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An J, Fan W, Mittal A, Zhang Y, Chen AT. Mobile App Use among Persons with Fibromyalgia: A Cross-sectional Survey. THE JOURNAL OF PAIN 2024; 25:104515. [PMID: 38522593 DOI: 10.1016/j.jpain.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/26/2024]
Abstract
Persons with fibromyalgia experience a diverse set of symptoms. Recommendations for management generally focus on multidisciplinary approaches involving multiple modalities. Mobile apps can be an essential component for self-management, yet little is known about how persons with fibromyalgia use mobile apps for health-related purposes. A cross-sectional survey (N = 663) was conducted to understand the real-world use of apps among persons with fibromyalgia. The survey included 2 main foci: 1) eHealth literacy and use of information sources, and 2) mobile app use patterns and preferences for health-related purposes, including the types of apps used and usage characteristics of apps currently in use, as well as those that had been discontinued. Respondents' average eHealth literacy as measured by eHealth Literacy Scale (eHEALS) was 31.4 (SD = 7.1), and they utilized diverse information sources. Approximately two-thirds of the sample used mobile apps; the remaining one-third did not. Diverse health management needs were represented in the apps reported, including scheduling/time management, notetaking, fitness, and wellness. Compared to apps that had been discontinued, participants rated apps that they still used higher in terms of ease of use and used them more frequently. Reasons for discontinuing app use included issues with privacy, the effort required, lack of interest, and lack of perceived quality. Other reasons for app nonuse were lack of awareness and how-to knowledge, indicating that disseminating information about apps and addressing other barriers, such as providing user support, are critical to increasing uptake. These study findings can inform both app design and dissemination. PERSPECTIVE: This article presents how persons with fibromyalgia use mobile apps to manage their health. The findings could inform the development of digital interventions or programs for this population.
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Affiliation(s)
- Jiaxin An
- School of Information, University of Texas at Austin, Austin, Texas
| | - Wei Fan
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
| | - Anant Mittal
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington
| | - Yan Zhang
- School of Information, University of Texas at Austin, Austin, Texas
| | - Annie T Chen
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington
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El Aoufy K, Melis MR, Magi CE, Bellando-Randone S, Tamburini M, Bandini G, Moggi-Pignone A, Matucci-Cerinic M, Bambi S, Rasero L. Evidence for telemedicine heterogeneity in rheumatic and musculoskeletal diseases care: a scoping review. Clin Rheumatol 2024:10.1007/s10067-024-07052-w. [PMID: 38985235 DOI: 10.1007/s10067-024-07052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/10/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
Telemedicine and digital health represent alternative approaches for clinical practice; indeed, its potential in healthcare services for prevention, diagnosis, treatment, rehabilitation, and disease monitoring is widely acknowledged. These are all crucial issues to consider when dealing with chronic Rheumatic and Musculoskeletal Diseases (RMDs). The aim was to determine the current state of telemedicine in the field of rheumatology, considering the tools and devices in use as well as the Patient Reported Outcomes. A scoping review was performed following the PRISMA-ScR, retrieving articles through five databases from 1990 to 2022. Inclusion criteria were as follows: (I) adult patients with RMDs, (II) original research papers in the English language with available abstracts, and (III) telehealth and telemedicine are provided as healthcare services. Within the 62 included studies, multiple tools of telemedicine were used: 21/62 websites/online platforms, 18/62 mobile applications, 16/62 telephone contacts, 5/62 video-consultations, and 1/62 wearable devices. Outcomes were classified based on the economic, clinical, and humanistic framework. Clinical outcomes assessed through digital tools were pain, disease activity, and serum uric acid levels. Humanistic outcomes have been grouped according to four categories (e.g., mental and physical function, health management, and health perception). The heterogeneity of digital tools in the field of rheumatology highlights the challenge of implementing reliable research into clinical practice. Effective telerehabilitation models have been presented, and the use of a tight control strategy has also been mentioned. Future research should focus on establishing studies on other RMDs as well as summarizing and formulating clinical guidelines for RMDs. Key Points • Evidence for the usefulness of telemedicine and digital health for managing and monitoring rheumatic and musculoskeletal diseases is progressively increasing. • Several digital tools effectively measure clinical and humanistic and patient reported outcomes in rheumatic and musculoskeletal diseases. • Integrating diverse digital tools in rheumatology is challenging yet promising. • Future research should focus on developing standardized recommendations for practical use of telemedicine in daily practice.
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Affiliation(s)
- Khadija El Aoufy
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy.
| | - Maria Ramona Melis
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Camilla Elena Magi
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
- Department of Geriatric Medicine, Division of Rheumatology, Careggi University Hospital, Florence, Italy
| | - Matteo Tamburini
- University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Alberto Moggi-Pignone
- Department of Experimental and Clinical Medicine, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Marco Matucci-Cerinic
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Milan, Italy
- Università Vita Salute San Raffaele, Milan, Italy
| | - Stefano Bambi
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
| | - Laura Rasero
- Department of Health Science, University of Florence, Viale Largo Brambilla, 3 - 50134, Florence, Italy
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O’Brien-Kelly J, Moore D, O’Leary I, O’Connor T, Moore Z, Patton D, Nugent L. Development and impact of a tailored eHealth resource on fibromyalgia patient's self-management and self-efficacy: A mixed methods approach. Br J Pain 2024; 18:292-307. [PMID: 38751562 PMCID: PMC11092935 DOI: 10.1177/20494637231221647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
Aim To develop an eHealth resource to support fibromyalgia patients and explore it for usability and impact on their self-management and self-efficacy. Background Fibromyalgia is a complex, non-progressive chronic condition characterised by a bewildering array of symptoms for patients to self-manage. International guidelines recommend patients receive illness-specific information once diagnosed to promote self-management and improve health-related quality of life. Design A 3-phase mixed methods exploratory sequential design. Methods Qualitative interviews explored the information and self-management needs of fibromyalgia patients attending a large tertiary hospital in Dublin. Identified themes together with an extensive review of the literature of interventions proven to be impactful by patients with fibromyalgia were utilised in the design and development of the eHealth resource. The resource was tested for usability and impact using pre and post-intervention outcomes measures. Results Patient interviews highlighted a lack of easy accessible evidenced information to support self-management implicating the urgent need for a practical solution through development of a tailored eHealth resource. Six themes emerged for inclusion; illness knowledge, primary symptoms, treatment options, self-management strategies, practical support and reliable resources. Forty-five patients who tested the site for usability and impact demonstrated a statistically significant improvement in self-efficacy after 4 weeks access with a medium positive effect size. Patients with the most severe fibromyalgia impact scores pre-intervention demonstrated the most improvement after 4 weeks. Patients gave the resource a System Usability Score A rating, highly recommending it for fellow patients diagnosed with fibromyalgia. Conclusions The study demonstrated how the development of a novel eHealth resource positively impacted fibromyalgia patients' self-efficacy to cope with this debilitating condition. Impact This study suggests that access to eHealth can positively impact patients self-efficacy, has the potential to be a template for eHealth development in other chronic conditions, supporting advanced nurse practitioners working in chronic disease management.
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Affiliation(s)
- Joanne O’Brien-Kelly
- Department of Pain Management, Beaumont Hospital, Dublin, Ireland
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - David Moore
- Department of Pain Management, Beaumont Hospital, Dublin, Ireland
| | - Ian O’Leary
- Multimedia Cork Institute of Technology, Cork, Ireland
| | - Tom O’Connor
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Linda Nugent
- School of Nursing and Midwifery, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
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Donisi V, De Lucia A, Pasini I, Gandolfi M, Schweiger V, Del Piccolo L, Perlini C. e-Health Interventions Targeting Pain-Related Psychological Variables in Fibromyalgia: A Systematic Review. Healthcare (Basel) 2023; 11:1845. [PMID: 37444679 DOI: 10.3390/healthcare11131845] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
There is growing evidence to support the potential benefit of e-Health interventions targeting psychosocial outcomes and/or pain-related psychological variables for chronic pain conditions, including fibromyalgia syndrome (FMS). This systematic review aims at providing an in-depth description of the available e-Health psychological and/or multicomponent interventions for patients with FMS. Searches were made in PubMed, Cochrane, Web of Science, and PsycINFO up to 15 May 2023, finally including twenty-six articles. The quality of the included articles was medium-high (average quality assessment score of 77.1%). 50% of studies were randomized controlled trials (RCTs) (n = 13), and the majority of them focused exclusively on adult patients with FMS (n = 23) who were predominantly female. Four categories of e-Health modalities were identified: web-based (n = 19), mobile application (m-Health) (n = 3), virtual reality (VR) (n = 2), and video consulting (n = 2). Interventions were mainly based on the cognitive behavioral therapy (CBT) approach (n = 14) and mostly involved contact with a healthcare professional through different digital tools. Overall, a growing number of psychological and multicomponent interventions have been created and delivered using digital tools in the context of FMS, showing their potentiality for improving psychosocial outcomes and pain-related psychological variables. However, some digital tools resulted as underrepresented, and the literature on this topic appears highly heterogeneous precluding robust conclusions.
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Affiliation(s)
- Valeria Donisi
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Annalisa De Lucia
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Ilenia Pasini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Marialuisa Gandolfi
- UOC Neurorehabilitation, Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre (CRRNC), University of Verona, Policlinico GB Rossi, 37134 Verona, Italy
| | - Vittorio Schweiger
- Pain Therapy Centre, Department of Surgery, Dentistry, Maternal and Infant Sciences, Verona University Hospital, Policlinico GB Rossi, 37134 Verona, Italy
| | - Lidia Del Piccolo
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
| | - Cinzia Perlini
- Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Science, University of Verona, 37134 Verona, Italy
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Janela D, Costa F, Weiss B, Areias AC, Molinos M, Scheer JK, Lains J, Bento V, Cohen SP, Correia FD, Yanamadala V. Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review. Digit Health 2023; 9:20552076231176696. [PMID: 37325077 PMCID: PMC10262679 DOI: 10.1177/20552076231176696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/02/2023] [Indexed: 06/17/2023] Open
Abstract
Background Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group. Conclusions Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.
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Affiliation(s)
| | | | - Brandon Weiss
- Lake Erie College of Osteopathic Medicine, Erie, PA, USA
| | | | | | - Justin K. Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jorge Lains
- Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal
- Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | | | - Steven P. Cohen
- Departments of Anesthesiology & Critical Care Medicine, Physical Medicine and Rehabilitation, Neurology, and Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Departments of Anesthesiology and Physical Medicine and Rehabilitation and Anesthesiology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Fernando Dias Correia
- Sword Health, Inc, Draper, UT, USA
- Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Vijay Yanamadala
- Sword Health, Inc, Draper, UT, USA
- Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA
- Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA
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Serrat M, Albajes K, Navarrete J, Almirall M, Lluch Girbés E, Neblett R, Luciano JV, Moix J, Feliu-Soler A. Effectiveness of two video-based multicomponent treatments for fibromyalgia: The added value of cognitive restructuring and mindfulness in a three-arm randomised controlled trial. Behav Res Ther 2022; 158:104188. [PMID: 36116229 DOI: 10.1016/j.brat.2022.104188] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/28/2022] [Accepted: 09/01/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES The aim of this study was to examine the effectiveness of two video-based multicomponent programs (FIBROWALK) and the Multicomponent Physiotherapy Program (MPP) for patients with fibromyalgia (FM) compared to treatment-as-usual (TAU) only. We posit that FIBROWALK, due to inclusion of specific psychological ingredients (cognitive restructuring and mindfulness), can produce additional clinical benefits when compared to TAU or MPP alone. METHODS A total of 330 patients with FM were recruited and randomly allocated (1:1:1) to TAU only, TAU + FIBROWALK, or TAU + MPP. FIBROWALK and MPP consisted of weekly videos on pain neuroscience education, therapeutic exercise and self-management patient education, but only the FIBROWALK intervention provided cognitive restructuring and mindfulness. Both programs were structurally equivalent. Between-group differences in functional impairment, pain, kinesiophobia, anxious-depressive symptoms and physical functioning were evaluated at post-treatment following Intention-To-Treat and complete-case approaches. RESULTS Compared to TAU only, individuals in the FIBROWALK arm showed larger improvements in all clinical outcomes; similarly, participants in the MPP program also showed greater improvements in functional impairment, perceived pain, kinesiophobia, depressive symptoms compared to TAU only. The FIBROWALK intervention showed superior effects in improving pain, anxiety and depressive symptoms and physical functioning compared to MPP. CONCLUSIONS This RCT supports the short-term effectiveness of the video-based multicomponent programs FIBROWALK and MPP for FM and provides evidence that cognitive-behavioural and mindfulness-based techniques can be clinically useful in the context of physiotherapeutic multicomponent treatment programs. TRIAL REGISTRATION NUMBER NCT04571528.
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Affiliation(s)
- Mayte Serrat
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, 08035, Barcelona, Spain; Escoles Universitàries Gimbernat, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Klara Albajes
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Jaime Navarrete
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain.
| | - Miriam Almirall
- Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital, 08035, Barcelona, Spain.
| | | | | | - Juan V Luciano
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Jenny Moix
- Department of Basics, Developmental and Educational Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
| | - Albert Feliu-Soler
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950, Barcelona, Spain; Psychological Research in Fibromyalgia and Chronic Pain (AGORA Research Group), Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Clinical and Health Psychology, Faculty of Psychology, Autonomous University of Barcelona, Bellaterra (Cerdanyola del Vallès), 08193, Barcelona, Spain.
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Baines R, Bradwell H, Edwards K, Stevens S, Prime S, Tredinnick‐Rowe J, Sibley M, Chatterjee A. Meaningful patient and public involvement in digital health innovation, implementation and evaluation: A systematic review. Health Expect 2022; 25:1232-1245. [PMID: 35526274 PMCID: PMC9327849 DOI: 10.1111/hex.13506] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/14/2022] [Accepted: 04/03/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction The importance of meaningfully involving patients and the public in digital health innovation is widely acknowledged, but often poorly understood. This review, therefore, sought to explore how patients and the public are involved in digital health innovation and to identify factors that support and inhibit meaningful patient and public involvement (PPI) in digital health innovation, implementation and evaluation. Methods Searches were undertaken from 2010 to July 2020 in the electronic databases MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus and ACM Digital Library. Grey literature searches were also undertaken using the Patient Experience Library database and Google Scholar. Results Of the 10,540 articles identified, 433 were included. The majority of included articles were published in the United States, United Kingdom, Canada and Australia, with representation from 42 countries highlighting the international relevance of PPI in digital health. 112 topic areas where PPI had reportedly taken place were identified. Areas most often described included cancer (n = 50), mental health (n = 43), diabetes (n = 26) and long‐term conditions (n = 19). Interestingly, over 133 terms were used to describe PPI; few were explicitly defined. Patients were often most involved in the final, passive stages of an innovation journey, for example, usability testing, where the ability to proactively influence change was severely limited. Common barriers to achieving meaningful PPI included data privacy and security concerns, not involving patients early enough and lack of trust. Suggested enablers were often designed to counteract such challenges. Conclusions PPI is largely viewed as valuable and essential in digital health innovation, but rarely practised. Several barriers exist for both innovators and patients, which currently limits the quality, frequency and duration of PPI in digital health innovation, although improvements have been made in the past decade. Some reported barriers and enablers such as the importance of data privacy and security appear to be unique to PPI in digital innovation. Greater efforts should be made to support innovators and patients to become meaningfully involved in digital health innovations from the outset, given its reported benefits and impacts. Stakeholder consensus on the principles that underpin meaningful PPI in digital health innovation would be helpful in providing evidence‐based guidance on how to achieve this. Patient or Public Contribution This review has received extensive patient and public contributions with a representative from the Patient Experience Library involved throughout the review's conception, from design (including suggested revisions to the search strategy) through to article production and dissemination. Other areas of patient and public contributor involvement include contributing to the inductive thematic analysis process, refining the thematic framework and finalizing theme wording, helping to ensure relevance, value and meaning from a patient perspective. Findings from this review have also been presented to a variety of stakeholders including patients, patient advocates and clinicians through a series of focus groups and webinars. Given their extensive involvement, the representative from the Patient Experience Library is rightly included as an author of this review.
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Affiliation(s)
- Rebecca Baines
- Centre for Health Technology University of Plymouth Plymouth UK
| | - Hannah Bradwell
- Centre for Health Technology University of Plymouth Plymouth UK
| | - Katie Edwards
- Centre for Health Technology University of Plymouth Plymouth UK
| | | | - Samantha Prime
- Centre for Health Technology University of Plymouth Plymouth UK
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Therapeutic Patient Education for Fibromyalgia during Spa Therapy: The FiETT Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084613. [PMID: 35457480 PMCID: PMC9030628 DOI: 10.3390/ijerph19084613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
Spa therapy is known to improve quality of life and diminish pain. We assessed the efficacy (Fibromyalgia Impact Questionnaire-FIQ) and safety at 6 months of a fibromyalgia-specific therapeutic patient education (TPE) program added to fibromyalgia-specific standardized spa therapy (SST), compared to SST alone, in a controlled randomized trial. We enrolled 157 patients, mostly women, attending spa centers in Southwest France in 2015–2016, and randomized them to SST + TPE (79) or SST (78). The intention-to-treat with “missing as failure” analysis showed a tendency toward a higher, though non-significant, benefit with TPE than without for FIQ (−9 vs. −3; p = 0.053) or pain intensity (−0.9 vs. −1.1; p = 0.58). In addition, pain relief (+3.2 vs. +4.3; p = 0.03) and fatigue (−1.6 vs. −3.7; p = 0.02) were significantly improved, and 87% patients in the SST + TPE arm still regularly practiced the physical exercises taught to them at 6 months. We suspect significant and lasting improvement from spa therapy, as well as our already well-informed and well-managed participants, to have prevented the demonstration of a significant benefit of TPE on FIQ.
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Piszczek CC, Foley CE, Farag S, Northup M, Overcarsh P, Wiedrick J, Yunker AC, Ecker AM. Social media utilization, preferences, and patterns of behavior in patients with gynecologic pelvic pain. Am J Obstet Gynecol 2022; 226:547.e1-547.e14. [PMID: 34752735 DOI: 10.1016/j.ajog.2021.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Social media is increasingly becoming a health resource for people suffering from complex and debilitating health conditions. A comprehensive understanding of how and why social media and the Internet are used among patients with chronic gynecologic pain will allow for the intentional development and incorporation of web-based tools into patient care plans. OBJECTIVE This study aimed to determine whether gynecologic patients with pain are more likely to use social media and the Internet to understand and manage their condition than those without pain. The survey was designed to explore how gynecologic patients with and without pain use and interact with social media and other web-based health resources and the clinical, personal, and demographic factors influencing these behaviors. STUDY DESIGN Patients presenting with a new complaint to a gynecologist at 1 of 6 Fellowship in Minimally Invasive Gynecologic Surgery-affiliated hospital systems were screened, consented, and assigned to pain and no-pain groups. Participants were surveyed about social media and Internet use, symptoms, bother, physician selection, motivation, trust, and demographic information. Survey responses were compared using the Fisher exact tests, odds ratios, and risk ratios from standard tabular analysis, univariate or multivariate tests of means, and regression analyses, as appropriate. RESULTS Of 517 participants included in the study, 475 (92%) completed the survey, 328 (69.1%) with pain and 147 (30.9%) without pain. Study participants in the pain group reported more than double the odds of using social media than those without pain (37.8% vs 19.7%; odds ratio, 2.47; 95% confidence interval, 1.54-3.96) and triple the odds of using the Internet (88.4% vs 69.4%; odds ratio, 3.37; 95% confidence, 2.04-5.56) to understand or manage their condition. Participants with pain were more likely than those without pain to engage in social media at a higher level (3.5 vs 1.7 on a scale of 0 to 10; P<.0001), be motivated by interpersonal elements of online engagement (Hotelling's T2=37.3; P<.0001), prefer an interactive component to their online health resource (35.6% vs 24.3%; risk ratio, 1.46; 95% confidence interval, 1.00-2.20; P=.0433), be influenced by others in their choice of a gynecologist (0.37 vs 0.32 on a scale of 0 to 1; P=.009), use social media as a coping tool (38.3% vs 17%; P=.0001), trust information found on social media (31.4% vs 16.7%; P=.0033), and trust other women with the same condition, informal health resources, and personal sources more and doctors and formal health resources less (P=.0083). Participants in both groups reported higher levels of social media engagement with higher levels of symptom bother (28% increase in engagement with every doubling of bother level (P<.0001). CONCLUSION Patients with gynecologic pain were more likely than those without pain to use social media and the Internet to understand and manage their condition. Patients with pain engaged in and trusted social media at a higher level, with engagement rising directly with bother level.
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Affiliation(s)
| | - Christine E Foley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sara Farag
- Division of Minimally Invasive Gynecologic Surgery, Department of Gynecology and Women's Health, Cleveland Clinic Florida, Weston, FL
| | - Megan Northup
- Department of Obstetrics and Gynecology, Scripps Clinic Medical Group, San Diego, CA
| | - Patricia Overcarsh
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Jack Wiedrick
- Biostatistics and Design Program, OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR
| | - Amanda C Yunker
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN
| | - Amanda M Ecker
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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10
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Egerton T, Lawford BJ, Campbell PK, Plinsinga ML, Spiers L, Mackenzie DA, Graham B, Mills K, Eyles J, Knox G, Metcalf B, Maclachlan LR, Besomi M, Dickson C, Abraham C, Vicenzino B, Hodges PW, Hunter DJ, Bennell KL. Expert-Moderated Peer-to-Peer Online Support Group for People With Knee Osteoarthritis: Mixed Methods Randomized Controlled Pilot and Feasibility Study. JMIR Form Res 2022; 6:e32627. [PMID: 35037880 PMCID: PMC8804962 DOI: 10.2196/32627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 11/22/2021] [Indexed: 12/13/2022] Open
Abstract
Background Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management. Objective The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations. Methods This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed. Results Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs. Conclusions Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958
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Affiliation(s)
- Thorlene Egerton
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia.,Physiotherapy Department, The University of Melbourne, Melbourne, Australia
| | - Belinda J Lawford
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Penny K Campbell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Melanie L Plinsinga
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Libby Spiers
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - David A Mackenzie
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Bridget Graham
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Kathryn Mills
- Discipline of Physiotherapy, Macquarie University, Sydney, Australia
| | - Jillian Eyles
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Gabrielle Knox
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Ben Metcalf
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - Liam R Maclachlan
- Kenneth G. Jamieson Department of Neurosurgery, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Manuela Besomi
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Chris Dickson
- Department of Integrative Medicine and Supportive Care, Chris O'Brien Lifehouse, Sydney, Australia
| | | | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Paul W Hodges
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - David J Hunter
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kim L Bennell
- Centre for Health, Exercise & Sports Medicine, The University of Melbourne, Melbourne, Australia
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11
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Brünahl CA, Klotz SGR, Dybowski C, Albrecht R, Höink J, Fisch M, Ketels G, Löwe B. Physiotherapy and combined cognitive-behavioural therapy for patients with chronic pelvic pain syndrome: results of a non-randomised controlled feasibility trial. BMJ Open 2021; 11:e053421. [PMID: 34907064 PMCID: PMC8671982 DOI: 10.1136/bmjopen-2021-053421] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To explore feasibility in terms of delivering and evaluating a combination of physiotherapy and psychotherapy for patients with chronic pelvic pain syndrome (CPPS). DESIGN Prospective non-randomised controlled pilot study. SETTING Tertiary care facility with a specialised interdisciplinary outpatient clinic for patients with CPPS. PARTICIPANTS A total of 311 patients was approached; 60 participated. 36 patients were included in the intervention group (mean age ±SD 48.6 years±14.8; 52.8% female) and 24 in the control group (mean age ±SD 50.6 years±14.5; 58.3% female). Fourteen participants were lost to follow-up. INTERVENTIONS Participants were non-randomly allocated to the intervention group with two consecutive treatment modules (physiotherapy and cognitive behavioural therapy) with a duration of 9 weeks each or to the control group (treatment as usual). MAIN OUTCOME MEASURES Feasibility was operationalised in terms of delivering and evaluating the therapeutic combination. Regarding eligibility as the first aspect of feasibility, willingness to participate, dropout and satisfaction were assessed; for the second aspect, standardised self-report questionnaires measuring health-related quality of life, depression severity and pain were applied. RESULTS Although eligibility and willingness-to-participate rates were low, satisfaction of the participants in the intervention group was high and dropout rates were low. Results indicated a small and non-significant intervention effect in health-related quality of life and significant effects regarding depression severity and pain. CONCLUSIONS The combination of physiotherapy and psychotherapy for patients with CPPS seems to be feasible and potentially promising with regard to effect. However, a subsequent fully powered randomised controlled trial is needed. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00009976) and ISRCTN (ISRCTN43221600).
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Affiliation(s)
- Christian A Brünahl
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne G R Klotz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Dybowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Albrecht
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Höink
- Department of Gynaecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gesche Ketels
- Department of Physiotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Maclachlan LR, Mills K, Lawford BJ, Egerton T, Setchell J, Hall LM, Plinsinga ML, Besomi M, Teo PL, Eyles JP, Mellor R, Melo L, Robbins S, Hodges PW, Hunter DJ, Vicenzino B, Bennell KL. Design, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review. J Med Internet Res 2020; 22:e15822. [PMID: 32329746 PMCID: PMC7210497 DOI: 10.2196/15822] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/27/2019] [Accepted: 02/02/2020] [Indexed: 02/01/2023] Open
Abstract
Background Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement. Objective The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs. Methods A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively. Results We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement. Conclusions Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42018090326; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018090326
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Affiliation(s)
- Liam R Maclachlan
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kathryn Mills
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Belinda J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Thorlene Egerton
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Jenny Setchell
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne M Hall
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Melanie L Plinsinga
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Manuela Besomi
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Pek Ling Teo
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Jillian P Eyles
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Rebecca Mellor
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | | | - Sarah Robbins
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Paul W Hodges
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - David J Hunter
- Faculty of Medicine and Health, University of Sydney, Kolling Institute of Medical Research, Institute of Bone and Joint Research, Sydney, Australia.,Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia
| | - Bill Vicenzino
- The School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kim L Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
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13
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Christie HL, Bartels SL, Boots LM, Tange HJ, Verhey FR, de Vugt ME. A systematic review on the implementation of eHealth interventions for informal caregivers of people with dementia. Internet Interv 2018; 13:51-59. [PMID: 30206519 PMCID: PMC6112102 DOI: 10.1016/j.invent.2018.07.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The objectives were to (1) systematically review the literature on the implementation of eHealth interventions for informal caregivers of people with dementia, and (2) identify determinants of successful implementation. METHODS Online databases were searched for articles about eHealth interventions for informal caregivers of people with dementia, providing information on their implementation. Articles were independently screened and inductively analyzed using qualitative analysis. The analysis was mapped onto the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). FINDINGS 46 articles containing 204 statements on implementation were included. The statements on implementation were grouped into four categories: Determinants associated with the eHealth application, informal caregiver, implementing organization, or wider context. Mapping of the determinants on the CFIR revealed that studies have focused mostly on characteristics of the intervention and informal caregiver. Limited attention has been paid to organizational determinants and the wider context. CONCLUSIONS Despite prolific effectiveness and efficacy research on eHealth interventions for caregivers of people with dementia, there is a critical dearth of implementation research. Furthermore, there is a mismatch between eHealth intervention research and implementation frameworks, especially concerning organizational factors and wider context. This review underscores the importance of future implementation research in bridging the gap between research and practice.
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Affiliation(s)
- Hannah L. Christie
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
- Corresponding author.
| | - Sara L. Bartels
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Lizzy M.M. Boots
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Huibert J. Tange
- Department of Family Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Frans R.J. Verhey
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
| | - Marjolein E. de Vugt
- Department of Psychiatry and Neuropsychology and Alzheimer Centre Limburg, School for Mental Health and Neurosciences, Maastricht University, Postbus 616, 6200, MD, Maastricht, the Netherlands
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14
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Granja C, Janssen W, Johansen MA. Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. J Med Internet Res 2018; 20:e10235. [PMID: 29716883 PMCID: PMC5954232 DOI: 10.2196/10235] [Citation(s) in RCA: 276] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/09/2018] [Indexed: 01/18/2023] Open
Abstract
Background eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Objective Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. Methods We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Results Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). Conclusions The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.
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Affiliation(s)
- Conceição Granja
- Future Journal, Norwegian Centre for E-health Research, Tromsø, Norway
| | - Wouter Janssen
- Telemedicine and E-health Research Group, University of Tromsø-The Artic University of Norway, Tromsø, Norway
| | - Monika Alise Johansen
- Future Journal, Norwegian Centre for E-health Research, Tromsø, Norway.,Telemedicine and E-health Research Group, University of Tromsø-The Artic University of Norway, Tromsø, Norway
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15
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Ali L, Fors A, Ekman I. Need of support in people with chronic obstructive pulmonary disease. J Clin Nurs 2018; 27:e1089-e1096. [PMID: 29149463 PMCID: PMC5900916 DOI: 10.1111/jocn.14170] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2017] [Indexed: 12/29/2022]
Abstract
AIM AND OBJECTIVE The aim of this study was to describe peoples' experiences and expectations of support when living with chronic obstructive pulmonary disease. METHOD We conducted and analysed face-to-face or telephone interviews with 17 individuals (aged 44-77 years) diagnosed with chronic obstructive pulmonary disease. The interviewer asked open-ended questions aimed at encouraging further narration, and we analysed the participants' narratives using a phenomenological hermeneutical approach. This report adheres to the COREQ guidelines. RESULTS The overall theme suggests that people with chronic obstructive pulmonary disease describe support as shared knowledge and experiences, based on the following subthemes; similar experiences, the need of genuine professional knowledge, self-reliance versus self-blame, and the Internet - feeling safe but uncertain. CONCLUSIONS People with chronic obstructive pulmonary disease find their strength through shared knowledge and dialogical support with others who have similar experiences and with professionals. A person-centred eHealth approach may be suitable for this group as it offers both collaboration and support. RELEVANCE TO CLINICAL PRACTICE There is a demand for access to genuine professional knowledge as additional support to patients' own capabilities and needs. Patient associations were assessed as reliable sources of information and to some extent also support, but the importance of access to professional sources was also stressed.
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Affiliation(s)
- Lilas Ali
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Andreas Fors
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Närhälsan Research and DevelopmentPrimary Health CareRegion Västra GötalandGothenburgSweden
| | - Inger Ekman
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
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16
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Kassianos AP, Georgiou G, Papaconstantinou EP, Detzortzi A, Horne R. Smartphone Applications for Educating and Helping Non-motivating Patients Adhere to Medication That Treats Mental Health Conditions: Aims and Functioning. Front Psychol 2017; 8:1769. [PMID: 29075216 PMCID: PMC5641822 DOI: 10.3389/fpsyg.2017.01769] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/25/2017] [Indexed: 01/29/2023] Open
Abstract
Background: Patients prescribed with medication that treats mental health conditions benefit the most compared to those prescribed with other types of medication. However, they are also the most difficult to adhere. The development of mobile health (mHealth) applications ("apps") to help patients monitor their adherence is fast growing but with limited evidence on their efficacy. There is no evidence on the content of these apps for patients taking psychotropic medication. The aim of this study is to identify and evaluate the aims and functioning of available apps that are aiming to help and educate patients to adhere to medication that treats mental health conditions. Method: Three platform descriptions (Apple, Google, and Microsoft) were searched between October 2015 and February 2016. Included apps need to focus on adherence to medication that treats mental health conditions and use at least a reinforcement strategy. Descriptive information was extracted and apps evaluated on a number of assessment criteria using content analysis. Results: Sixteen apps were identified. All apps included self-monitoring properties like reminders and psycho-educational properties like mood logs. It was unclear how the latter were used or how adherence was measured. Major barriers to medication adherence like patients' illness and medication beliefs and attitudes were not considered nor where information to patients about mediation side effects. Very few apps were tailored and none was developed based on established theories explaining the processes for successful medication adherence like cognitions and beliefs. Reported information on app development and validation was poor. Discussion: A variety of apps with different properties that tackle both intentional and unintentional non-adherence from a different perspective are identified. An evidence-based approach and co-creation with patients is needed. This will ensure that the apps increase the possibility to impact on non-adherence. Theories like social cognition models can be useful in ensuring that patients' education, motivation, skills, beliefs, and type of adherence are taken into consideration when developing the apps. Findings from this study can help clinicians and patients make informed choices and pursue policy-makers to integrate evidence when developing future apps. Quality-assurance tools are needed to ensure the apps are systematically evaluated.
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Affiliation(s)
- Angelos P. Kassianos
- Department of Applied Health Research, University College London, London, United Kingdom
| | | | | | | | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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17
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What do people search online concerning the “elusive” fibromyalgia? Insights from a qualitative and quantitative analysis of Google Trends. Clin Rheumatol 2017; 36:1873-1878. [DOI: 10.1007/s10067-017-3665-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/03/2017] [Accepted: 04/25/2017] [Indexed: 12/15/2022]
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18
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Piga M, Cangemi I, Mathieu A, Cauli A. Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda. Semin Arthritis Rheum 2017; 47:121-128. [PMID: 28420491 DOI: 10.1016/j.semarthrit.2017.03.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/17/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically review the scientific literature regarding tele-rheumatology and draw conclusions about feasibility, effectiveness, and patient satisfaction. METHODS PubMed, Scopus, and Cochrane database searches were performed (April 2016) using relevant MeSH and keyword terms for telemedicine and rheumatic diseases. Articles were selected if reporting outcomes for feasibility, effectiveness, and patient satisfaction and methodologically appraised using the Cochrane Collaboration's tool for assessing risk of bias and a modified version of CONSORT 2010 Statement. RESULTS A total of 177 articles were screened, 23 were selected for the present review but only 9 were RCTs. Five studies reported on feasibility, 14 effectiveness, and 9 satisfaction rates for different tele-rheumatology interventions grouped in synchronous (remotely delivered consultation) and asynchronous (remote disease activity assessment; tele-monitoring of treatment strategies or rehabilitation; and remotely delivered self-management programs). Seven studies (30.4%) were on rheumatoid arthritis, 2 (8.7%) were on systemic sclerosis (1 including also rheumatoid arthritis patients), 5 (21.7%) on fibromyalgia, 2 (8.7%) on osteoarthritis, 3 (13.0%) on juvenile idiopathic arthritis and 4 (17.4%) on mixed disease cohorts. Interventions and outcomes heterogeneity prevented meta-analysis of results. Overall, feasibility and patient satisfaction rates were high or very high across intervention types. Effectiveness was equal or higher than standard face-to-face approach in controlled trials which, however, were affected by small sample size and lack of blinding participants according to appraisal tools. CONCLUSION Telemedicine may provide a well-accepted way to remotely deliver consultation, treatment and monitoring disease activity in rheumatology. Higher quality RCTs demonstrating effectiveness of different tele-rheumatology interventions are needed.
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Affiliation(s)
- Matteo Piga
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy.
| | - Ignazio Cangemi
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
| | - Alessandro Mathieu
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
| | - Alberto Cauli
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
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19
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Dorstyn D, Roberts R, Murphy G, Kneebone I, Migliorini C, Craig A, Hutchinson C, Field D. Piloting an email-based resource package for job seekers with multiple sclerosis. Disabil Rehabil 2017; 39:867-873. [PMID: 28293978 DOI: 10.3109/09638288.2016.1161847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. METHOD Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test - revised and Patient Health Questionnaire-9 - secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. RESULTS Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. CONCLUSIONS Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated. Implications for Rehabilitation Research indicates a high unemployment rate among working-age adults with MS. A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group. This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, potentially, improving vocational outcomes. Work and MS has potential applicability to other disability groups.
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Affiliation(s)
- Diana Dorstyn
- a School of Psychology, Faculty of Health Sciences , University of Adelaide , South Australia , Australia
| | - Rachel Roberts
- a School of Psychology, Faculty of Health Sciences , University of Adelaide , South Australia , Australia
| | - Gregory Murphy
- b School of Public Health , LaTrobe University , Victoria , Australia
| | - Ian Kneebone
- c Discipline of Clinical Psychology, Graduate School of Health , University of Technology Sydney , Sydney , Australia
| | - Christine Migliorini
- d Centre for Developmental Psychiatry and Psychology , Monash University , Victoria , Australia
| | - Ashley Craig
- e Sydney Medical School-Northern, Kolling Institute of Medical Research, The University of Sydney , Sydney , Australia
| | - Claire Hutchinson
- a School of Psychology, Faculty of Health Sciences , University of Adelaide , South Australia , Australia
| | - Deborah Field
- f Lyell McEwin Hospital, SA Health , South Australia , Australia
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Werner NE, Stanislawski B, Marx KA, Watkins DC, Kobayashi M, Kales H, Gitlin LN. Getting what they need when they need it. Identifying barriers to information needs of family caregivers to manage dementia-related behavioral symptoms. Appl Clin Inform 2017; 8:191-205. [PMID: 28224163 PMCID: PMC5373763 DOI: 10.4338/aci-2016-07-ra-0122] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/09/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Consumer health informatics (CHI) such as web-based applications may provide the platform for enabling the over 15 million family caregivers of patients with Alzheimer's Disease or related dementias the information they need when they need it to support behavioral symptom management. However, for CHI to be successful, it is necessary that it be designed to meet the specific information needs of family caregivers in the context in which caregiving occurs. A sociotechnical systems approach to CHI design can help to understand the contextual complexities of family caregiving and account for those complexities in the design of CHI for family caregivers. OBJECTIVES This study used a sociotechnical systems approach to identify barriers to meeting caregivers' information needs related to the management of dementia-related behavioral symptoms, and to derive design implications that overcome barriers for caregiver-focused web-based platforms. We have subsequently used these design implications to inform the development of a web-based platform, WeCareAdvisor,TM which provides caregivers with information and an algorithm by which to identify and manage behavioral symptoms for which they seek management strategies. METHODS We conducted 4 focus groups with family caregivers (N=26) in a Midwestern state. Qualitative content analysis of the data was guided by a sociotechnical systems framework. RESULTS We identified nine categories of barriers that family caregivers confront in obtaining needed information about behavioral symptom management from which we extrapolated design implications for a web-based platform. Based on interactions within the sociotechnical system, three critical information needs were identified: 1) timely access to information, 2) access to information that is tailored or specific to caregiver's needs and contexts, and 3) usable information that can directly inform how caregivers' manage behaviors. CONCLUSIONS The sociotechnical system framework is a useful approach for identifying information needs of family caregivers to inform design of web-based platforms that are user-centered.
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Affiliation(s)
- Nicole E Werner
- Nicole E. Werner, Ph.D., Assistant Professor, Department of Industrial and Systems Engineering, Discovery Fellow, Living Environments Laboratory, Wisconsin Institute for Discovery, Affiliate Faculty, Center for Quality and Productivity Improvement, Affiliate Faculty, William S. Middleton Memorial VA Hospital, University of Wisconsin-Madison , 1513 University Avenue Madison, WI 53706, Phone: 608.890.2578, Fax: 608.262.8454,
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Pals RAS, Olesen K, Willaing I. What does theory-driven evaluation add to the analysis of self-reported outcomes of diabetes education? A comparative realist evaluation of a participatory patient education approach. PATIENT EDUCATION AND COUNSELING 2016; 99:995-1001. [PMID: 26830513 DOI: 10.1016/j.pec.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the effects of the Next Education (NEED) patient education approach in diabetes education. METHODS We tested the use of the NEED approach at eight intervention sites (n=193). Six additional sites served as controls (n=58). Data were collected through questionnaires, interviews and observations. We analysed data using descriptive statistics, logistic regression and systematic text condensation. RESULTS Results from logistic regression demonstrated better overall assessment of education program experiences and enhanced self-reported improvements in maintaining medications correctly among patients from intervention sites, as compared to control sites. Interviews and observations suggested that improvements in health behavior could be explained by mechanisms related to the education setting, including using person-centeredness and dialogue. However, similar mechanisms were observed at control sites. Observations suggested that the quality of group dynamics, patients' motivation and educators' ability to facilitate participation in education, supported by the NEED approach, contributed to better results at intervention sites. CONCLUSION The use of participatory approaches and, in particular, the NEED patient education approach in group-based diabetes education improved self-management skills and health behavior outcomes among individuals with diabetes. PRACTICE IMPLICATIONS The use of dialogue tools in diabetes education is advised for educators.
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Affiliation(s)
- Regitze A S Pals
- Health Promotion Research, Steno Diabetes Center A/S, Niels Steensens Vej 6, 2820 Gentofte, Denmark.
| | - Kasper Olesen
- Health Promotion Research, Steno Diabetes Center A/S, Niels Steensens Vej 6, 2820 Gentofte, Denmark.
| | - Ingrid Willaing
- Health Promotion Research, Steno Diabetes Center A/S, Niels Steensens Vej 6, 2820 Gentofte, Denmark.
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Win KT, Hassan NM, Oinas-Kukkonen H, Probst Y. Online Patient Education for Chronic Disease Management: Consumer Perspectives. J Med Syst 2016; 40:88. [PMID: 26846749 DOI: 10.1007/s10916-016-0438-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/07/2016] [Indexed: 01/27/2023]
Abstract
Patient education plays an important role in chronic disease management. The aim of this study is to identify patients' preferences in regard to the design features of effective online patient education (OPE) and the benefits. A review of the existing literature was conducted in order to identify the benefits of OPE and its essential design features. These design features were empirically tested by conducting survey with patients and caregivers. Reliability analysis, construct validity and regression analysis were performed for data analysis. The results identified patient-tailored information, interactivity, content credibility, clear presentation of content, use of multimedia and interpretability as the essential design features of online patient education websites for chronic disease management.
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Affiliation(s)
- Khin Than Win
- Faculty of Engineering and Information Science, University of Wollongong, Wollongong, Australia.
| | - Naffisah Mohd Hassan
- Faculty of Engineering and Information Science, University of Wollongong, Wollongong, Australia.
| | - Harri Oinas-Kukkonen
- Department of Information Processing Science, University of Oulu, Oulu, Finland.
| | - Yasmine Probst
- Faculty of Engineering and Information Science, University of Wollongong, Wollongong, Australia.
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Sparks T, Kawi J, Menzel NN, Hartley K. Implementation of Health Information Technology in Routine Care for Fibromyalgia: Pilot Study. Pain Manag Nurs 2016; 17:54-62. [DOI: 10.1016/j.pmn.2015.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 10/03/2015] [Accepted: 10/05/2015] [Indexed: 10/22/2022]
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Beauvais C. Include patient education in daily practice: Promoting the patient-centered care approach. Joint Bone Spine 2015; 82:219-21. [DOI: 10.1016/j.jbspin.2014.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Accepted: 12/14/2014] [Indexed: 12/01/2022]
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The Technological Growth in eHealth Services. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2015; 2015:894171. [PMID: 26146515 PMCID: PMC4469784 DOI: 10.1155/2015/894171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 04/27/2015] [Indexed: 12/31/2022]
Abstract
The infusion of information communication technology (ICT) into health services is emerging as an active area of research. It has several advantages but perhaps the most important one is providing medical benefits to one and all irrespective of geographic boundaries in a cost effective manner, providing global expertise and holistic services, in a time bound manner. This paper provides a systematic review of technological growth in eHealth services. The present study reviews and analyzes the role of four important technologies, namely, satellite, internet, mobile, and cloud for providing health services.
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Win KT, Hassan NM, Bonney A, Iverson D. Benefits of Online Health Education: Perception from Consumers and Health Professionals. J Med Syst 2015; 39:27. [DOI: 10.1007/s10916-015-0224-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 02/02/2015] [Indexed: 02/07/2023]
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Allam A, Kostova Z, Nakamoto K, Schulz PJ. The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial. J Med Internet Res 2015; 17:e14. [PMID: 25574939 PMCID: PMC4296094 DOI: 10.2196/jmir.3510] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 10/16/2014] [Accepted: 11/08/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes. OBJECTIVE The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated. METHODS We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time. RESULTS The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=-0.41, P=.01) and patients accessing both social support features and gaming (B=-0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t91=-2.41, P=.02; U=812, P=.02). CONCLUSIONS The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 57366516; http://www.controlled-trials. com/ISRCTN57366516 (Archived by webcite at http://www.webcitation.org/6PBvvAvvV).
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Affiliation(s)
- Ahmed Allam
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano (Università della Svizzera italiana), Lugano, Switzerland.
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Riva S, Camerini AL, Allam A, Schulz PJ. Interactive sections of an Internet-based intervention increase empowerment of chronic back pain patients: randomized controlled trial. J Med Internet Res 2014; 16:e180. [PMID: 25119374 PMCID: PMC4147711 DOI: 10.2196/jmir.3474] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 05/22/2014] [Accepted: 05/31/2014] [Indexed: 12/02/2022] Open
Abstract
Background Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective. Objective This study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes. Methods A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden. Results All patients completed the study. Overall, the intervention had a moderate effect (F1.52=2.83, P=.03, η2=0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=−1.5, P=.04, d=0.28; final assessment: mean difference=−1.6, P=.03, d=−0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups. Conclusions Results suggest that interactive sections as part of Internet-based interventions can positively alter patients’ feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed. Trial Registration ClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR).
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Affiliation(s)
- Silvia Riva
- Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland.
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Green N, Rubinelli S, Scott D, Visser A. Health communication meets artificial intelligence. PATIENT EDUCATION AND COUNSELING 2013; 92:139-141. [PMID: 23866991 DOI: 10.1016/j.pec.2013.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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