Interactive sections of an Internet-based intervention increase empowerment of chronic back pain patients: randomized controlled trial
Open accessAbstract
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 (F1.52=2.83, P=.03, η(2)=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=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=-1.5, P=.04, d=0.28; final assessment: mean difference=-1.6, P=.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; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR).
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In two studies, changes in illness-related outcomes were also associated with a positive influence on patient empowerment.
“In two studies these changes were also associated with a positive influence on patient empowerment (Allam et al., 2015, Riva et al., 2014).”
From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as Riva et al., 2014
The Results report that interactive website sections increased empowerment and reduced medication misuse among chronic back pain patients. They do not establish that changes in illness-related outcomes were themselves associated with changes in empowerment; both were measured as outcomes of the intervention. (LLM, conf=0.82)
Experimental — accuracy not yet measuredRiva et al. (2014) found a positive impact of points (with leaderboards) on outcomes related to chronic back pain, including reduced medication misuse, lowered pain burden, and increased exercise.
“Riva et al. (2014) similarly found a positive impact of points (with leaderboards) on outcomes related to chronic back pain, including reduced medication misuse, lowered pain burden, and increased exercise.”
From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as Riva et al. (2014)
The ONESELF Website section describes quiz points and a ranking visible to participants, but the study tested interactive features as a package, not the separate effect of points or rankings. The Results report reduced medication misuse in the interactive group; physical exercise declined in both groups, and pain burden fell equally in both groups. Thus the claimed increases in exercise and intervention-specific reduction in pain burden are not supported. (LLM, conf=0.90)
Experimental — accuracy not yet measuredGamification was found to have a positive influence on healthcare utilization, reduction of medication misuse, and blood glucose monitoring.
“Gamification was found to have a positive influence on healthcare utilization (Allam et al., 2015), the reduction of medication misuse (Allam et al., 2015, Riva et al., 2014) and blood glucose monitoring (Cafazzo et al., 2012).”
From Gamification for health and wellbeing: A systematic review of the literature (2016) · cites this paper as Riva et al., 2014
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- Authors
- Riva, S., Camerini, A.-L., Allam, A., & Schulz, P. J.
- Affiliations
- University of Milan (IT)
- Università della Svizzera italiana (CH)
- Corresponding author
- Riva, Silvia
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2014-08-13
- Volume
- 16
- Issue
- 8
- Pages
- e180
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC4147711
- OpenAlex
- W2087425257
- Cited by
- 96
- References
- 63
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 9 · 2020: 4 · 2019: 15 · 2018: 8 · 2017: 8 · 2016: 13 · 2015: 9 · 2014: 2 · 2012: 1
- FWCI
- 7.75
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- St Mary's University Repository (St Mary's University Twickenham London) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Science Foundation
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (130030)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Health Literacy and Information Accessibility
- Keywords
- chronic back pain, online intervention, patient empowerment, self-management, medication misuse, physical activity, pain burden, online health interventions
- MeSH terms
- Adult, Back Pain, Female, Humans, Male, Middle Aged, Power, Psychological, Self Care, Socioeconomic Factors, Internet, Chronic Pain
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