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Evaluating an online self-management program for patients with RA: an explorative RCT.

Zuidema, R.M., Gaal, B.G.I. van, Dulmen, S. van, Repping-Wuts, H., Nijhuis-van der Sanden M.W.G. Evaluating an online self-management program for patients with RA: an explorative RCT. Journal of Advanced Nursing: 2016, 72(suppl. 1) 82. Abstract. 5th European Nursing Congress: 'Caring for older people: how can we do the right things right?' 4-7 oktober 2016, Rotterdam.
Background
Rheumatoid arthritis (RA) is a chronic autoimmune disease, which redominantly affects the joints. Many RA patients face physical problems such as pain, stiffness, and fatigue which cause difficulties in everyday life.1 Every day RA patients have to make many decisions about managing their disease. An online self-management program has been developed to support these patients and has been evaluated. To do this we dentified outcomes and process measures that were relevant to the program objectives. We also conducted qualitative interviews with nurses, users, and nonusers of the program. Materials and methods: Mixed methods were used, alongside an exploratory RCT, qualitative interviews were performed in 2 hospitals in the Netherlands. 190 eligible RA patients were included and randomized to the intervention or control group. The control group received care as usual; the intervention group got access to the online program in addition to receiving care as usual.
The online program was a theory based ehealth self-management support program consisting of nine health related problem modules. We developed the program with RA-patients and healthcare professionals according the six intervention mapping steps. The content of the modules is tailored to the user’s self-efficacy, and patients can use the online program as often as they want, working through a module or modules at their own speed.

Objective
This feasibility study aims to evaluate the potential effectiveness of the online program
and determine effect sizes for the various outcomes:
1) the Patient Activation Measurement;
2) the health-related quality of life survey;
3) the Rheumatoid Arthritis Self-Efficacy scale;
4) the Perceived Efficacy in Patient-Physician Interactions;
5) the short version of the selfmanagement ability scale;
6) A scale to assess the focus on fatigue;
7) the pain and fatigue Numeric Rating Scales.
All instruments will be administered at baseline (T0) and after 6 (T1) and 12 months (T2). In the process evaluation we used the framework of Saunders et al.2 to evaluate feasibility of the online program. Parallel to the RCT interviews were held with patients and nurses.

Results
The inclusion of RA patients started in January 2015 and the follow-up will last until June 2016. At this moment an amount of 76 patients are using the online program.

Conclusion
This study will provide insight into the potential effectiveness of the online program for RA patients.
1 Krishnan E, Fries J. Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998:a longitudinal study of 3035 patients. Am J Med. 2003 Oct 1;115 (5):371–376.
2 Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot 2005 Apr;6 (2):134–47.