Self Care Intervention System May Be Comparable to Therapist-Guided Version for Atopic Dermatitis Patients

Dorian Kern, MSc

A research letter suggests that a redesigned, online self-care intervention system, compared to the original therapist-guided system for eczema patients, may be useful for atopic dermatitis (AD) patients.

AD patients have reported mixed outcomes from cognitive behavioral therapy (CBT), though some benefits had been reported regarding eczema patient symptoms through an online CBT protocol that was developed. This study’s authors, led by Dorian Kern, MSc, of the Centre for Psychiatry Research at Norra Stationsgatan, decided a revised version of this CBT system—without a therapist—for AD patients would be useful, as therapists’ knowledge of AD symptoms was seen to be lacking.

Background

“We aimed to evaluate the potential utility of this online self-management psychological intervention for AD,” Kern and colleagues wrote. “We also compared it to the original, comprehensive, therapist- guided version. Significant improvements in self-rated AD symptoms (POEM scores), with large effect sizes, were reported at the 3-month follow-up.”

The investigators used an uncontrolled pre-post evaluation of the redesigned CBT intervention for AD patients, developing the program with dermatologists to ensure safety. AD patients for the study were recruited through advertisements and interviewed through telephone communication.

Study participants were required to have self-reported AD and to be ages 16 years or older to participate. The researchers’ implemented the study from March to August of 2021, with participants using a website to read educational information and use CBT-based tools such as exposure and mindfulness.

Findings

The investigators’ primary outcome for the study was a score change of 3.4 points on the Patient Oriented Eczema Measure (POEM). A high number on the POEM score system would indicate very severe eczema. With regard to secondary outcomes, a change in the Client Satisfaction Questionnaire score was decided upon.

The research team ended up with 20 female study participants with a mean age of 42.5 years. A somewhat moderate effect size (t = 2.5162, df = 17; P = .04) was reported for data collected after the newly-designed intervention, compared to baseline.

A larger effect size (t = 3.9306, df = 15; P = .005) was reported by the study participants by the 3-month follow-up interview. The investigators found that neither significant increases in symptoms nor adverse events (AEs) were reported by participants.

“Significant improvements in self-rated AD symptoms (POEM scores), with large effect sizes, were reported at the 3-month follow-up,” they wrote. “These results are similar to those reported for the original treatment. Findings suggest that a self-care intervention is feasible and potentially comparable to a comprehensive, therapist-guided version, provided that the intervention is well designed and includes clinical interviews and on-demand technical support.”

This research letter, “Optimized User Experience, Efficiency, and Resource Use in Online Self-Management of Atopic Dermatitis,” was published online in JAMA Dermatology.