title: Interactive Health Communication Applications for people with chronic disease. Maintenance of physical activity after Internet-based physical activity interventions in patients with rheumatoid arthritis. Principles of evidence-based medicine. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Predictors of exercise and effects of exercise on symptoms, function, aerobic fitness, and disease outcomes of rheumatoid arthritis. A randomized controlled trial of an online self-management program for adults with arthritis pain The 6-min walk test (6MW) as an efficacy endpoint in pulmonary arterial hypertension clinical trials: demonstration of a ceiling effect. The Effect of Social Support Features and Gamification on a Web-Based Intervention for Rheumatoid Arthritis Patients: Randomized Controlled Trial Using internet technology to deliver a home-based physical activity intervention for patients with rheumatoid arthritis: A randomized controlled trial. Exercise Maintenance of Persons with Arthritis after Participation in a Class Experience
abstract: BACKGROUND : Interactive Health Communication Applications ( IHCAs ) are computer-based , usually web-based health information packages for patients that combine information with at least one of social support , decision support , or behaviour change support . These are innovations in health care and their effects on health are uncertain . OBJECTIVES : To assess the effects of IHCAs for people with chronic disease . SEARCH STRATEGY : We design ed a four-part search strategy . First , we search ed electronic bibliographic data bases for published work ; second , we search ed the grey literature and third , we search ed for ongoing and recently completed clinical trials in the appropriate data bases . Finally , research ers of included studies were contacted , and reference lists from relevant primary and review articles were followed up . As IHCAs require relatively new technology , the search commenced at 1990 where possible . SELECTION CRITERIA : R and omised controlled trials ( RCTs ) of Interactive Health Communication Applications for adults and children with chronic disease . DATA COLLECTION AND ANALYSIS : One review er screened abstract s. Two review ers screened all c and i date studies to determine eligibility , apply quality criteria , and extract data from included studies . Authors of included RCTs were contacted for missing data . Results of RCTs were pooled using a r and om effects model and st and ardised mean differences ( SMDs ) were calculated to provide net effect sizes . MAIN RESULTS : We screened 24,757 unique citations and retrieved 958 papers for further assessment , yielding 28 RCTs involving 4042 participants . One of these had an inadequate method of concealment of allocation , and sensitivity analyses were performed to determine the effects of including or excluding these data in the meta-analyses . Results in the abstract are from the meta-analyses excluding data from this study .IHCAs were found to have a positive effect on knowledge ( SMD 0.49 ; 95 % confidence interval ( CI ) 0.14 to 0.84 ) and on social support ( SMD 0.47 ; 95 % CI 0.28 to 0.66 ) . IHCAs were found to have no effect on self-efficacy ( SMD 0.15 ; 95 % CI -0.13 to 0.43 ) or behavioural outcomes ( SMD -0.09 ; 95 % CI -0.49 to 0.32 ) . IHCAs had a negative effect on clinical outcomes ( SMD -0.32 ; 95 % CI -0.63 to -0.02 ) . REVIEW ERS ' CONCLUSIONS : The number and range of IHCAs is increasing rapidly ; however there is a shortage of high quality evaluative data . Consumers who wish to increase their knowledge or social support amongst people with a similar problem may find an IHCA helpful . However , consumers whose primary aim is to achieve optimal clinical outcomes should not use an IHCA at present . Further research is needed to determine the reason for this negative effect on clinical outcomes , whether an optimal IHCA can achieve behaviour change and improved health outcomes , and if so , what are the essential features of such an IHCA , and the extent to which they differ according to patient group or condition OBJECTIVES To investigate the maintenance of physical activity 12 months after two 1-year Internet-based physical activity interventions in patients with RA . METHODS This follow-up study was a r and omized comparison of an Internet-based individualized training ( IT ) and a general training ( GT ) programme in sedentary RA patients . Outcome measures included physical activity ( meeting public health recommendations for moderate physical activity , i.e. 30 min for at least 5 days/week ; or vigorous physical activity , i.e. 20 min for at least 3 days/week ) , functional ability and quality of life ( QoL ) . RESULTS Of the 152 RA patients who completed the initial study , 110 ( 72 % ) were available at follow-up . At 24 months , the proportions of patients meeting public health recommendations for moderate intensity physical activity were significantly higher compared with baseline in both the IT and GT groups ( 19 and 24 % , respectively , P < 0.05 ) , whereas the proportions of patients meeting the recommendation for vigorous activity was only significantly higher compared with baseline in the IT group ( P < 0.05 ) but not in the GT group . There were no differences between the IT and GT groups concerning proportions of patients meeting moderate or vigorous physical activity recommendations at 24 months . Apart from a significantly higher RAQoL score in the IT group at 24 months compared with baseline , there were no significant differences within or between the programmes regarding functional ability or QoL. CONCLUSION In RA patients , the effectiveness of both an individualized and a general 1-year Internet-based physical activity programme is sustained with respect to moderate intensity physical activity up to 12 months after the interventions Evidence -based medicine integrates clinical expertise , patients ' values and preferences , and the best available evidence from the medical literature . Evidence -based orthopedics is a model to assist surgeons to improve the process of asking questions , obtaining relevant information efficiently , and making informed decisions with patients . With an increasing appreciation for higher levels of evidence , orthopedic surgeons should move away from lower forms of evidence . The adoption of r and omized trials and high- quality prospect i ve studies to guide patient care requires 2 prerequisites : ( 1 ) greater appreciation for the conduct of r and omized trials in orthopedics and ( 2 ) improved education and training in evidence -based method ologies in surgery OBJECTIVE To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis ( PsA ) and to construct new criteria from observed data . METHODS Data were collected prospect ively from consecutive clinic attendees with PsA and other inflammatory arthropathies . Subjects were classified by each of 7 criteria . Sensitivity and specificity were compared using conditional logistic regression analysis . Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold st and ard definition of " case"-ness . Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria , which were then constructed using a receiver operating characteristic curve . RESULTS Data were collected on 588 cases and 536 controls with rheumatoid arthritis ( n = 384 ) , ankylosing spondylitis ( n = 72 ) , undifferentiated arthritis ( n = 38 ) , connective tissue disorders ( n = 14 ) , and other diseases ( n = 28 ) . The specificity of each set of criteria was high . The sensitivity of the Vasey and Espinoza method ( 0.97 ) was similar to that of the method of McGonagle et al ( 0.98 ) and greater than that of the methods of Bennett ( 0.44 ) , Moll and Wright ( 0.91 ) , the European Spondylarthropathy Study Group ( 0.74 ) , and Gladman et al ( 0.91 ) . The CASPAR ( ClASsification criteria for Psoriatic ARthritis ) criteria consisted of established inflammatory articular disease with at least 3 points from the following features : current psoriasis ( assigned a score of 2 ; all other features were assigned a score of 1 ) , a history of psoriasis ( unless current psoriasis was present ) , a family history of psoriasis ( unless current psoriasis was present or there was a history of psoriasis ) , dactylitis , juxtaarticular new bone formation , rheumatoid factor negativity , and nail dystrophy . These criteria were more specific ( 0.987 versus 0.960 ) but less sensitive ( 0.914 versus 0.972 ) than those of Vasey and Espinoza . CONCLUSION The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source 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 . METHODS R and omized 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 r and omized 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 . RESULTS 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 . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP OBJECTIVE To determine the effects of participation in a low-impact aerobic exercise program on fatigue , pain , and depression ; to examine whether intervention groups compared with a control group differed on functional ( grip strength and walk time ) and disease activity ( total joint count , erythrocyte sedimentation rate , and C-reactive protein ) measures and aerobic fitness at the end of the intervention ; and to test which factors predicted exercise participation . METHODS A convenience sample of 220 adults with rheumatoid arthritis ( RA ) , ages 40 - 70 , was r and omized to 1 of 3 groups : class exercise , home exercise using a videotape , and control group . Measures were obtained at baseline ( T1 ) , after 6 weeks of exercise ( T2 ) , and after 12 weeks of exercise ( T3 ) . RESULTS Using structural equation modeling , overall symptoms ( latent variable for pain , fatigue , and depression ) decreased significantly at T3 ( P < 0.04 ) for the class exercise group compared with the control group . There were significant interaction effects of time and group for the functional measures of walk time and grip strength : the treatment groups improved more than the control group ( P < or= 0.005 ) . There were no significant increases in measures of disease activity . Fatigue and perceptions of benefits and barriers to exercise affected participants ' amount of exercise , supporting previous research . CONCLUSION This study supported the positive effects of exercise on walk time and grip strength , and demonstrated that fatigue and perceived benefits /barriers to exercise influenced exercise participation . Furthermore , overall symptoms of fatigue , pain , and depression were positively influenced in this selective group of patients with RA ages 40 - 70 years 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 r and omized 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 BACKGROUND PAH trials traditionally use 6MW as the primary endpoint . Concerns regarding a " ceiling effect " masking efficacy have led to exclusion of patients with milder disease from most trials ( BL 6MW>450 m ) . STRIDE I evaluated the selective endothelin A receptor antagonist , sitaxsentan ( SITAX ) , in a 12-week r and omized , double-blind , trial ( 178 patients ) employing  placebo ( PBO )  , 100 mg or 300 mg SITAX orally once daily in PAH and included patients with NYHA class II , congenital heart disease and a BL 6MW>450 m , groups often excluded from previous trials . METHODS We analyzed 6MW effects For All Pts ( intention-to treat ) and those meeting Traditional enrollment criteria , defined as patients with NYHA class III or IV and 6MW < or = 450 m at BL with idiopathic PAH or PAH related to connective tissue disease . The 100 mg and 300 mg SITAX arms are pooled based on similar treatment effects on 6MW . CONCLUSION Existence of a " ceiling effect " is supported by these data . The magnitude of the treatment effect and statistical power when using 6MW as the endpoint . Comparisons between PAH trials that do not adjust for the effects of differing enrollment criteria require caution Background Rheumatoid arthritis ( RA ) is chronic systematic disease that affects people during the most productive period of their lives . Web-based health interventions have been effective in many studies ; however , there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients ’ behavioral and health outcomes . Objective The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity , health care utilization , medication overuse , empowerment , and RA knowledge of RA patients . The effect of gamification on website use was also investigated . Methods We conducted a 5-arm parallel r and omized controlled trial for RA patients in Ticino ( Italian-speaking part of Switzerl and ) . A total of 157 patients were recruited through brochures left with physicians and were r and omly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website . Data were collected at 3 time points through question naires at baseline , posttest 2 months later , and at follow-up after another 2 months . Primary outcomes were physical activity , health care utilization , and medication overuse ; secondary outcomes included empowerment and RA knowledge . All outcomes were self-reported . Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time . Results The best-fit multilevel models ( growth curve models ) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors . The growth curve analyses of experimental conditions were compared to the control group . Physical activity increased over time for patients having access to social support sections plus gaming ( unst and ardized beta coefficient [B]=3.39 , P=.02 ) . Health care utilization showed a significant decrease for patients accessing social support features ( B=–0.41 , P=.01 ) and patients accessing both social support features and gaming ( B=–0.33 , P=.03 ) . Patients who had access to either social support sections or the gaming experience of the website gained more empowerment ( B=2.59 , P=.03 ; B=2.29 , P=.05 ; respectively ) . Patients who were offered a gamified experience used the website more often than the ones without gaming ( t 91=–2.41 , P=.02 ; U=812 , P=.02 ) . Conclusions The Web-based intervention had a positive impact ( more desirable outcomes ) on intervention groups compared to the control group . Social support sections on the website decreased health care utilization and medication overuse and increased empowerment . Gamification alone or with social support  increased physical activity and empowerment and decreased health care utilization . This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 57366516 ; http://www.controlled-trials . com/IS RCT N57366516 ( Archived by webcite at http://www.webcitation.org/6PBvvAvvV ) OBJECTIVE To compare the effectiveness of 2 Internet-based physical activity interventions for patients with rheumatoid arthritis ( RA ) . METHODS A total of 160 physically inactive patients with RA who had a computer with Internet access were r and omly assigned to an Internet-based physical activity program with individual guidance , a bicycle ergometer , and group contacts ( individualized training [ IT ] group ; n = 82 ) or to an Internet-based program providing only general information on exercises and physical activity ( general training [ GT ] group ; n = 78 ) . Outcome measures included quantity of physical activity ( question naire and activity monitor ) , functional ability , quality of life , and disease activity ( baseline , 3 , 6 , 9 , and 12 months ) . RESULTS The proportion of physically active patients was significantly greater in the IT than in the GT group at 6 ( 38 % versus 22 % ) and 9 months ( 35 % versus 11 % ; both P < 0.05 ) regarding a moderate intensity level for 30 minutes in succession on at least 5 days a week , and at 6 ( 35 % versus 13 % ) , 9 ( 40 % versus 14 % ) , and 12 months ( 34 % versus 10 % ; all P < 0.005 ) regarding a vigorous intensity level for 20 minutes in succession on at least 3 days a week . In general , there were no statistically significant differences regarding changes in physical activity as measured with an activity monitor , functional ability , quality of life , or disease activity . CONCLUSION An Internet-based physical activity intervention with individually tailored supervision , exercise equipment , and group contacts is more effective with respect to the proportion of patients who report meeting physical activity recommendations than an Internet-based program without these additional elements in patients with RA . No differences were found regarding the total amount of physical activity measured with an activity monitor This study investigated factors related to an initial exercise experience to explain exercise maintenance in 120 adults with rheumatoid arthritis or osteoarthritis . Integral secondary analysis was used to incorporate data from a prospect i ve , controlled trial of exercise ( Minor et al. : Arthritis Rheum 32:1396 , 1989 ) with data collected at 18 months follow-up . The dependent variable was  self-directed exercise  ( min/wk ) reported at 3 , 9 , and 18 or more months after exercise class participation . Predictor variables included physical , psychosocial , disease , and programmatic factors . The all possible regressions search procedure result ed in three explanatory models ( p = .0001 ) . At 3 months the model ( R2 = .45 ) included initial aerobic capacity , depression , and anxiety ; and changes in depression and social activity . The 9-month model ( R 2 = .35 ) consisted of initial anxiety and physical activity , change in depression , support of friends for exercise , and exercise behavior at prior assessment . At 18 or more months ( R2 = .42 ) , model variables were initial aerobic capacity , change in pain , and exercise behavior at the two prior assessment s. Neither disease nor program factors appeared as significant . This limited study indicates that factors associated with  exercise behavior  in this sample are similar to those in the general population ; explanatory factors change over time , and changes ascribed to a trial behavior may influence subsequent decision making
target: There is very limited evidence for the effectiveness of IDIs on PA and HRQoL in RA and JIA and no evidence for their effectiveness in PsA or AS
background: The aim of this systematic review was to evaluate the evidence from r and omised controlled trials ( RCTs ) evaluating the effectiveness of interactive digital interventions ( IDIs ) for physical activity ( PA )  and  health related quality of life ( HRQoL )  in people with Inflammatory Arthritis [ rheumatoid arthritis ( RA ) , juvenile idiopathic arthritis ( JIA ) axial Spondyloarthritis ( AS ) and psoriatic arthritis ( PsA ) ] .