RAHelp.org: An online intervention for rheumatoid arthritis

Shigaki, C.L.,1 Smarr, K.,2,3 Siva, C.,3 Ge, B.,4 Musser, D.,5 Johnson, R.6

1Dept. Health Psychology, 2Harry S. Truman VAH, 3School of Medicine, 4Dept Biostatistics, 5Dept Engineering, 6School of Nursing

RAHelp.org appears to be beneficial in terms of self-efficacy and quality of life among individuals with RA who are willing to use an online service format.

The Department of Health PsychologyUniversity of Missouri School of Health Professions

Group differences with moderate to large effect sizes were found immediately post-intervention for social interactions (AIMS-2 Social; p=.02), self-efficacy (ASES; p=.00002), loneliness (LS-3; p=.02) and quality of life (QOLS; p=.003).At 9 months post-intervention differences in self-efficacy (ASES; p=.000007) and quality of life (QOLS; p=.004) remained significant. The difference between groups on social interaction approached significance, but the difference in loneliness was no longer significant. (Figures show data for participants with data at all 3 time points).

Funding acknowledgement: This research was supported by a grant from the National Institute on Disability and Rehabilitation Research (NIDRR) of the Department of Education under grant #H133B031120. Support and facilities were also provided by the Harry S. Truman Memorial VA Hospital. The opinions presented are those of the grantee and do not necessarily reflect those of the Department of Education or the Department of Veterans’ Affairs

Rheumatoid arthritis (RA) is a chronic autoimmune condition characterized by pain, swelling, and redness of the joints. The progression of the disease may lead to significant joint destruction, deformity, and disability.1 Approximately 1.3 million American adults have RA and there is no known cure.2 Pharmacologic approaches can sometimes significantly reduce pain and disability from the disease, but nonsteroidal anti-inflammatory drugs and anti-rheumatic drugs can produce several side effects that may become problematic for patients.3 Several studies have shown psychological and psychosocial interventions to be effective insofar as improved pain, functioning, psychological status, coping, and self-efficacy.4 Self-management interventions that improve self-efficacy are particularly important for RA patients. High self-efficacy in persons with RA is associated with better health outcomes as well as lower care costs.5-7 The Internet may present new opportunities for delivering effective self-management programs and evidence suggests that Internet-based interventions would be used and valued by RA patients.8,9

Objective: To test an intervention for improving self-management in rheumatoid arthritis (RA) using an online, cognitive-behavioral, self-management group program (RAHelp.org).

Background

Design: Two-group, randomized trial; treatment vs. waiting-list control group.Setting: RAHelp.org is a secure website that provides 10 educational modules for improving self-efficacy in self-management of RA, plus personal tools (journal, to do list), group interaction (discussion board, chat, messaging) and psychoeducational resources (library).11

Participants: Nation-wide convenience sample of adults recruited primarily through online advertisements. Mean RA duration was 8.5 years. No significant differences between groups on demographic or health variables at baseline (NT=54, NC=52).Analyses: Non-parametric methods were used due to non-normal distributions of outcome data (Wilcoxon rank sum test & nonparametric analysis of covariance)

Methods

Arthritis Impact Measurement Scales-2 (AIMS-2) Affective, Physical, Role, Social, and Symptoms components

Arthritis Self-Efficacy Scale (ASES) Center for Epidemiologic Studies – Depression Scale (CES-D) Quality of Life Scale (QOLS) Rapid Assessment of Disease Activity in Rheumatology (RADAR) Social Provisions Scale (SPS) UCLA Loneliness Scale-3 (LS-3)

Main outcome measures12-17

Conclusions

Table 1: Participant characteristics RAHelp.org Waiting-list

control group

Age 50.3 (11.6) 49.3 (12.3)Gender Female Male

 50 (93%)4 (7%)

 48 (92%)

4 (8%)Ethnicity White Non-white

 50 (93%)4 (7%)

 50 (96%)3* (6%)

Education Graduate school At least some college High school diploma

 16 (30%)28 (53%) 9 (17%)

 14 (27%)33 (65%)

4 (8%)

Marital status Married Divorced, separated Widowed Single Other

 33 (61%)12 (22%)3 (6%)3 (6%)3 (6%)

 34 (65%)9 (17%)3 (6%)

5 (10%)1 (2%)

Employment status Employed full-time Employed part-time Retired /disabled /unempl.

 27 (51%)6 (11%)

20 (38%)

 28 (54%)8 (15%)

16 (31%)

Results

ASES-T ASES-C0

10

20

30

40

50

60

70

80

90PrePost9 mos

N=45N=43

Social T Social C3.2

3.4

3.6

3.8

4

4.2

4.4

PrePost9 mos

N=43 N=45

QOLS T QOLS C79

80

81

82

83

84

85

86

87

88

89

PrePost9 mos

N=45N=43

LS-3 T LS-3 C33

34

35

36

37

38

39

40

41

PrePost9 mos

N=45N=43