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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
Open accessAbstract
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.
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“depression in five out of six studies that included this outcome [Ferwerda et al., 2017; Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Simister et al., 2018; Peters et al., 2017]”
From Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review (2021) · cites this paper as Ferwerda et al., 2017
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“anxiety in three out of four studies [Ferwerda et al., 2017; Hedman-Lagerlöf et al., 2018; Peters et al., 2017]”
From Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review (2021) · cites this paper as Ferwerda et al., 2017
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“Regarding detection bias, one study was at a low risk of bias (Simister et al., 2018) and two other studies were at an unclear risk of bias, since blinding of outcome assessment was insufficiently described (Ferwerda et al., 2017; Shigaki et al., 2013).”
From Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review (2021) · cites this paper as Ferwerda et al., 2017
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“Concerning selection bias, more than half of the included studies (Ferwerda et al., 2017; Friesen et al., 2017; Hedman-Lagerlöf et al., 2018; Simister et al., 2018; Vallejo et al., 2015) reported a proper randomization method and allocation concealment (e.g., via a random number generator).”
From Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review (2021) · cites this paper as Ferwerda et al., 2017
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Dworkin, R. H., Turk, D. C., Wyrwich, K. W., Beaton, D., Cleeland, C. S., Farrar, J. T., Haythornthwaite, J. A., Jensen, M. P., Kerns, R. D., Ader, D. N., et al. (2008) · The Journal of Pain · doi:10.1016/j.jpain.2007.09.005 · Cited by 3,471
The empirical status of cognitive-behavioral therapy: A review of meta-analyses
Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2005.07.003 · Cited by 3,215
American college of rheumatology preliminary definition of improvement in rheumatoid arthritis
Felson, D. T., Anderson, J. J., Boers, M., Bombardier, C., Fürst, D. E., Goldsmith, C. H., Katz, L. M. G., Lightfoot, R. W., Paulus, H. E., Strand, V., et al. (1995) · Arthritis & Rheumatism · doi:10.1002/art.1780380602 · Cited by 2,825
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EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis
Nagy, G., Roodenrijs, N. M. T., Welsing, P. M. J., Kedves, M., Hamar, A., van der Goes, M. C., Kent, A., Bakkers, M., Pchelnikova, P., Blaas, E., et al. (2021) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2021-220973 · Cited by 300
Telemedicine application in patients with chronic disease: a systematic review and meta-analysis
Ma, Y., Zhao, C., Zhao, Y., Lu, J., Jiang, H., Cao, Y., & Xu, Y. (2022) · BMC Medical Informatics and Decision Making · doi:10.1186/s12911-022-01845-2 · Cited by 161
Mehta, S., Peynenburg, V. A., & Hadjistavropoulos, H. D. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-018-9984-x · Cited by 153
Roodenrijs, N. M. T., Hamar, A., Kedves, M., Nagy, G., van Laar, J. M., van der Heijde, D. M. F. M., & Welsing, P. M. J. (2021) · RMD Open · doi:10.1136/rmdopen-2020-001512 · Cited by 117
“In one study, in an unselected population of RA patients, willingness to try a b/tsDMARD was assessed and improved statistically significantly.”
Ferreira, R. J. O., Duarte, C. C. M., Ndosi, M. E., de Wit, M. P. T., Gossec, L., & da Silva, J. A. P. (2017) · Arthritis Care & Research · doi:10.1002/acr.23284 · Cited by 104
Metadata
- Authors
- Ferwerda, M., van Beugen, S., van Middendorp, H., Spillekom-van Koulil, S., Donders, A. R. T., Visser, H., Taal, E., Creemers, M. C. W., van Riel, P. C. L. M., & Evers, A. W. M.
- Affiliations
- Leiden University (NL)
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
- Medical Psychology and
- Radboud University Medical Center (NL)
- Rijnstate Hospital (NL)
- University of Twente (NL)
- Jeroen Bosch Ziekenhuis (NL)
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
- Corresponding author
- Ferwerda, Maaike
- ORCID
- Venue
- Pain
- Published
- 2017-01-12
- Volume
- 158
- Issue
- 5
- Pages
- 868-878
- ISSN
- 0304-3959 (ISSN-L)
- 1872-6623
- OpenAlex
- W2578268303
- Cited by
- 85
- References
- 47
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 9 · 2023: 10 · 2022: 10 · 2021: 13 · 2020: 7 · 2019: 7 · 2018: 8 · 2017: 3
- FWCI
- 7.82
- Type
- journal article
- Language
- en
- Open access
- green
- research.utwente.nl
- Licence
- other-oa
- Locations
- Pain (publishedVersion)
- PubMed (publishedVersion)
- University of Twente Research Information (acceptedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- University of Twente Research Information (submittedVersion, other-oa)
- Funders
- Pfizer (WS682746)
- ZonMw
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- rheumatoid arthritis, internet-based cognitive behavioral therapy, psychological distress, depression, anxiety, fatigue, physical function, chronic pain
- MeSH terms
- Activities of Daily Living, Adult, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Female, Follow-Up Studies, Humans, Male, Middle Aged, Netherlands, Pain Measurement, Physical Examination, Psychiatric Status Rating Scales, Time Factors, Cognitive Behavioral Therapy, Outcome Assessment, Health Care, Disease Management, Mood Disorders, Internet
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