# Health-Related Quality of Life Before and After Sobriety in Combination With an Adjunctive Journaling App in Patients With Alcohol-Related Liver Disease: Prospective Single-Arm Study

## TL;DR

A study found that combining hepatologist-led sobriety support with a journaling app improved physical quality of life in patients with alcohol-related liver disease.

## Contribution

This is the first study to evaluate hepatologist-led abstinence support with a digital journaling app in outpatient ALD care.

## Key findings

- Physical HRQOL scores improved significantly within 8 weeks of starting abstinence support and journaling app use.
- Patients who maintained abstinence showed continued physical HRQOL improvements up to 24 weeks.
- Mental and social HRQOL domains did not show significant improvement during the study period.

## Abstract

Alcohol-related liver disease (ALD) is a global health concern, and harmful alcohol use negatively affects clinical outcomes and health-related quality of life (HRQOL). Previous studies have demonstrated impaired HRQOL in chronic liver disease, including ALD; however, evidence remains limited regarding whether hepatologist-delivered abstinence support in outpatient practice can improve HRQOL. Digital interventions such as smartphone journaling apps may support behavior change, but their effectiveness in hepatology-led care settings has not been well established.

This study aimed to prospectively evaluate changes in HRQOL over time among patients with ALD receiving routine hepatologist-led abstinence support supplemented by a smartphone-based journaling app.

This was a prospective single-arm observational study. Eligibility criteria included a diagnosis of ALD, outpatient follow-up in hepatology, advice to abstain from alcohol, and written informed consent; patients were excluded if they reported abstinence for >1 year, had no intention to reduce or abstain from alcohol, or declined medical follow-up. In total, 21 outpatients with ALD (mean age 51, SD 3 years; men: n=12, 57.1%) were enrolled from a gastroenterology and hepatology outpatient clinic between August 2021 and July 2023 (convenience sampling). Participants attended scheduled visits at 4, 8, 12, and 24 weeks and received brief abstinence counseling by hepatologists while using a journaling app. HRQOL was assessed using the Japanese version of the 36-Item Short Form Health Survey version 2 at entry, week 8, and week 24. Changes in subscale and summary scores were analyzed using paired t tests (2-sided α=.05) with 95% CIs; when normality assumptions were not met, Wilcoxon signed-rank tests were applied.

From entry to week 8, significant improvements were observed in physical functioning (mean difference [MD] +4.70, 95% CI 1.62-7.78; P=.005), role physical (MD +7.87, 95% CI 1.05-14.70; P=.02), general health (MD +5.82, 95% CI 1.74-9.88; P=.007), and role emotional (MD +7.85, 95% CI 0.29-15.41; P=.04). The Physical Component Summary score also improved (MD +4.78, 95% CI 1.22-8.34; P=.01). These findings were consistent in sensitivity analysis using the Wilcoxon signed-rank test. No significant changes were observed in mental or social HRQOL domains. In subgroup analyses, patients who maintained abstinence during the first 8 weeks (7/21, 33.3%) showed continued improvement in physical HRQOL up to 24 weeks, whereas those who continued drinking (11/21, 52.4%) did not exhibit meaningful change.

In this exploratory observational study, hepatologist-led abstinence support supplemented by a smartphone-based journaling app was associated with improvements in physical HRQOL. Unlike previous studies that have focused on addiction specialist–led interventions, this study evaluated abstinence support delivered by hepatologists in routine outpatient practice, providing a real-world assessment of a digitally supported approach. These findings suggest that hepatologist-led, digitally supported care may be a feasible strategy in clinical settings with limited access to specialized addiction services.