Journal of Behavioral Medicine

, Volume 38, Issue 3, pp 483–496 | Cite as

A randomized controlled trial of an online self-management program for adults with arthritis pain

  • Kimberlee J. Trudeau
  • Lynette A. Pujol
  • Pronabesh DasMahapatra
  • Raya Wall
  • Ryan A. Black
  • Kevin Zacharoff
Article

Abstract

The objective of this RCT was to assess the efficacy of an online pain self-management program with adults who had a self-reported doctor diagnosis of arthritis pain (N = 228). Participants were recruited via flyers and online postings then randomized to the experimental condition or the wait-list control condition. Individuals in the experimental condition reported significantly (1) increased arthritis self-efficacy and (2) reduced pain catastrophizing from baseline to follow up compared to those in the control condition. High user engagement (>204.5 min on the website) was also significantly associated with improved self-management outcomes. These findings suggest that use of an online self-management program may positively impact self-efficacy and catastrophizing among adults with arthritis pain at 6 month follow up. Nonsignificant findings for hypothesized variables such as pain intensity and health behaviors are also discussed. Future longitudinal research is needed to assess if cognitive changes associated with participation in an online self-management program leads to reduced pain.

Keywords

Arthritis Online Self-management Self-efficacy Pain catastrophizing 

References

  1. Allison, P.D. (2012). Handling missing data by maximum likelihood [Statistical Horizons SAS Global Forum]. http://www.statisticalhorizons.com/wpcontent/uploads/MissingDataByML.pdf. Accessed August 1, 2013
  2. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  3. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.CrossRefPubMedGoogle Scholar
  4. Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.Google Scholar
  5. Barsky, A. J., Ahern, D. K., Orav, E. J., Nestoriuc, Y., Liang, M. H., Berman, I. T., & Wilk, K. G. (2010). A randomized trial of three psychosocial treatments for the symptoms of rheumatoid arthritis. Seminars in Arthritis and Rheumatism, 40, 222–232. doi:10.1016/j.semarthrit.2010.04.001 CrossRefPubMedCentralPubMedGoogle Scholar
  6. Benka, J., Nagyova, I., Rosenberger, J., Calfova, A., Macejova, Z., Middel, B., & Groothoff, J. W. (2012). Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study. Disability and Rehabilitation, 34, 754–761. doi:10.3109/09638288.2011.619618 CrossRefPubMedGoogle Scholar
  7. Berman, R. L. H., Iris, M. A., Bode, R., & Drengenberg, C. (2009). The effectiveness of an online mind-body intervention for older adults with chronic pain. The Journal of Pain: Official Journal of the American Pain Society, 10, 68–79. doi:10.1016/j.jpain.2008.07.006 CrossRefGoogle Scholar
  8. Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. JAMA: The Journal of the American Medical Association, 288(19), 2469–2475. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12435261
  9. Bromberg, J., Wood, M. E., Black, R. A., Surette, D. A., Zacharoff, K. L., & Chiauzzi, E. J. (2011). A randomized trial of a web-based intervention to improve migraine self-management and coping. Headache, 42, 244–261. doi:10.1111/j.1526-4610.2011.02031.x Google Scholar
  10. Bruce, B., Lorig, K., & Laurent, D. (2007). Participation in patient self-management programs. Arthritis and Rheumatism, 57, 851–854. doi:10.1002/art.22776 CrossRefPubMedGoogle Scholar
  11. Burns, J. W., Kubilus, A., Bruehl, S., et al. (2003). Do changes in cognitive factors influence outcome following multidisciplinary treatment for chronic pain? A cross-lagged panel analysis. Journal of Consulting and Clinical Psychology, 71, 81–91.CrossRefPubMedGoogle Scholar
  12. Chiauzzi, E., Pujol, L. A., Wood, M., Bond, K., Black, R., Yiu, E., & Zacharoff, K. (2010). painACTION-Back Pain: A self-management website for people with chronic back pain. Pain Medicine, 11(7), 1044–1058.Google Scholar
  13. Cleeland, C. S., & Ryan, K. M. (1994). Pain assessment: global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore, 23(2), 129–138. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/8080219
  14. Corporation, Vovici. (2012). Vovici 6. Herndon, VA: Vovici Corporation.Google Scholar
  15. Crawford, J. R., & Henry, J. D. (2003). The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample. The British Journal of Clinical Psychology/the British Psychological Society, 42, 111–131. doi:10.1348/014466503321903544 CrossRefPubMedGoogle Scholar
  16. D’Eon, J. L., Harris, C. A., & Ellis, J. A. (2004). Testing factorial validity and gender invariance of the pain catastrophizing scale. Journal of Behavioral Medicine, 27(4), 361–372. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15559733
  17. DasMahapatra, P., Bromberg, J., Black, R., Venuti, S., & Zacharoff, K. (2013). Self-management website for people with chronic neuropathic pain: Findings from a randomized controlled trial. Newton, MA: Unpublished manuscript, Inflexxion, Inc.Google Scholar
  18. DasMahapatra, P., Chiauzzi, E., Pujol, L. M., Los, C., & Trudeau, K. J. (2014). Mediators and moderators of chronic pain outcomes in an online self-management program. Clinical Journal of Pain. doi:10.1097/AJP.0000000000000125 Google Scholar
  19. Dixon, K. E., Keefe, F. J., Scipio, C. D., Perri, L. M., & Abernethy, A. P. (2007). Psychological interventions for arthritis pain management in adults: A meta-analysis. Health Psychology, 26, 241–250.CrossRefPubMedGoogle Scholar
  20. Edwards, R. R., Bingham, C. O., Bathon, J., & Haythornthwaite, J. A. (2006). Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis and Rheumatism, 55, 325–332. doi:10.1002/art.21865 CrossRefPubMedGoogle Scholar
  21. Edwards, R. R., Giles, J., Bingham, C. O., Campbell, C., Haythornthwaite, J. A., & Bathon, J. (2010). Moderators of the negative effects of catastrophizing in arthritis. Pain Medicine (Malden, Mass.), 11(4), 591–599. doi:10.1111/j.1526-4637.2010.00804.x
  22. Farrar, J. T., Young, J. P., LaMoreaux, L., Werth, J. L., & Poole, R. M. (2001). Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain, 94(2), 149–158. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11690728
  23. Fox, S. (2007). Online health search 2006. Retrieved March 22, 2007, from http://www.pewinternet.org/pdfs/PIP_Online_Health_2006.pdf
  24. Gloster, A. T., Rhoades, H. M., Novy, D., Klotsche, J., Senior, A., Kunik, M., & Stanley, M. A. (2008). Psychometric properties of the Depression Anxiety and Stress Scale-21 in older primary care patients. Journal of Affective Disorders, 110, 248–259. doi:10.1016/j.jad.2008.01.023 CrossRefPubMedCentralPubMedGoogle Scholar
  25. Guillemin, F., Challier, B., Urlacher, F., Vançon, G., & Pourel, J. (1999). Quality of life in ankylosing spondylitis: validation of the ankylosing spondylitis Arthritis Impact Measurement Scales 2, a modified Arthritis Impact Measurement Scales Questionnaire. Arthritis Care and Research: The Official Journal of the Arthritis Health Professions Association, 12(3), 157–162. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10513505
  26. Guy, W. (1976). ECDEU assessment manual for psychopharmacology. Rockville, MD: U.S. Department of Health, Education, and Welfare.Google Scholar
  27. Jensen, M. P., Neilson, W. R., & Kerns, R. D. (2003). Toward the development of a motivational model of pain self-management. The Journal of Pain, 4, 477–492.CrossRefPubMedGoogle Scholar
  28. Jensen, M. P., Turner, J. A., Romano, J. M., & Strom, S. E. (1995). The Chronic Pain Coping Inventory: development and preliminary validation. Pain, 60(2), 203–216. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7784106
  29. Keller, S., Bann, C. M., Dodd, S. L., Schein, J., Mendoza, T. R., & Cleeland, C. S. (2004). Validity of the brief pain inventory for use in documenting the outcomes of patients with noncancer pain. The Clinical Journal of Pain, 20(5), 309–318. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15322437
  30. Kernan, W. N., Viscoli, C. M., Makuch, R. W., Brass, L. M., & Horwitz, R. I. (1999). Stratified randomization for clinical trials. Journal of Clinical Epidemiology, 52(1), 19–26. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9973070
  31. Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R., & Wolfe, F. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II. Arthritis and Rheumatism, 58, 26–35. doi:10.1002/art.23176 CrossRefPubMedCentralPubMedGoogle Scholar
  32. Lorig, K., Chastain, R. L., Ung, E., Shoor, S., & Holman, H. R. (1989). Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis and Rheumatism, 32(1), 37–44. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2912463
  33. Lorig, K., Laurent, D. D., Plant, K., Krishnan, E., & Ritter, P. L. (2014). The components of action planning and their associations with behavior and health outcomes. Chronic Illness, 10, 50–59. doi:10.1177/1742395313495572 CrossRefPubMedGoogle Scholar
  34. Lorig, K. R., Ritter, P. L., Laurent, D. D., & Plant, K. (2008). The internet-based arthritis self-management program: A one-year randomized trial for patients with arthritis or fibromyalgia. Arthritis and Rheumatism, 59, 1009–1017. doi:10.1002/art.23817 CrossRefPubMedGoogle Scholar
  35. Lorig, K., Ritter, P. L., & Plant, K. (2005). A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Arthritis and Rheumatism, 53, 950–957. doi:10.1002/art.21604 CrossRefPubMedGoogle Scholar
  36. Lorig, K. R., Ritter, P., Stewart, A. L., Sobel, D. S., Brown, B. W., Bandura, A., et al. (2001). Chronic disease self-management program: 2-year health status and health care utilization outcomes. Medical Care, 39(11), 1217–1223. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11606875
  37. Lorig, K., Stewart, A., Ritter, P., Gonzalez, V., Laurent, D., & Lynch, J. (1996). Outcome measures for health education and other health care interventions. Thousand Oaks, CA: SAG Publications, Inc. Retrieved from http://www.sagepub.com/books/Book5623
  38. Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress Scales (2nd ed.). Sydney: Psychology Foundation.Google Scholar
  39. Macea, D. D., Gajos, K., & Daglia, A. (2010). The efficacy of web-based cognitive behavioral interventions for chronic pain: A systematic review and meta-analysis. The Journal of Pain, 11, 917–929. doi:10.1016/j.jpain.2010.06.005 CrossRefPubMedGoogle Scholar
  40. Marks, R. (2001). Efficacy theory and its utility in arthritis rehabilitation: Review and recommendations. Disability and Rehabilitation, 23(7), 271–280. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11354579
  41. Marks, R., Allegrante, J. P., & Lorig, K. (2005). A review and synthesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: Implications for health education practice (Part I). Health Promotions Practice, 6, 37–43.CrossRefGoogle Scholar
  42. McCaffery, M., & Beebe, A. (1993). Pain: Clinical manual for nursing practice. Baltimore, MD: V. V. Mosby Company.Google Scholar
  43. McCracken, L. M., & Turk, D. C. (2002). Behavioral and cognitive-behavioral treatment for chronic pain: Outcome, predictors of outcome, and treatment process. Spine, 27, 2564–2573.CrossRefPubMedGoogle Scholar
  44. Mendoza, T., Mayne, T., Rublee, D., & Cleeland, C. (2006). Reliability and validity of a modified Brief Pain Inventory short form in patients with osteoarthritis. European Journal of Pain (London, England), 10, 353–361. doi:10.1016/j.ejpain.2005.06.002 CrossRefGoogle Scholar
  45. Molton, I. R., Graham, C., Stoelb, B. L., & Jensen, M. P. (2007). Current psychological approaches to the management of chronic pain. Current Opinion in Anaesthesiology, 20, 485–489. doi:10.1097/ACO.0b013e3282ef6b40 CrossRefPubMedGoogle Scholar
  46. Murray, E., Burns, J., See Tai, S., Lai, R., & Nazareth, I. (2005). Interactive Health Communication Applications for people with chronic disease (Review). Cochrane Database of Systematic Reviews, (4, Art. No.: CD004274). doi:10.1002/14651858.CD004274.pub4
  47. Newman, S., Steed, L., & Mulligan, K. (2004). Self-management interventions for chronic illness. Lancet, 364, 1523–1537. doi:10.1016/S0140-6736(04)17277-2 CrossRefPubMedGoogle Scholar
  48. Nicassio, P. M., Kay, M. A., Custodio, M. K., Irwin, M. R., Olmstead, R., & Weisman, M. H. (2011). An evaluation of a biopsychosocial framework for health-related quality of life and disability in rheumatoid arthritis. Journal of Psychosomatic Research, 71, 79–85. doi:10.1016/j.jpsychores.2011.01.008 CrossRefPubMedCentralPubMedGoogle Scholar
  49. Osman, A., Barrios, F. X., Gutierrez, P. M., Kopper, B. A., Merrifield, T., & Grittmann, L. (2000). The Pain Catastrophizing Scale: further psychometric evaluation with adult samples. Journal of Behavioral Medicine, 23(4), 351–365. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10984864
  50. Ren, X. S., Kazis, L., & Meenan, R. F. (1999). Short-form Arthritis Impact Measurement Scales 2: Tests of reliability and validity among patients with osteoarthritis. Arthritis Care and Research: The Official Journal of the Arthritis Health Professions Association, 12(3), 163–171. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10513506
  51. Romano, J. M., Jensen, M. P., & Turner, J. A. (2003). The chronic pain coping inventory-42: Reliability and validity. Pain, 104, 65–73. doi:10.1016/S0304-3959(02)00466-9 CrossRefPubMedGoogle Scholar
  52. SAS Institute. (2011). Sas 9.3 System Options: Reference (p. 336). SAS Institute. Retrieved from http://books.google.com/books?id=x2mkj8YTYa0C&pgis=1
  53. Schabenberger, O. (2005). Introducing the GLIMMIX procedure for generalized linear mixed models. In Proceedings of the thirtieth annual SAS users group international conference. Cary, NC: SAS Institute Inc.Google Scholar
  54. Simpson, C., Franks, C., Morrison, C., & Lempp, H. (2005). The patient’s journey: Rheumatoid arthritis. BMJ (Clinical Research Ed.), 331, 887–889. doi:10.1136/bmj.331.7521.887 Google Scholar
  55. Smeets, R. J. E. M., Vlaeyen, J. W. S., Kester, A. D. M., & Knottnerus, J. A. (2006). Reduction of pain catastrophizing mediates the outcome of both physical and cognitive-behavioral treatment in chronic low back pain. The Journal of Pain : Official Journal of the American Pain Society, 7, 261–271. doi:10.1016/j.jpain.2005.10.011 CrossRefGoogle Scholar
  56. Smith, B. W., & Zautra, A. J. (2008). Vulnerability and resilience in women with arthritis: Test of a two-factor model. Journal of Consulting and Clinical Psychology, 76, 799–810. doi:10.1037/0022-006X.76.5.799 CrossRefPubMedGoogle Scholar
  57. Somers, T. J., Keefe, F. J., Godiwala, N., & Hoyler, G. H. (2009). Psychosocial factors and the pain experience of osteoarthritis patients: New findings and new directions. Current Opinion in Rheumatology, 21, 501–506. doi:10.1097/BOR.0b013e32832ed704 CrossRefPubMedGoogle Scholar
  58. Stinson, J. N., McGrath, P. J., Hodnett, E. D., Feldman, B. M., Duffy, C. M., Huber, L. B., & White, M. E. (2010). An internet-based self-management program with telephone support for adolescents with arthritis: A pilot randomized controlled trial. Journal of Rheumatology, 37, 1944–1952.CrossRefPubMedGoogle Scholar
  59. Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and Validation. Psychological Assessment, 7(4), 524–32. Retrieved from http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ523917&ERICExtSearch_SearchType_0=no&accno=EJ523917
  60. Ten Klooster, P. M., Veehof, M. M., Taal, E., van Riel, P. L. C. M., & van de Laar, M. A. F. J. (2008). Confirmatory factor analysis of the arthritis impact measurement scales 2 short form in patients with rheumatoid arthritis. Arthritis and Rheumatism, 59, 692–698. doi:10.1002/art.23569 CrossRefPubMedGoogle Scholar
  61. Trudeau, K. J., Ainscough, J. L., Pujol, L. A., & Charity, S. (2010). What arthritis pain practitioners and patients want in an online self-management programme. Musculoskeletal Care, 8, 189–196.CrossRefPubMedCentralPubMedGoogle Scholar
  62. Turner, J. A., Holtzman, S., & Mancl, L. (2007). Mediators, moderators, and predictors of therapeutic change in cognitive-behavioral therapy for chronic pain. Pain, 127, 276–286.CrossRefPubMedGoogle Scholar
  63. Vriezekolk, J. E., van Lankveld, W. G. J. M., Geenen, R., & van den Ende, C. H. M. (2011). Longitudinal association between coping and psychological distress in rheumatoid arthritis: A systematic review. Annals of the Rheumatic Diseases, 70, 1243–1250. doi:10.1136/ard.2010.143271 CrossRefPubMedGoogle Scholar
  64. Westfall, P. H., Tobias, R. R. D., & Wolfinger, R. D. (2011). Multiple comparisons and multiple tests using SAS (2nd ed., p. 625). Cary, NC: SAS Institute. Retrieved from http://books.google.com/books/about/Multiple_comparisons_and_multiple_tests.html?id=pnWf5pWYjSEC&pgis=1
  65. Williams, A., Eccleston, C., & Morley, S. (2012). Psychological therapies for the management of chronic pain (excluding headache) in adults (Review). Cochrane Database Systematic Reviews, 11, CD007407.Google Scholar
  66. Zautra, A. J., Fasman, R., Parish, B. P., & Davis, M. C. (2007). Daily fatigue in women with osteoarthritis, rheumatoid arthritis, and fibromyalgia. Pain, 128, 128–135. doi:10.1016/j.pain.2006.09.004 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Kimberlee J. Trudeau
    • 1
  • Lynette A. Pujol
    • 2
  • Pronabesh DasMahapatra
    • 1
  • Raya Wall
    • 1
  • Ryan A. Black
    • 1
  • Kevin Zacharoff
    • 1
  1. 1.Inflexxion, Inc.NewtonUSA
  2. 2.University of Texas Health Science CenterSan AntonioUSA

Personalised recommendations