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

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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.

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  • Allison, P.D. (2012). Handling missing data by maximum likelihood [Statistical Horizons SAS Global Forum]. Accessed August 1, 2013

  • 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.

    Article  Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.

    Article  CAS  PubMed  Google Scholar 

  • Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.

    Google Scholar 

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

  • 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 

  • Bruce, B., Lorig, K., & Laurent, D. (2007). Participation in patient self-management programs. Arthritis and Rheumatism, 57, 851–854. doi:10.1002/art.22776

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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.

  • 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

  • Corporation, Vovici. (2012). Vovici 6. Herndon, VA: Vovici Corporation.

    Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

  • 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 

  • 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 

  • 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.

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

  • 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

  • Fox, S. (2007). Online health search 2006. Retrieved March 22, 2007, from

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • 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

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology. Rockville, MD: U.S. Department of Health, Education, and Welfare.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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

  • 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

  • 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

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • 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

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

  • 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

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress Scales (2nd ed.). Sydney: Psychology Foundation.

    Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Marks, R. (2001). Efficacy theory and its utility in arthritis rehabilitation: Review and recommendations. Disability and Rehabilitation, 23(7), 271–280. Retrieved from

  • 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.

    Article  Google Scholar 

  • McCaffery, M., & Beebe, A. (1993). Pain: Clinical manual for nursing practice. Baltimore, MD: V. V. Mosby Company.

    Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • 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

  • 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

  • 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

    Article  PubMed  Google Scholar 

  • SAS Institute. (2011). Sas 9.3 System Options: Reference (p. 336). SAS Institute. Retrieved from

  • 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.

  • 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 

  • 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

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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

  • 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

    Article  PubMed  Google Scholar 

  • 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.

    Article  PubMed Central  PubMed  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

  • 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 

  • 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

    Article  PubMed  Google Scholar 

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The authors would like to thank the following individuals for their contributions to this project: Ted Fields, Suzanne Gauthier, Penney Cowan, Mila Pavek, Emil Chiauzzi, Jonas Bromberg, Synne Wing Venuti, Evelyn Corsini, and Pedro Teixeira. Thanks also to the reviewers who provided input on previous drafts. This work was supported by a grant from the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (5R44AR061191-03). The funders had no part in designing the study, the collection of data and its analysis, or in the decision to complete or write this manuscript.

Conflict of Interest

Kimberlee J. Trudeau and Kevin Zacharoff are current employees of Inflexxion, Inc., Newton, MA. Raya Wall, Ryan A. Black, and Pronabesh DasMahapatra were employees of Inflexxion, Inc., Newton, MA at the time this study was conducted. Lynette A. Pujol has no conflicts to report.

Human and Animal Rights and Informed Consent

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all patients for being included in the study.

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Correspondence to Kimberlee J. Trudeau.

Additional information Identifier: NCT01463189.

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Trudeau, K.J., Pujol, L.A., DasMahapatra, P. et al. A randomized controlled trial of an online self-management program for adults with arthritis pain. J Behav Med 38, 483–496 (2015).

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