title: The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial.
abstract: Whether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager.
  
  
  
  The aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life.
  
  
  
  A multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included.
  
  
  
  A total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI -0.12 to 1.05) and 9 months (mean change 0.39, 95% CI -0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group.
  
  
  
  This study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals' knowledge and self-management skills improve may result in long-term gains in asthma control.
  
  
  
  International Standard Randomized Controlled Trial Number (ISRCTN): 34326236; http://www.isrctn.com/ISRCTN34326236 (Archived by Webcite at http://www.webcitation.org/6mGxoI1R7).
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, QC, Canada.|School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.|Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.|Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montreal, QC, Canada.
authors.forename: Sara
authors.identifier: 0000-0001-5172-6790
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Centre for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, McGill University, Montreal, QC, Canada.
authors.forename: Pierre
authors.identifier: 0000-0001-9983-3608
authors.initials: P
authors.lastname: Ernst
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, QC, Canada.|Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Susan J
authors.identifier: 0000-0001-9755-2490
authors.initials: SJ
authors.lastname: Bartlett
authors.affiliation: Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Marie-France
authors.identifier: 0000-0002-5818-4880
authors.initials: MF
authors.lastname: Valois
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, QC, Canada.|School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.|Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montreal, QC, Canada.|The College at Brockport, Department of Mathematics, State University of New York, Brockport,, NY, United States.
authors.forename: Tasneem
authors.identifier: 0000-0002-4156-4289
authors.initials: T
authors.lastname: Zaihra
authors.affiliation: Department of Information Technology, HEC Montreal, Montreal, QC, Canada.
authors.forename: Guy
authors.identifier: 0000-0001-7425-1994
authors.initials: G
authors.lastname: Paré
authors.affiliation: Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Roland
authors.identifier: 0000-0002-1591-613X
authors.initials: R
authors.lastname: Grad
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Center, McGill University, Montreal, QC, Canada.|School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.|Centre de recherche interdisciplinaire en réadaptation (CRIR), Constance Lethbridge Rehabilitation Center, Montreal, QC, Canada.
authors.forename: Owis
authors.identifier: 0000-0001-6191-8745
authors.initials: O
authors.lastname: Eilayyan
authors.affiliation: Department of Psychiatry, Faculty of Medicine, McGill University, Montreal, QC, Canada.
authors.forename: Robert
authors.identifier: 0000-0002-5505-6621
authors.initials: R
authors.lastname: Perreault
authors.affiliation: Department of Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.|Biostatistics and Occupational Health and the Clinical and Health Informatics Research Group, Department of Epidemiology, McGill University, Montreal, QC, Canada.
authors.forename: Robyn
authors.identifier: 0000-0003-0134-6954
authors.initials: R
authors.lastname: Tamblyn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy*; D019090:Case Management; D019468:Disease Management; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010865:Pilot Projects; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D017216:Telemedicine / Q000379:methods; D055815:Young Adult
keywords: Internet; asthma; case management; nursing; quality of life; self-care