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A tailored-guided internet-based cognitive-behavioral intervention for patients with rheumatoid arthritis as an adjunct to standard rheumatological care: results of a randomized controlled trial

Ferwerda, Maaikea,b,*; van Beugen, Sylviaa,b; van Middendorp, Henriëta,b; Spillekom-van Koulil, Saskiab; Donders, A. Rogier T.c; Visser, Henkd; Taal, Erike; Creemers, Marjonne C.W.f; van Riel, Piet C.L.M.g; Evers, Andrea W.M.a,b

doi: 10.1097/j.pain.0000000000000845
Research Paper
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For patients with chronic pain conditions such as rheumatoid arthritis (RA), who experience elevated levels of distress, tailored-guided internet-based cognitive-behavioral treatment may be effective in improving psychological and physical functioning, and reducing the impact of RA on daily life. A multicenter, randomized controlled trial was conducted for RA patients with elevated levels of distress as assessed by a disease-specific measure. The control group (n = 71) received standard care and the intervention group (n = 62) additionally received an internet-based tailored cognitive-behavioral intervention. Main analyses were performed using a linear mixed model estimating differences between the intervention and control groups in scores of psychological functioning, physical functioning, and impact of RA on daily life at preassesment and postassessment, and at 3, 6, 9, and 12 months. Patients who received the internet-based intervention reported a larger improvement in psychological functioning compared with the control group, indicating less depressed mood (P < 0.001, d = 0.54), negative mood (P = 0.01, d = 0.38), and anxiety (P < 0.001, d = 0.48) during the course of the 1-year follow-up period. Regarding physical functioning, a trend was found for the intervention group reporting less fatigue than the control group (P = 0.06, d = 0.24), whereas no effect was found on pain. No effects were found for the impact of RA on daily life, except for the intervention group experiencing fewer role limitations due to emotional problems (P < 0.001, d = 0.53). Offering guided internet-based cognitive-behavioral therapy is a promising development to aid patients with psychological distress particularly in improving psychological functioning. Further research on adherence and specific intervention ingredients is warranted.

Guided internet-based cognitive-behavioral therapy is effective in reducing psychological symptoms and role limitations for patients with rheumatoid arthritis as an adjunct to standard rheumatological care.

aHealth, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands

Departments of bMedical Psychology and

cHealth Evidence, Radboud University Medical Center, Nijmegen, the Netherlands

dDepartment of Rheumatology, Rijnstate Hospital, Arnhem, the Netherlands

eDepartment of Psychology, Health and Technology, Arthritis Centre Twente, University of Twente, Enschede, the Netherlands

fDepartment of Rheumatology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, the Netherlands

gScientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands

Corresponding author. Address: Medical and Neuropsychology Unit, Institute of Psychology Health, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands. Tel.: +3171 5273627; fax: +3171 5273619. E-mail address: m.ferwerda@fsw.leidenuniv.nl (M. Ferwerda).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received April 06, 2016

Received in revised form December 29, 2016

Accepted January 04, 2017

© 2017 International Association for the Study of Pain
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