Using an online self-help tool for 10 weeks improved rheumatoid arthritis patients’ quality of life up to 9 months after the intervention, according to a small, randomized trial.
However, patients didn’t see improvements in health status or pain and other symptoms beyond those of patients who were randomized to a waiting list and didn’t receive the intervention, according to Cheryl L. Shigaki, Ph.D., of the department of health psychology at the University of Missouri, Columbia, and her colleagues (Arthritis Care Res. 2013;65:1573-81).
The only previous study of an online self-management intervention involved patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia, and those with RA showed sustained improvement in self-reported global health and activity limitation at 12 months after beginning the program (Arthritis Rheum. 2008;59:1009-17).
The self-management tool included content delivered via a visual slideshow, as well as access to the online site RAHelp.org, which provided peer support through social networking applications. Patients in the intervention group also had weekly phone calls with a counselor trained in cognitive-behavioral group interventions.
The mean age of the 106 patients who underwent the intervention (54 patients) or went on a wait list (52 patients) was 49 and 50 years, respectively, and 98 of the 106 patients were women. A total of 86% had attended graduate school or at least some college, and 94% of the 106 patients were white.
Immediately after the 10-week intervention period, participants in the treatment group had significantly better scores on the Arthritis Self-Efficacy Scale than did those in the wait-list group (83.9 vs. 68.5, respectively), and that difference was maintained 9 months after the intervention (84.1 vs. 68.6). The effect size associated with the intervention at both time points was large, at 0.92.
The intervention had significantly greater positive effect on quality of life than did being on the waiting list, Dr. Shigaki and her colleagues noted, and had a moderate effect size on Quality of Life Scale scores that was retained from immediately after the intervention (88.4 vs. 84.9) through 9 months later (88.0 vs. 83.1).
The investigators acknowledged that it’s difficult to determine how much of the intervention’s impact was attributable to the online materials and peer support, and how much was because of the phone calls with counselors. However, given the public’s increasing comfort with online communications since the trial began in 2003, they said, "we expect that a future version of RAHelp could be conducted safely and effectively without scheduled phone contacts, and that most, if not all, interactions could be conducted online."
The investigators cautioned that the participants were not blinded to the intervention and may have benefited from an attention effect. The participants also were early adopters of Internet tools and services, and they had a high level of education and income. Thus, their results may not be generalizable to a broader population. But they may represent people "who accept and are comfortable with, or even perhaps prefer, receiving health care services online."
The program could be scaled up by "significantly reducing the amount of clinician phone contact time without introducing untoward risk or consumer rejection," the researchers added.
Reimbursement could be a barrier to expanding similar programs, however. "At this time, there is no clear and consistent way to recoup costs associated with online self-management programming," Dr. Shigaki and her colleagues cautioned. But that could change as Medicare shifts its thinking on reimbursement for behavioral and psychosocial approaches that reduce the overall costs of chronic illness.
The study was funded by a grant from the National Institute on Disability and Rehabilitation Research of the Department of Education. One of the authors reported receiving honoraria from the Association of Rheumatology Health Professionals.