管理后,两组患儿支气管哮喘控制率、C-ACT得分均高于管理前,差异有统计学意义(P<0.05)。管理1个月后,两组患儿用药依从性、记录PEFR天数比较,差异无统计学意义(P>0.05);记录症状天数比较,差异有统计学意义(P<0.05)。APP管理组16例哮喘患儿监护人中,对APP管理的满意度为93.7%(15/16),认可度为81.3%(13/16)。结论儿童哮喘自我管理工具有较高的接受度和满意度,但在提高哮喘控制率、C-ACT得分及用药依从性方面没有显著优势,未来需进一步优化APP功能,并开展大样本随机对照研究。
Objective To develop a self-management application( APP) for childhood asthma based on mobile Internet technology and apply it to clinical practice,which explores the clinical value of mobile Internet technology preliminarily in the self-management of childhood asthma. Methods According to the basic elements of childhood asthma management,a self-management APP for childhood asthma was developed,tested and optimized based on the Android mobile phone operating system. A total of 64 children with bronchial asthma who were visited the Allergy Department of Beijing Children' s Hospital,Capital Medical University,were selected from February to June of the year 2016. According to the wishes of guardians,these patients were divided into APP management group( n = 28) and traditional diary card management group( n = 36). Using the self-management APP for childhood asthma downloaded on smart phones,patients in APP management group were managed remotely,while patients in traditional diary card management group were managed with traditional diary cards in paper version to record their symptoms,medication and so on. The asthma control rate and the childhood asthma control test( C-ACT) scores were compared between two groups before and after the management. The medication compliance and self-management situation of childhood asthma [the number of days of symptom recording and the number of days of( peak expiratory flow rate) ]during the one-month management were compared between two groups. And guardians' satisfaction and acceptance of the self-management APP were evaluated with questionnaire. Results Eighteen patients from APP management group and 33 patients from traditional diary card management group completed the one-month management. There was no significant difference in asthma control rate and C-ACT scores between two groups before and after one-month management( P > 0. 05),while the asthma control rate and C-ACT scores after one-month management were both higher than that before the management in each group( P < 0. 05).After one-month management,there was no significant difference in medication compliance and the number of days of PEFR between two groups( P > 0. 05),while there was significant difference in the number of days of symptom recording( P < 0. 05).The satisfaction rate of the APP management group was 93. 7%( 15/16) and the acceptance rate was 81. 3%( 13/16).Conclusion The self-management APP for childhood asthma is highly accepted and satisfied among users, but it has no significant advantage in improving asthma control rate, C-ACT scores and medication compliance, which needs further optimization of APP function and a large sample of randomized controlled study to support it.
Objective To develop a self-management application( APP) for childhood asthma based on mobile Internet technology and apply it to clinical practice,which explores the clinical value of mobile Internet technology preliminarily in the self-management of childhood asthma. Methods According to the basic elements of childhood asthma management,a self-management APP for childhood asthma was developed,tested and optimized based on the Android mobile phone operating system. A total of 64 children with bronchial asthma who were visited the Allergy Department of Beijing Children' s Hospital,Capital Medical University,were selected from February to June of the year 2016. According to the wishes of guardians,these patients were divided into APP management group( n = 28) and traditional diary card management group( n = 36). Using the self-management APP for childhood asthma downloaded on smart phones,patients in APP management group were managed remotely,while patients in traditional diary card management group were managed with traditional diary cards in paper version to record their symptoms,medication and so on. The asthma control rate and the childhood asthma control test( C-ACT) scores were compared between two groups before and after the management. The medication compliance and self-management situation of childhood asthma [the number of days of symptom recording and the number of days of( peak expiratory flow rate) ]during the one-month management were compared between two groups. And guardians' satisfaction and acceptance of the self-management APP were evaluated with questionnaire. Results Eighteen patients from APP management group and 33 patients from traditional diary card management group completed the one-month management. There was no significant difference in asthma control rate and C-ACT scores between two groups before and after one-month management( P > 0. 05),while the asthma control rate and C-ACT scores after one-month management were both higher than that before the management in each group( P < 0. 05).After one-month management,there was no significant difference in medication compliance and the number of days of PEFR between two groups( P > 0. 05),while there was significant difference in the number of days of symptom recording( P < 0. 05).The satisfaction rate of the APP management group was 93. 7%( 15/16) and the acceptance rate was 81. 3%( 13/16).Conclusion The self-management APP for childhood asthma is highly accepted and satisfied among users, but it has no significant advantage in improving asthma control rate, C-ACT scores and medication compliance, which needs further optimization of APP function and a large sample of randomized controlled study to support it.
引文
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[16]刘晓颖,王静,王群,等.哮喘患儿对长程控制治疗反应性的差异及其相关因素分析[J].中国当代儿科杂志,2015,17(7):692-697.DOI:10.7499/j.issn.1008-8830.2015.07.010.LIU X Y,WANG J,WANG Q,et al,Related factors for asthmatic children's responses to long-term treatment[J].Chin J Contemp Pediatr,2015,17(7):692-697.DOI:10.7499/j.issn.1008-8830.2015.07.010.
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[19]全国儿科哮喘协作组,中国疾病预防控制中心环境与健康相关产品安全所.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-736.DOI:10.3760/cma.j.issn.0578-1310.2013.10.003.The National Cooperative Group on Childhood Asthma,Institute of Environmental Health and Related Product Safety,Chinese Center for Disease Control and Prevention.Third nationwide survey of childhood asthma in urban areas of China[J].Chinese Journal of Pediatrics,2013,51(10):729-736.DOI:10.3760/cma.j.issn.0578-1310.2013.10.003.
[20]RYAN D,PRICE D,MUSGRAVE S D,et al.Clinical and cost effectiveness of mobile phone supported self monitoring of asthma:multicentre randomised controlled trial[J].BMJ,2012,344:e1756.DOI:10.1136/bmj.e1756.
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[22]LIN H C,CHIANG L C,WEN T N,et al.Development of online diary and self-management system on e-Healthcare for asthmatic children in Taiwan[J].Comput Methods Programs Biomed,2014,116(3):299-310.DOI:10.1016/j.cmpb.2014.05.004
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[2]顾希茜,段红梅,侯小妮,等.哮喘儿童照顾者家庭疾病管理体验的质性研究[J].中华现代护理杂志,2014,20(16):1921-1925.DOI:10.3760/j.issn.1674-2907.2014.16.011.GU X Q,DUAN H M,HOU X N,et al.Disease management experiences of family caregivers of asthmatic children:a qualitative research[J].Chinese Journal of Modern Nursing,2014,20(16):1921-1925.DOI:10.3760/j.issn.1674-2907.2014.16.011.
[3]马志强,蒋晓.基于用户体验的智能手机网站界面设计探讨[J].包装工程,2012,34(16):63-66.MA Z Q,JIANG X.Research on web sites interface design of intelligence mobile phone based on user experience[J].Packaging Engineering,2012,34(16):63-66.
[4]徐丰.界面设计中视觉信息的主导作用分析[J].包装工程,2015,37(2):102-106.XU F.Leading role of visual information in the interface design[J].Packaging Engineering,2015,37(2):102-106.
[5]LIU A H,ZEIGER R,SORKNESS C,et al.Development and cross-sectional validation of the childhood asthma control test[J].Journal of Allergy and Clinical Immunology,2007,119(4):817-825.DOI:10.1016/j.jaci.2006.12.662.
[6]LEE M S,KAO J K,LEE C H,et al.Correlations between pulmonary function and childhood asthma control test results in 5-11-year-old children with asthma[J].Pediatr Neonatol,2014,55(3):218-224.DOI:10.1016/j.pedneo.2013.10.003.
[7]VOOREND-VAN B S,VAESSEN-VERBERNE A A,LANDSTRA A M,et al.Monitoring childhood asthma:web-based diaries and the asthma control test[J].J Allergy Clin Immunol,2014,133(6):1599-1605.DOI:10.1016/j.jaci.2013.10.005.
[8]顾希茜,段红梅,向莉.儿童哮喘控制测试在门诊定期随访管理中的应用价值[J].中华护理杂志,2014,49(5):625-628.DOI:10.376l/j.issn.0254-1769.2014.05.028.GU X Q,DUAN H M,XIANG L.Application of children asthma control test in the follow-up management of asthma children[J].Chinese Journal of Nursing,2014,49(5):625-628.DOI:10.376l/j.issn.0254-1769.2014.05.028.
[9]徐叔云,魏伟.临床药理学[M].北京:人民卫生出版社,2006:124.
[10]胡雪琴,陈青寿.儿童哮喘缓解期糖皮质激素治疗依从性的调查分析及对策[J].护理与康复,2010,9(3):194-195.DOI:10.3969/j.issn.1671-9875.2010.03.004.HU X Q,CHEN Q S.Investigation and analysis on glucocorticoid treatment compliance for children in asthma remission phase and strategies[J].Nursing and Rehabilitation Journal,2010,9(3):194-195.DOI:10.3969/j.issn.1671-9875.2010.03.004.
[11]XIANG L,ZHAO J,ZHENG Y,et al.Uncontrolled asthma and its risk factors in Chinese children:a cross-sectional observational study[J].J Asthma,2016,53(7):699-706.DOI:10.3109/02770903.2016.1144199.
[12]向莉,许巍,姚瑶,等.儿童哮喘国际共识[J].中华实用儿科临床杂志,2014,29(1):67-76.DOI:10.3760/cma.j.issn.2095-428X.2014.01.019.XIANG L,XU W,YAO Y,et al.International consensus on pediatric asthma[J].Chin J Appl Clin Pediatr,2014,29(1):67-76.DOI:10.3760/cma.j.issn.2095-428X.2014.01.019.
[13]马旭升,涂林修,梅依君,等.儿童哮喘规范化管理治疗效果评价[J].临床儿科杂志,2015,33(8):706-709.DOI:10.3969 j.issn.1000-3606.2015.08.007MA X S,TU L X,MEI Y J,et al.Treatment efficacy evaluation of standardized management for children with asthma[J].Journal of Clinical Pediatrics,2015,33(8):706-709.DOI:10.3969j.issn.1000-3606.2015.08.007.
[14]WATSON W T A,GILLESPIE C,THOMAS N,et al.Smallgroup,interactive education and the effect on asthma control by children and their families[J].CMAJ,2009,181(5):257-263.DOI:10.1503/cmaj.080947.
[15]皇惠杰,刘晓颖,侯晓玲,等.尘螨变应原免疫治疗联合药物治疗对哮喘合并变应性鼻炎患儿临床疗效及气道高反应性的影响[J].首都医科大学学报,2016,37(5):568-573.DOI:10.3969/j.issn.1006-7795.2016.05.002.HUANG H J,LIU X Y,HOU X L,et al.Effects of dust mite allergy immunotherapy on clinical efficacy and airway hyperresponsiveness in allergic asthma and rhinitis children sensitized to dust mite[J].Journal of Capital Medical University,2016,37(5):568-573.DOI:10.3969/j.issn.1006-7795.2016.05.002.
[16]刘晓颖,王静,王群,等.哮喘患儿对长程控制治疗反应性的差异及其相关因素分析[J].中国当代儿科杂志,2015,17(7):692-697.DOI:10.7499/j.issn.1008-8830.2015.07.010.LIU X Y,WANG J,WANG Q,et al,Related factors for asthmatic children's responses to long-term treatment[J].Chin J Contemp Pediatr,2015,17(7):692-697.DOI:10.7499/j.issn.1008-8830.2015.07.010.
[17]COVAR R A,STRUNK R,ZEIGER R S,et al.Predictors of remitting,periodic,and persistent childhood asthma[J].Journal of Allergy&Clinical Immunology,2010,125(2):359-366.DOI:10.1016/j.jaci.2009.10.037.
[18]FU L,FREISHTAT R J,GORDISH-DRESSMAN H,et al.Natural progression of childhood asthma symptoms and strong influence of sex and puberty[J].Ann Ame Thorac Soc,2014,11(6):939-944.DOI:10.1513/Annals ATS.201402-084OC.
[19]全国儿科哮喘协作组,中国疾病预防控制中心环境与健康相关产品安全所.第三次中国城市儿童哮喘流行病学调查[J].中华儿科杂志,2013,51(10):729-736.DOI:10.3760/cma.j.issn.0578-1310.2013.10.003.The National Cooperative Group on Childhood Asthma,Institute of Environmental Health and Related Product Safety,Chinese Center for Disease Control and Prevention.Third nationwide survey of childhood asthma in urban areas of China[J].Chinese Journal of Pediatrics,2013,51(10):729-736.DOI:10.3760/cma.j.issn.0578-1310.2013.10.003.
[20]RYAN D,PRICE D,MUSGRAVE S D,et al.Clinical and cost effectiveness of mobile phone supported self monitoring of asthma:multicentre randomised controlled trial[J].BMJ,2012,344:e1756.DOI:10.1136/bmj.e1756.
[21]JAN R,WANG J,HUANG M,et al.An internet-based interactive telemonitoring system for improving childhood asthma outcomes in Taiwan[J].Telemed J E Health,2007,13(3):257-268.DOI:10.1089/tmj.2006.0053.
[22]LIN H C,CHIANG L C,WEN T N,et al.Development of online diary and self-management system on e-Healthcare for asthmatic children in Taiwan[J].Comput Methods Programs Biomed,2014,116(3):299-310.DOI:10.1016/j.cmpb.2014.05.004
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