Acceptance and Commitment Therapy Eczema Management Program for Children With Eczema: A Pilot Randomised Controlled Trial.

Abstract

Introduction: Eczema significantly affects the quality of life of affected children and their families, with psychological stress often overlooked. Acceptance and Commitment Therapy (ACT) provides a supplementary approach to address these psychological challenges and enhance overall care.

Objective: This pilot randomised controlled trial aimed to examine the feasibility, acceptability and preliminary effectiveness of the Family ACT-based Eczema Management Program (FACT-EMP).

Methods: Parents and children aged 6-12 diagnosed with eczema from three outpatient clinics in Hong Kong were randomly assigned to either the FACT-EMP group, receiving four weekly ACT-based sessions plus eczema management education, or a waitlist control group receiving routine care. Feasibility and acceptability were assessed through recruitment, retention and completion rates, supplemented by focus group feedback on parental experiences. Primary clinical outcomes were children's eczema Severity Scoring of Atopic Dermatitis (SCORAD) and parental self-efficacy. Secondary outcomes included parental distress, quality of life, psychological flexibility and self-compassion of both parents and children.

Results: From July 2021 to June 2023, 181 of 944 screened parent-child dyads met the inclusion criteria, and 78 were randomised and analysed (parents' mean [SD] age, 41.3 [11.0] years; 70 mothers [89.7%]; children's mean [SD] age, 8.3 [1.9] years; 53 boys [67.9%]). Recruitment, retention and completion rates were 43.1%, 87.2% and 76.9%, respectively. No significant between-group differences in SCORAD scores were observed immediately post-intervention. At 3-month post-intervention, SCORAD scores decreased significantly more in the FACT-EMP group than in the waitlist control group (adjusted mean difference, aMD, -7.73; 95% CI, -13.92 to -1.54). Parental self-efficacy scores also improved significantly more in the FACT-EMP group than the control, with an aMD of 18.69 (95% CI, 13.80 to 33.58) immediately post-intervention and 28.90 (95% CI, 13.93 to 43.84) at 3 months.

Conclusion: FACT-EMP is potentially feasible, acceptable and effective in improving children's eczema symptoms and enhancing parents' self-efficacy in disease management over 3 months.

Trial registration: NCT04919330.