Het ontwikkelen en testen van een online ondersteuningsprogramma voor Reumatoide Artritis patiënten

Rationale: Rheumatoid Arthritis (RA) is a chronic inflammatory and systemic disease, which predominantly affects the joints. RA occurs in 0.5-1.0% of the adult population worldwide and two to four times more in women than in men. In the Netherlands approximately 150.000 people suffer from RA, making it the most common inflammatory joint disease. Because of
the large impact of RA on health status and healthcare expenditures, there is a growing interest in self-management for RA patients. However, while traditional delivery of selfmanagement support is effective overall, several problems in the development of e-delivered programs have led to variations in their effectiveness.

Objective: 1) To evaluate the potential effectiveness and effect size of the e-health selfmanagement support program for patients with RA. 2) To identify outcome measures most likely to capture potential patient benefit. 3) To evaluate continued participation or dropping out of the e-health intervention.

Study design: The intervention will be tested in an early randomized controlled trial with a six and twelve month follow-up from baseline.

Study population: Patients with RA and their healthcare professionals at the outpatient clinic of two hospitals in the Netherlands.

Intervention: On top of usual care the treatment group will receive a e-health selfmanagement program. The intervention consists of nine modules and strategies to support the behavioural change and behavioural maintenance of self-management behaviour.

Outcome: We will measure self-management behaviour (PAM-13), quality of life (RAND-36),
self-management skills (SMAS-S), coping with fatigue (using MPCIF),
Self-Efficacy (PEPPI-5 and RASE), pain and fatigue (NRS)

The aim of the pilot trial is to:

1. evaluate the potential effectiveness and effect size of the online self-management program for Rheumatoid Arthritis patients

2. to identify outcome measures most likely to capture potential patient benefit;

3. to evaluate continued participation or dropping out of the online self-management program.

Baseline data collection will start in December 2014. Repeated measures will be executed at six months and 12 months when the intervention is finished, again by filling out the questionnaire. The estimated time to fill out the questionnaire is 30 to 45 minutes.

All participants in the study receive usual care containing regular visits to a rheumatologist
and a specialized nurse from whom they receive medical treatment, advice and information
about their disease and socio-psychological aspects. RA patients receive this care in a
structural way.



In addition to the care as usual, participants in the treatment group will receive the e-health
intervention. The intervention consists of nine modules:1) Finding balance between rest and
activity, 2) Setting boundaries, 3) Communication with professionals, 4) Coping with assistive
devices and home and household products, 5) Medication intake, 6) Coping with worries, 7)
Coping with RA, and 8) Coping with social support, 9) Performing physical activities.
Strategies to support the behavioural change and behavioural maintenance of selfmanagement
behaviour are: 1) providing information to increase patients’ knowledge, 2)
creating awareness by making assignments, 3) persuasive communication to change the
attitude of patients, 4) modelling through video’s and texts to increase patients’ self-efficacy,
5) social comparison through video’s and texts to increase patients’ self-efficacy, 6)
reinterpreting emotional and somatic state by texts to increase self-efficacy, 7) feedback and
planning coping response by text messages to maintain changed behaviour and 8) selfevaluation
through past temporal comparisons to maintain changed behaviour.