EHealth to improve psychological functioning and self-management of people with chronic kidney disease: a randomized controlled trial.

Abstract

Psychological distress is common among patients with chronic kidney disease (CKD), and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL eHealth care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with CKD not on dialysis ( N = 121). Primary outcome of the open two-arm parallel randomized controlled trial in 4 Dutch hospitals was psychological distress at post-test directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life (HRQoL), self-efficacy, chronic disease self-management, and personalized outcomes, i.e., perceived progress compared to the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, HRQoL, self-efficacy, and chronic condition self-management, whereas ANCOVAs showed significantly more perceived progress in the intervention group at post-test on personally prioritized areas of functioning, b = 0.46, 95%CI[0.07, 0.85], and self-management, b = 0.55, 95%CI[0.16, 0.95], with Cohen's d s of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. Compared to regular care only, the eHealth intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly post-intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments.Trial Registration: Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).