Eczema Self-management for Patients, Caregivers Benefits From Online Assistance

Online behavioral health interventions that complement usual care among children and young people with eczema and that also consider parental and carer contributions to self-care showed a sustained benefit at managing eczema severity, according to recent study findings in The BMJ.

“Despite the self-management of eczema presenting particular challenges, there have been few rigorously developed online interventions for eczema, and none have been evaluated in a trial large enough to detect differences in health outcomes,” the study authors wrote. “As parents and carers of children and young people with eczema are likely to have different support needs, we developed 2 separate interventions to be evaluated in 2 independent randomised controlled trials.”

Their analysis of data from the Eczema Care Online trials evaluated outcomes among parents and caregivers of children aged 0 to 12 years with eczema (trial 1) and young people aged 13 to 25 years (trial 2) receiving care at 98 general practices in England. In these parallel studies, participants were randomized 1:1 to usual care only or usual care plus an online intervention. Every 4 weeks for 24 weeks, eczema symptoms were evaluated via the Patient Oriented Eczema Measure (POEM), which grades eczema severity on a scale of 0 (clear or almost clear) to 28 (severe eczema). Secondary outcomes included eczema control and itch intensity. In trial 1, 169 parents/carers were randomized to usual care and 171, the intervention plus usual care. For trial 2, there were 169 and 168 young people, respectively. Follow-up finished on December 31, 2021, after recruitment that took place from December 2, 2019, to December 8, 2020.

At baseline, the mean (SD) overall POEM score was 12.8 (5.3) in trial 1 and 15.2 (5.4) in trial 2. Follow-up rates were high at the 24-week mark, at 91.5% of the parents and carers and 90.2% of the young people.

Compared with usual care, eczema improved among those randomized to the intervention plus usual care by a mean –1.5 (95% CI, –2.5 to –0.6; P = .002) among the parents and carers, and this rose to –1.9 (95% CI, –3.0 to –0.8; P < .001) among the young people. In addition, follow-up that extended to 52 weeks shows POEM scores and eczema improvement were sustained. Follow-up rates also remained high at 52 weeks, at 89.1% in trial 1 and 84.0% in trial 2.

A statistically significant difference was seen overall that favored both intervention groups, with adjusted mean differences of −0.7 (95% CI,−1.0 to −0.4) for parents or carers and −0.9 (95% CI, −1.3 to −0.6) for young people at 24 weeks.

In trial 1, 92% of the parents/carers were women, 83% of participants were White, and 62% had moderate eczema. For trial 2, these totals were 77%, 86%, and 55%, respectively. During both trials at baseline, participants were queried on how effective they thought online interventions were or if they had ever used website or apps for eczema management.

The study investigators noted that their number needed to treat was 6 (parents and carers, 95% CI, 3-13; young people, 95% CI, 4-18) in both trials, if they hoped to achieve a 2.5 improvement in POEM score at 24 weeks. This finding, they highlighted, “compares favorably with many drug treatments and is particularly important in the absence of identifiable harms and in the context of a low cost and highly scalable intervention.”

Even with their positive findings, the study researchers wrote that more research is needed on effective eczema management in a more specialized setting, because most people with eczema are managed in the primary care setting in the United Kingdom.

Still, they believe their online intervention can be adapted to other health care settings.

“A small amount of benefit at low cost with no identifiable harms for a condition that affects a large number of people can lead to substantial health benefit for the public in absolute terms,” the authors concluded. “The findings reinforce the key role of health professionals in signposting patients and carers toward self-management support for long term conditions.”

Reference

Santer M, Muller I, Becque T, at al. Eczema Care Online behavioural interventions to support self-care for children and young people: two independent, pragmatic, randomised controlled trials. BMJ. Published online December 7, 2022. doi:10.1136/bmj-2022-072007