Armstrong 2018 — Online vs in-person care for psoriasis: equivalency RCT
Citation
Armstrong AW, Chambers CJ, Maverakis E, Cheng MY, Dunnick CA, Chren MM, et al. Effectiveness of Online vs In-Person Care for Adults With Psoriasis: A Randomized Clinical Trial. JAMA Netw Open. 2018 Oct 5;1(6):e183062. DOI: 10.1001/jamanetworkopen.2018.3062. PMID 30646223.
Study design and population
12-month pragmatic multicentre randomised equivalency trial. n = 296 adults with physician-diagnosed psoriasis; Northern California, Southern California and Colorado.
Reported metrics
- Between-group BSA change difference: −0.05 % (95 % CI −1.58 to 1.48) — within ±3 equivalence bound
- Between-group PASI change: −0.27 (95 % CI −0.85 to 0.31)
- Patient global assessment −0.11 (95 % CI −0.32 to 0.10)
- All within pre-specified equivalence margins
Surrogate-to-outcome linkage
Demonstrates equivalence of an online collaborative connected-health model to in-person dermatology for chronic inflammatory disease — disease-activity outcomes (PASI / BSA / PGA) preserved under a remote referral pathway. Anchors the claim that teledermatology-enabled pathway redesign does not compromise clinical efficacy while improving access.
CRIT1–7 appraisal
| Criterion | Score | Justification |
|---|---|---|
| CRIT1 Relevance | 3 | Direct — online vs. in-person psoriasis care equivalency. |
| CRIT2 Methodology | 3 | Pragmatic RCT with pre-specified equivalence margin. |
| CRIT3 Reporting | 3 | Between-group differences with 95 % CIs; equivalence margin explicit. |
| CRIT4 Applicability | 3 | Ambulatory multi-state US setting; adults with moderate chronic disease. |
| CRIT5 Evidence weight | 2 | Pragmatic RCT. |
| CRIT6 Risk of bias | 2 | Open-label; digitally-enabled motivated patients — limits external validity to digitally excluded populations. |
| CRIT7 Contribution | 3 | Core anchor for the outcome-equivalence claim in chronic inflammatory disease. |
Aggregate: very strong.
Limitations and notes
12-month horizon; single indication (psoriasis); open-label; digital-literacy selection.
Strength as anchor
Very strong. One of the few RCT-level equivalency trials in teledermatology for chronic inflammatory disease. Pairs with Whited 2013 (VA store-and-forward RCT on clinical course) for skin-cancer analogue.