Lorig Kate R, Ritter Philip L, Laurent Diana D, Plant Kathryn
Stanford University School of Medicine, Stanford, California, USA.
Arthritis Rheum. 2008 Jul 15;59(7):1009-17. doi: 10.1002/art.23817.
To determine the efficacy of an Internet-based Arthritis Self-Management Program (ASMP) as a resource for arthritis patients unable or unwilling to attend small-group ASMPs, which have proven effective in changing health-related behaviors and improving health status measures.
Randomized intervention participants were compared with usual care controls at 6 months and 1 year using repeated-measures analyses of variance. Patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia and Internet and e-mail access (n = 855) were randomized to an intervention (n = 433) or usual care control (n = 422) group. Measures included 6 health status variables (pain, fatigue, activity limitation, health distress, disability, and self-reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 5 utilization variables (physician visits, emergency room visits, chiropractic visits, physical therapist visits, and nights in hospital), and self-efficacy.
At 1 year, the intervention group significantly improved in 4 of 6 health status measures and self-efficacy. No significant differences in health behaviors or health care utilization were found.
The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP.
确定基于互联网的关节炎自我管理项目(ASMP)对于无法或不愿参加已被证明能有效改变健康相关行为及改善健康状况指标的小组ASMP的关节炎患者的有效性。
采用重复测量方差分析,在6个月和1年时将随机干预参与者与常规护理对照组进行比较。患有类风湿性关节炎、骨关节炎或纤维肌痛且能使用互联网和电子邮件的患者(n = 855)被随机分为干预组(n = 433)或常规护理对照组(n = 422)。测量指标包括6个健康状况变量(疼痛、疲劳、活动受限、健康困扰、残疾和自我报告的总体健康状况)、4种健康行为(有氧运动、伸展和强化运动、压力管理实践以及与医生沟通)、5个利用变量(看医生次数、急诊室就诊次数、脊椎按摩治疗次数、物理治疗次数以及住院天数)和自我效能感。
1年后,干预组在6项健康状况指标中的4项以及自我效能感方面有显著改善。在健康行为或医疗保健利用方面未发现显著差异。
基于互联网的ASMP在1年时被证明能有效改善健康状况指标,是小组ASMP的可行替代方案。