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Accepted for/Published in: Journal of Medical Internet Research

Date Submitted: Oct 12, 2018
Open Peer Review Period: Oct 14, 2018 - Nov 11, 2018
Date Accepted: Nov 29, 2018
(closed for review but you can still tweet)

The final, peer-reviewed published version of this preprint can be found here:

Efficacy of a Web-Based Self-Management Enhancing Program for Patients with Rheumatoid Arthritis: Explorative Randomized Controlled Trial

Zuidema R, van Dulmen S, Nijhuis- van der Sanden M, Meek I, van den Ende E, Fransen J, van Gaal B

Efficacy of a Web-Based Self-Management Enhancing Program for Patients with Rheumatoid Arthritis: Explorative Randomized Controlled Trial

J Med Internet Res 2019;21(4):e12463

DOI: 10.2196/12463

PMID: 31038461

PMCID: 6658318

Efficacy of an online self-management enhancing programme for patients with rheumatoid arthritis: an explorative RCT

  • Rixt Zuidema; 
  • Sandra van Dulmen; 
  • Maria Nijhuis- van der Sanden; 
  • Inger Meek; 
  • Els van den Ende; 
  • Jaap Fransen; 
  • Betsie van Gaal

ABSTRACT

Background:

Online self-management enhancing programmes has the potential to support patients with Rheumatoid Arthritis in their self-management, for example improve their health status and self-efficacy or decrease overuse of medication. We developed an online self-management enhancing program in collaboration with RA patients and professionals as co-designers, based on the Intervention Mapping Framework. While self-management programs are complex interventions, it is informative to perform an explorative Randomized Controlled Trial before embarking on a larger trial.

Objective:

This study aimed to evaluate the efficacy of an online self-management enhancing programme for patients with rheumatoid arthritis and to identify outcome measures most likely to capture potential benefits.

Methods:

A multicentre exploratory randomised controlled trial was performed with an intervention and a control group. Both groups received care as usual. In addition, the intervention group received 12 months of access to an online self-management programme. Assessment occurred at baseline, 6 and 12 months. Outcome measures included self-management behaviour (PAM-13, SMAS-S), self-efficacy (RASE, PEPPI-5), general health status (RAND-36), focus on fatigue (MPCI-F), perceived pain and fatigue (NRS scales). A linear mixed model for repeated measures, using the intention-to-treat principle, was applied to study differences between the patients in the intervention (n=78) and control (n=79) groups. A sensitivity analysis was performed in the intervention group to study the influence of patients with high (N=30) and low (N=40) use of the intervention.

Results:

The intervention group scored statistically significantly better on the subscale RAND-36 vitality. The group with high use scored statistically significantly better on the subscale RAND-36 perception, although the effect sizes were small. No other statistically significant or clinically relevant effects were found.

Conclusions:

Based on these results, it is not possible to conclude on the positive effects of the intervention or to select outcome measures to be regarded as the primary/main or secondary outcomes for a future trial. A process evaluation should be performed to provide more insight into the low compliance with and effectiveness of the intervention. Clinical Trial: The trial is registered in the Dutch Trial Register (ID: NTR4871). URL: http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=4871


 Citation

Please cite as:

Zuidema R, van Dulmen S, Nijhuis- van der Sanden M, Meek I, van den Ende E, Fransen J, van Gaal B

Efficacy of a Web-Based Self-Management Enhancing Program for Patients with Rheumatoid Arthritis: Explorative Randomized Controlled Trial

J Med Internet Res 2019;21(4):e12463

DOI: 10.2196/12463

PMID: 31038461

PMCID: 6658318

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