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Safari R, Jackson J, Sheffield D. Digital Self-Management Interventions for People With Osteoarthritis: Systematic Review With Meta-Analysis. J Med Internet Res 2020; 22:e15365. [PMID: 32706657 PMCID: PMC7428148 DOI: 10.2196/15365] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 11/13/2019] [Accepted: 02/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is not curable, but the symptoms can be managed through self-management programs (SMPs). Owing to the growing burden of OA on the health system and the need to ensure high-quality integrated services, delivering SMPs through digital technologies could be an economic and effective community-based approach. OBJECTIVE This study aims to analyze the effectiveness of digital-based structured SMPs on patient outcomes in people with OA. METHODS A total of 7 web-based and 3 gray literature databases were searched for randomized controlled trials assessing digital-based structured SMPs on self-reported outcomes including pain, physical function, disability, and health-related quality of life (QoL) in people with OA. Two reviewers independently screened the search results and reference lists of the identified papers and related reviews. Data on the intervention components and delivery and behavioral change techniques used were extracted. A meta-analysis, risk of bias sensitivity analysis, and subgroup analysis were performed where appropriate. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to assess the quality of evidence. RESULTS A total of 8 studies were included in this review involving 2687 patients with knee (n=2); knee, hip, or both (n=5); and unspecified joint (n=1) OA. SMPs were delivered via telephone plus audio and video, internet, or mobile apps. Studies reported that digital-based structured SMPs compared with the treatment as usual control group (n=7) resulted in a significant, homogeneous, medium reduction in pain and improvement in physical function (standardized mean difference [SMD] -0.28, 95% CI -0.38 to -0.18 and SMD -0.26, 95% CI -0.35 to -0.16, respectively) at posttreatment. The digital-based structured SMP effect on pain and function reduced slightly at the 12-month follow-up but remained to be medium and significant. The posttreatment effect of digital-based structured SMPs was small and significant for disability, but nonsignificant for QoL (SMD -0.10, 95% CI -0.17 to 0.03 and SMD -0.17, 95% CI -0.47 to 0.14, respectively; each reported in 1 study only). The 12-month follow-up effect of the intervention was very small for disability and QoL. The quality of evidence was rated as moderate for pain and physical function and low and very low for disability and QoL, respectively, using the GRADE approach. CONCLUSIONS Digital-based structured SMPs may result in improvement in pain and physical function that is largely sustained at the 12-month follow-up in people with knee and hip OA. The effects on disability and QoL are smaller and less clear. The quality of evidence is moderate to low, and further research is required to confirm the findings of the review and assess the effects of digital-based structured SMPs on other health-related outcomes.
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Affiliation(s)
- Reza Safari
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
| | - Jessica Jackson
- Health and Social Care Research Centre, University of Derby, Derby, United Kingdom
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Pool AC, Kraschnewski JL, Poger JM, Smyth J, Stuckey HL, Craig TJ, Lehman EB, Yang C, Sciamanna CN. Impact of online patient reminders to improve asthma care: A randomized controlled trial. PLoS One 2017; 12:e0170447. [PMID: 28158200 PMCID: PMC5291361 DOI: 10.1371/journal.pone.0170447] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/06/2017] [Indexed: 12/05/2022] Open
Abstract
Importance Asthma is one of the most burdensome chronic illnesses in the US. Despite widespread dissemination of evidence-based guidelines, more than half of the adults with asthma have uncontrolled symptoms. Objective To examine the efficacy of an online tool designed to improve asthma control. Design 12-month single blind randomized controlled trial of the online tool (Intervention condition, IC) versus an active control tool (CC). Setting Patients enrolled in an insurance plan. Participants Participants were 408 adults (21–60 years of age) with persistent asthma. Intervention At least once each month and before provider visits, participants in the IC answered questions online about their asthma symptoms, asthma medications and asthma care received from providers, such as an asthma management plan. The tool then provided tailored feedback to remind patients 1) to ask health care providers specific questions that may improve asthma control (e.g., additional controller medications) and 2) to consistently perform specific self-care behaviors (e.g., proper inhaler technique). Participants in the CC received similar questions and feedback, yet focused instead on preventive services unrelated to asthma control (e.g., cancer screening). Main outcome measures The main outcome measure was asthma control, as assessed by the 5-question Asthma Control Test (ACT). Secondary outcomes included quality of life, medication use and healthcare utilization (e.g., emergency department visits). Results After 12 months, 323 participants completed follow-up measures (79.2%). Participants in the IC reported a greater mean improvement in the ACT score than participants in the CC (2.3 vs. 1.2; p = 0.02) and 9 of 11 individual asthma control survey items showed non-significant improvements favoring the IC. No differences were observed in medication adherence, number of asthma controller medications or health care utilization. Conclusion and relevance Simple and brief online patient reminders improved asthma control among insured patients. Although future studies are needed to understand the mechanism of the improvement, the magnitude of the effect on asthma control was similar to the addition of an additional controller medication. Given the widespread use of the Internet, simple tools such as this may be useful for improving the control of other chronic diseases as well. Trial registration This study is registered at clinicaltrials.gov, NCT00921401, “Improving the Quality of Asthma Care Using the Internet”
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Affiliation(s)
- Andrew C. Pool
- Department of Public Health, Temple University College of Health Professions and Social Work Philadelphia, Pennsylvania, United States of America
- Center for Obesity Research and Education (CORE), Temple University School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Jennifer L. Kraschnewski
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Jennifer M. Poger
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Joshua Smyth
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania, United States of America
| | - Heather L. Stuckey
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Timothy J. Craig
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Pediatrics, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Erik B. Lehman
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Chengwu Yang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
| | - Christopher N. Sciamanna
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, United States of America
- * E-mail:
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Algeo N, Hunter D, Cahill A, Dickson C, Adams J. Usability of a digital self-management website for people with osteoarthritis: A UK patient and public involvement study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.2.78] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Naomi Algeo
- Occupational therapist, University College London Hospitals NHS Foundation Trust; research intern, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - David Hunter
- Florance and Cope Chair of Rheumatology, professor of medicine, Institute of Bone and Joint Research, University of Sydney, staff specialist, Royal North Shore Hospital, Australia
| | | | - Chris Dickson
- Project manager of myjointpain.org, Arthritis Australia, New South Wales, Australia
| | - Jo Adams
- Professor of musculoskeletal health, Faculty of Health Sciences, University of Southampton; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
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Informing the development of an Internet-based chronic pain self-management program. Int J Med Inform 2017; 97:109-119. [DOI: 10.1016/j.ijmedinf.2016.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 08/05/2016] [Accepted: 10/03/2016] [Indexed: 11/19/2022]
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Brooks MA, Beaulieu JE, Severson HH, Wille CM, Cooper D, Gau JM, Heiderscheit BC. Web-based therapeutic exercise resource center as a treatment for knee osteoarthritis: a prospective cohort pilot study. BMC Musculoskelet Disord 2014; 15:158. [PMID: 24884547 PMCID: PMC4030010 DOI: 10.1186/1471-2474-15-158] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 05/06/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although beneficial effects of exercise in the management of knee osteoarthritis (OA) have been established, only 14 -18% of patients with knee OA receive an exercise from their primary care provider. Patients with knee OA cite lack of physician exercise advice as a major reason why they do not exercise to improve their condition. The purpose of this pilot study was to investigate use of a web-based Therapeutic Exercise Resource Center (TERC) as a tool to prescribe strength, flexibility and aerobic exercise as part of knee OA treatment. It was hypothesized that significant change in clinical outcome scores would result from patients' use of the TERC. METHODS Sixty five individuals diagnosed with mild/moderate knee OA based on symptoms and radiographs were enrolled through outpatient physician clinics. Using exercise animations to facilitate proper technique, the TERC assigned and progressed patients through multiple levels of exercise intensity based on exercise history, co-morbidities and a validated measure of pain and function. Subjects completed a modified short form WOMAC (mSF-WOMAC), World Health Organization Quality of Life (WHO-QOL) and Knee Self-Efficacy Scale (K-SES) at baseline and completion of the 8 week program, and a user satisfaction survey. Outcomes were compared over time using paired t-tests and effect sizes calculated using partial point biserial (pr). RESULTS Fifty two participants completed the 8 week program with average duration of knee pain 8.0 ± 11.0 yrs (25 females; 61.0 ± 9.4 yrs; body mass index, 28.8 ± 6.3 kg/m2). During the study period, all outcome measures improved: mSF-WOMAC scores decreased (better pain and function) (p<.001; large effect, pr=0.70); WHO-QOL physical scores increased (p=.015; medium effect, pr=0.33); and K-SES scores increased (p<.001; large effect, pr=0.54). No significant differences were found in study outcomes as a function of gender, age, BMI or symptom duration. Patients reported very positive evaluation of the TERC (94% indicated the website was easy to use; 90% specified the exercise animations were especially helpful). CONCLUSION This pilot study demonstrated the web-based TERC to be feasible and efficacious in improving clinical outcomes for patients with mild/moderate knee OA and supports future studies to compare TERC to current standard of care, such as educational brochures.
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Affiliation(s)
- M Alison Brooks
- University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI 53705, USA
| | - John E Beaulieu
- Visual Health Information, Inc., 11003 A St. South, Tacoma, WA 98444, USA
| | | | - Christa M Wille
- University of Wisconsin-Madison, 4195 Medical Sciences Center, 1300 University Ave, Madison, WI 53706, USA
| | - David Cooper
- Visual Health Information, Inc., 11003 A St. South, Tacoma, WA 98444, USA
| | - Jeff M Gau
- Oregon Research Institute, 1776 Millrace Drive, Eugene, OR 97403, USA
| | - Bryan C Heiderscheit
- University of Wisconsin-Madison, 4120 Medical Sciences Center, 1300 University Ave, Madison, WI 53706, USA
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Pietrzak E, Cotea C, Pullman S, Nasveld P. Self-Management and Rehabilitation in Osteoarthritis: Is There a Place for Internet-Based Interventions? Telemed J E Health 2013; 19:800-5. [DOI: 10.1089/tmj.2012.0288] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Eva Pietrzak
- Centre for Military and Veterans' Health, Research Coordination Unit, The University of Queensland, Mayne Medical School, Herston, Queensland, Australia
| | - Cristina Cotea
- Centre for Military and Veterans' Health, Research Coordination Unit, The University of Queensland, Mayne Medical School, Herston, Queensland, Australia
| | - Steve Pullman
- Centre for Military and Veterans' Health, Research Coordination Unit, The University of Queensland, Mayne Medical School, Herston, Queensland, Australia
| | - Peter Nasveld
- Centre for Military and Veterans' Health, Research Coordination Unit, The University of Queensland, Mayne Medical School, Herston, Queensland, Australia
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Rejas J, Monfort J, Campillo MA, Ruiz MA, Pardo A, Soto J. Criterion Validity of the ARthritis Treatment Satisfaction (ARTS) Questionnaire. Clin Drug Investig 2009; 29:527-38. [DOI: 10.2165/00044011-200929080-00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Hartmann CW, Sciamanna CN, Blanch DC, Mui S, Lawless H, Manocchia M, Rosen RK, Pietropaoli A. A website to improve asthma care by suggesting patient questions for physicians: qualitative analysis of user experiences. J Med Internet Res 2007; 9:e3. [PMID: 17478412 PMCID: PMC1794671 DOI: 10.2196/jmir.9.1.e3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2006] [Revised: 12/12/2006] [Accepted: 12/12/2006] [Indexed: 11/29/2022] Open
Abstract
Background Asthma is one of the most prevalent chronic conditions in the United Sates, yet despite the existence of national guidelines, nearly three fourths of patients with asthma do not have adequate control and clinical adherence to guidelines is low. While there are many reasons for this, physician inertia with respect to treatment change is partly to blame. Research suggests that patients who ask for specific tests and treatments are more likely to receive them. Objectives This study investigated the impact and experience of using an interactive patient website designed to give patients individual feedback about their condition and to suggest tailored questions for patients to ask their physician. The website was designed to be used prior to a physician visit, to increase the likelihood that patients would receive recommended tests and treatments. Methods A total of 37 adult patients with asthma participated in semi-structured telephone interviews aimed at eliciting information about their experiences with the website. Transcripts were coded using qualitative data analysis techniques and software. Themes were developed from subsets of codes generated through the analysis. In addition, 26 physicians were surveyed regarding their impressions of the website. Results Opportunities exist for improving website feedback, although the majority of both patient and physician respondents held favorable opinions about the site. Two major themes emerged regarding patients’ experiences with the website. First, many patients who used the website had a positive shift in their attitudes regarding interactions with their physicians. Second, use of the website prompted patients to become more actively involved in their asthma care. No patient reported any negative experiences as a result of using the website. Physicians rated the website positively. Conclusions Patients perceived that the interactive website intervention improved communication and interaction with their physicians, suggesting that patients can play a role in overcoming the clinical inertia of providers. Although the design and content of the website can be improved upon, the main findings suggest that use of the website is well accepted and is perceived to improve the quality of care that patients receive.
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Affiliation(s)
- Christine W Hartmann
- Department of Health Policy, Jefferson Medical College, Philadelphia, PA 19107, USA.
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