Effects of online care on functional and psychological outcomes in patients with psoriasis: A randomized controlled trial

Abstract

Background: The impact of online care on patients' functional and psychological outcomes is critical to determine yet still unknown.

Objective: To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving functional status and mental health of patients with psoriasis.

Methods: This 12-month randomized controlled equivalency trial randomly assigned patients with psoriasis 1:1 to receive online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions index and Patient Health Questionnare-9.

Results: Overall, 296 patients were randomly assigned to the online or in-person groups. The between-group difference in overall improvement in the EuroQol Visual Analogue Scale was -0.002 (95% confidence interval, -2.749 to 2.745), falling within an equivalence margin of ±8. The between-group difference in overall improvement in the 5-level EuroQol-5 Dimensions index was 0 (95% confidence interval, -0.003 to 0.003), falling within an equivalence margin of ±0.1. The between-group difference in overall improvement in Patient Health Questionnare-9 score was -0.33 (95% CI, -1.20 to 0.55), falling within an equivalence margin of ±3.

Limitations: Slightly different attrition rates between online and in-person arms (11% vs 9%), but no impact on outcomes.

Conclusion: The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in patients with psoriasis.

Keywords: EQ-5D; EQ-5D-5L; PHQ-9; clinical trial; connected health; depression; equivalency trial; functional impairment; inflammatory skin diseases; mental health; online care; patient outcomes; psoriasis; randomized controlled trial; teledermatology; telemedicine.