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Internet-based chronic disease self-management: a randomized trial
Lorig KR, Ritter PL, Laurent DD, Plant K
Medical Care 2006 Nov;44(11):964-971
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: The small-group chronic disease self-management program (CDSMP) has proven effective in changing health-related behaviors and improving health statuses. An internet-based CDSMP was developed to reach additional chronic-disease patients. OBJECTIVES: We sought to determine the efficacy of the internet-based CDSMP. DESIGN: We compared randomized intervention participants with usual-care controls at 1 year. We compared intervention participants with the small-group CDSMP at 1 year. SUBJECTS: Nine-hundred fifty-eight patients with chronic diseases (heart, lung, or type 2 diabetes) and internet and e-mail access were randomized to intervention (457) or usual care control (501). MEASURES: Measures included 7 health status variables (pain, shortness of breath, fatigue, illness intrusiveness, 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), 3 utilization variables (physician visits, emergency room visits, and nights in hospital), and self-efficacy. RESULTS: At 1 year, the intervention group had significant improvements in health statuses compared with usual care control patients. The intervention group had similar results to the small-group CDSMP participants. Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year. CONCLUSIONS: The internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program.

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