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Interactive sections of an internet-based intervention increase empowerment of chronic back pain patients: randomized controlled trial
Riva S, Camerini A-L, Allam A, Schulz PJ
Journal of Medical Internet Research 2014 Aug;16(8):e180
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: Yes; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: No. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective. OBJECTIVE: This study aims to assess the impact of interactive sections of an internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes. METHODS: A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden. RESULTS: All patients completed the study. Overall, the intervention had a moderate effect (F[1,52] = 2.83, p = 0.03, eta2 = 0.30, d = 0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment mean difference +1.2, p = 0.03, d = 0.63; final assessment mean difference +0.8, p = 0.09, d = 0.44) and reduced medication misuse (midterm assessment mean difference -1.5, p = 0.04, d = 0.28; final assessment mean difference -1.6, p = 0.03, d = -0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups. CONCLUSIONS: Results suggest that interactive sections as part of internet-based interventions can positively alter patients' feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed. TRIAL REGISTRATION: ClinicalTrials.gov NCT02114788.

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