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

Zuidema, Rixt; Dulmen, Sandra van; Sanden, Maria W. G. Nijhuis-van der; Meek, I.; Ende, Cornelia van den; Fransen, Jaap; Gaal, Betsie van

doi:10.2196/12463

Cited by 32 publications

(49 citation statements)

References 47 publications

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“…We observe a lack of participatory techniques to understand the lived experience of self‐managing RA. While advances are being made in the development of self‐management interventions, particularly technological, 78‐80 it is vital that these interventions are informed by a deep understanding of the lived experience of the patient community and their needs and concerns. We suggest the incorporation of techniques that emphasize participation, such as participatory action research, to deepen knowledge of the dimensions of self‐concept, self‐esteem and self‐efficacy.…”

Section: Discussionmentioning

confidence: 99%

Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self‐managing rheumatoid arthritis

Donnelly

Manning

Mannan

et al. 2020

Health Expectations

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Section: Discussionmentioning

confidence: 99%

Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self‐managing rheumatoid arthritis

Donnelly

Manning

Mannan

et al. 2020

Health Expectations

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“…A 12-month-long self-management programme delivered via the internet did not improve pain or fatigue compared with standard of care treatment in an RCT of 157 patients with RA. 69…”

Section: Treatmentmentioning

confidence: 99%

Management of Fatigue in Rheumatoid Arthritis

Pope

2020

RMD Open

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Fatigue in rheumatoid arthritis is highly prevalent. It is correlated only weakly with disease activity but more so with pain, mood, personality features, poor sleep, obesity and comorbidities. Fatigue can be measured by many standardised questionnaires and more easily with a Visual Analogue Scale or numeric rating scale. Most patients with RA have some fatigue, and at least one in six have severe fatigue. Chronic pain and depressed mood are also common in RA patients with significant fatigue. It affects function and quality of life and is worse on average in women. Evidence-based treatment for fatigue includes treatment of underlying disease activity (with on average modest improvement of fatigue), exercise programmes and supervised self-management programmes with cognitive-behavioural therapy, mindfulness and reinforcement (such as reminders). The specific programmes for exercise and behavioural interventions are not standardised. Some medications cause fatigue such as methotrexate. More research is needed to understand fatigue and how to treat this common complex symptom in RA that can be the worst symptom for some patients.

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“…Other (effective) eHealth interventions for CVD prevention focused primarily on one or two risk factors (eg, physical activity [ 15 ] and smoking cessation [ 37 ]). Results of web-based self-management programs with multiple components in other diseases show comparable results [ 38 - 40 ]. Vascular View tried to guide patients by using a questionnaire to advise them in choosing courses in the welcome module and lifestyle module [ 20 ].…”

Section: Discussionmentioning

confidence: 97%

Evaluation of a Web-Based Self-Management Program for Patients With Cardiovascular Disease: Explorative Randomized Controlled Trial

Engelen¹,

Dulmen²,

Puijk-Hekman³

et al. 2020

J Med Internet Res

Self Cite

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Background Web-based self-management programs have the potential to support patients with cardiovascular disease (CVD) in their self-management (eg, by focusing on behavior change and improving physical activity). The intervention mapping framework was used to develop a web-based program called Vascular View. The Vascular View program contained 6 modules (coping with CVD, setting boundaries, lifestyle, healthy nutrition, being physically active, interaction with health professionals) aiming to increase self-management behavior by tailoring to the perceived problems and (support) needs of patients after CVD. Objective The aim was to test the effectiveness of Vascular View before embarking on a full-scale randomized clinical trial (RCT) by evaluating the potential effectiveness and effect sizes of the Vascular View program and identifying outcome measures most likely to capture the potential benefits. Methods An explorative RCT was performed. Both control and intervention groups received care as usual and, in addition, the intervention group received 12 months of access to a web-based self-management program. Assessment occurred at baseline, 6 months, and 12 months. Outcome measures included general patient-reported outcome measurements: Illness Perception Questionnaire (IPQ), Rand-36, Patient Activation Measure, and patient self-efficacy. Module-specific patient-reported outcome measurements were Beliefs about Medicines Questionnaire, International Physical Activity Questionnaire, Dutch Healthy Diet Index, Fagerström Test for Nicotine Dependence (FTND), Alcohol Use Disorders Identification Test, and Perceived Efficacy in Patient-Physician Interaction. Linear mixed models for repeated measures using intention-to-treat and per-protocol analysis were applied to study differences between the patients in the intervention and control groups. Floor and ceiling effects were explored to give insight into the outcome measures most likely to capture the potential benefits. Results A total of 105 patients in the control group and 103 patients in the intervention group participated in the study. A positive direction of change between baseline and 12 months was shown for most outcome measurements in favor of the intervention group, of which 2 out of 10 outcomes showed a significant effect: attribution of cause of the disease to risk factors and immunity factors (IPQ) and dependency of nicotine (FTND). Floor and ceiling effects were seen in the IPQ, Rand-36, and the self-efficacy questionnaire. Conclusions No conclusion for the efficacy of the Vascular View program or selection of outcome measurements can be taken yet. A process evaluation will be conducted to gain thorough insight into the working elements of the program, patient needs in eHealth, and the use of the program by patients. This can determine for whom web-based self-management programs will work and help to adapt the program. Trial Registration Dutch Trial Register NTR5412; https://www.trialregister.nl/trial/5303 International Registered Report Identifier (IRRID) RR2-10.2196/resprot.6352

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

Cited by 32 publications

References 47 publications

Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self‐managing rheumatoid arthritis

Renegotiating dimensions of the self: A systematic review and qualitative evidence synthesis of the lived experience of self‐managing rheumatoid arthritis

Management of Fatigue in Rheumatoid Arthritis

Evaluation of a Web-Based Self-Management Program for Patients With Cardiovascular Disease: Explorative Randomized Controlled Trial

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