Online Self-management Research Articles

The Effects of Online Self-management Interventions for Patients With Mood Disorders: Protocol for a Systematic Review and Meta-analysis.

Self-management has become important as a complementary approach to the recovery of patients with mood disorders, and the need for a remote intervention program has been revealed in relation to the COVID-19 pandemic. The aim of this review is to systematically review the studies for evidence on the effects of online self-management interventions based on cognitive behavioral therapy or psychoeducation for patients with mood disorders and to verify the statistical significance of the effectiveness of the interventions. A comprehensive literature search will be conducted using a search strategy in nine electronic bibliographic databases and will include all randomized controlled trial studies conducted up through December 2021. In addition, unpublished dissertations will be reviewed to minimize publication bias and to include a wider range of research. All steps in selecting the final studies to be included in the review will be performed independently by two researchers, and any discrepancies will be resolved through discussion. Institutional review board approval was not required because this study was not conducted on people. Systematic literature searches, data extraction, narrative synthesis, meta-analysis, and final writing of the systematic review and meta-analysis are expected to be completed by 2023. This systematic review will provide a rationale for the development of web-based or online self-management interventions for the recovery of patients with mood disorders and will be used as a clinically meaningful reference in terms of mental health management. DERR1-10.2196/45528.

Development of a co-created online self-management program for people with lower limb loss: self-management for amputee rehabilitation using technology (SMART)

Purpose To develop an online self-management program for individuals with recent lower limb loss, called Self-Management for Amputee Rehabilitation using Technology (SMART). Materials and methods We used the Intervention Mapping Framework as a blueprint and involved stakeholders throughout the process. A six-step study was conducted including (1) needs assessment using interviews, (2) translating needs to content, (3) applying the content into a prototype using theory-based methods, (4) a usability assessment using think-aloud cognitive testing, (5) planning for future adoption and implementation, and (6) assessing feasibility using mixed-methods to generate a plan to assess the effectiveness on health-outcomes in a randomized controlled trial. Results Following interviews with healthcare professionals (n = 31) and people with lower limb loss (n = 26), we determined the content of a prototype version. We then tested usability (n = 9) and feasibility (n = 12) by recruiting individuals with lower limb loss from different pools. We modified SMART to be assessed in a randomized controlled trial. SMART is a six-week online program with weekly contact of a peer mentor with lower limb loss who supported patients with goal-setting and action-planning. Conclusions Intervention mapping facilitated the systematic development of SMART. SMART may improve health outcomes, but this would need to be confirmed in future studies. Implications for rehabilitation Learning new coping strategies and habits are essential after lower limb loss. Given the limitations and inaccessibility of educational and rehabilitation programs, online self-management education can assist patients in their recovery. Self-Management for Amputee Rehabilitation using Technology (SMART) has the potential to augment the self-management behaviors in individuals with lower limb loss through an improvement in access to educational content, skill-based videos, and support of a peer.

Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial—an update to the published protocol

Supported online self-management versus care as usual for symptoms of fatigue, pain and urgency/incontinence in adults with inflammatory bowel disease (IBD-BOOST): study protocol for a randomised controlled trial—an update to the published protocol

Experience-based design: Empowering individuals while they wait for interprofessional chronic pain care

ObjectivesChronic pain is highly prevalent and a leading cause of disability. Long wait times for interprofessional care provide an opportunity to introduce web-based interventions that improve psychosocial function and patients’ readiness and ability to manage their condition. Here we describe the process of partnering with people with lived experience (PWLE) to develop an online self-management program enhanced by motivational interviewing. We also report the multiphase usability testing of the program. MethodsPWLE were included in all aspects of this project from program inception to content creation, module development, usability testing, and knowledge dissemination. Phase 1 included the development of the interactive, web-based modules. This process involved weekly meetings and asynchronous content creation with a core team of interprofessional pain experts, researchers, and PWLE. Phase 2 included usability testing by our PWLE and clinical expert advisory. Phase 3 included survey-based usability testing with a sample of 10 PWLE. ResultsWe created a chronic pain & motivational empowerment program includes a series of eight interactive educational web-based modules. Topics included: setting expectations, chronic pain explained, biopsychosocial factors, empowered management, self-awareness & compassion & acceptance, values, goal setting, and communication. The program is accompanied by a reflection journal and can be enhanced by one-on-one coaching sessions using a motivational interviewing approach. Phase two usability testing resulted in numerous content changes and the addition of accessibility features. Phase 3 usability testing with PWLE found the program highly accessible and easy to use. ConclusionsThe engagement of our PWLE team member and advisors made the online program more relevant, sensitive and helpful to the needs of people with pain. Practical valueThis PWLE-centric project sets the foundation for future work to examine the feasibility and effectiveness of the program for supporting individuals with chronic pain self-manage.

SCI Thrive: Results From A Peer-Led Online Self-Management Program

<h3>Research Objectives</h3> To test the effectiveness of a peer-led self-management program for individuals with spinal cord injury (SCI). <h3>Design</h3> Randomized wait-list control. <h3>Setting</h3> Community, virtual. <h3>Participants</h3> 184 individuals with SCI from 24 states and 3 countries who responded to listserv posts about the study and able to engage in the online format. <h3>Interventions</h3> 6-week peer-led online self-management program, with 4 video conference sessions, to address individual goals. <h3>Main Outcome Measures</h3> Perceived Quality of Life, self-efficacy, Craig Handicap Assessment and Reporting Technique (CHART). <h3>Results</h3> Participants were 51 years old on average (SD=14.9), with 58% male, mean of 15.5 (SD=14.0) years injured, with 59% cervical injuries and 64% incomplete injuries. The treatment group had significantly higher scores on CHART occupational subscale (P=.022), but no other differences were found at the end of 6 weeks. Analysis of all participants who completed SCI Thrive showed significant increase in self-efficacy between baseline (6.32) and 6 weeks (6.81; p<.001) which was maintained at 3 months post treatment (6.83; p=.001). Those who were more engaged in SCI Thrive (posted online, completed homework, attended video conferences) reported higher quality of life (p=.001), self-efficacy (p=.007), and increased mobility on the CHART (p=.026). <h3>Conclusions</h3> SCI Thrive is a highly accessible program for individuals with SCI and shows promise for improving self-efficacy. Strategies to increase engagement should be added to maximize benefits. Measurement tools may have been impacted by COVID-19 pandemic. Further research is needed to determine whether SCI Thrive is more effective when all participants share a focus, such as on physical activity or community participation. <h3>Author(s) Disclosures</h3> Authors have nothing to disclose.

MyGuide: Perceptions and Acceptance of an Online Concussion Self-Management Tool

<h3>Research Objectives</h3> To investigate the perceptions and acceptance of clinicians and people with concussion using an online concussion self-management tool. <h3>Design</h3> Using a mixed-methods content analysis approach, we interviewed and analyzed responses from clients and clinicians who used the online self-management tool within the past 2 years. We also asked participants about their acceptability of the tool using the Health Information Technology Usability Evaluation Scale (Health-ITUES). <h3>Setting</h3> Participants were living in the community setting. All participants (clinicians and people with history of concussion) completed an online survey. Representative clinicians and people with concussion participated in a semi-structured interview via Zoom. <h3>Participants</h3> A total of 16 participants were included in this study, comprising of 8 people with concussion and 8 healthcare providers. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Qualitative data (semi-structured interviews) and quantitative questionnaire (Health Information Technology Usability Evaluation Scale (Health-ITUES)) was used to understand acceptance and perception of the MyGuide Tool for concussion management. <h3>Results</h3> Participants reported two key benefits of using the online self-management tool, namely, the tool's emphasis on the interconnectedness of physical and psychological symptoms, and the ability to provide reassurance that symptoms being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions, and believed the content was useful for increasing clients' independence in managing their own recovery. People with concussion indicated that the using the tool early in their recovery was important as knowledge and information was most needed at that point. Some people with concussion described that the tool had reduced benefit as it was used too late in their concussion management. Rather than using the site regularly as a management tool, several people with concussion reported that they worked through the material once and didn't refer to it afterwards. <h3>Conclusions</h3> Findings will provide insight into the acceptability and potential benefit of an online self-management tool in concussion rehabilitation and may provide important design considerations in this population. <h3>Author(s) Disclosures</h3> N/A.

Development and Evaluation of an Online Self-Management Program in Patients with Chronic Kidney Failure Undergoing Hemodialysis

Purpose: This study was performed to develop and evaluate an online self-management program for enhancing hemodialysis-related knowledge, self-efficacy, ways of coping, self-management behavior, physical and mental health-related quality of life in patients with chronic kidney failure undergoing hemodialysis.Methods: The research used a quasi-experimental design with a non-equivalent control group pre-post test design with convenience sampling. The participants were 53 patients (27 in the experimental group and 26 in the control group). A pretest and posttest were conducted to measure the main variables. For the experimental group, the online self-management program, consisting of counseling-centered activities in small groups, was administered for 8 weeks. Data were analyzed using the x&lt;sup&gt;2&lt;/sup&gt; test, t-test and independent/paired t-test with the SPSS 27 statistics program.Results: Statistically significant increases were found in hemodialysis-related knowledge, self-efficacy, active ways of coping, self-management behavior, physical and mental health-related quality of life but not in passive ways of coping in the experimental group compared to the control group.Conclusion: The results of this study indicate that the online self-management program was effective in increasing hemodialysis-related knowledge, self-efficacy, active ways of coping, self-management behavior, physical and mental health-related quality of life among patients with hemodialysis. Therefore, it can be safely utilized as a nursing intervention for patients with chronic kidney failure undergoing hemodialysis in pandemic situations with high risk of infection.

Feasibility of a Remotely Delivered Trial Testing an Online Self-Management Programme for People Living With CKD

Feasibility of a Remotely Delivered Trial Testing an Online Self-Management Programme for People Living With CKD

Optimized User Experience, Efficiency, and Resource Use in Online Self-Management of Atopic Dermatitis

This quality improvement study describes the revision of an internet-delivered, self-guided psychological treatment for atopic dermatitis.

Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives.

BackgroundPopulation aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care.ObjectiveThis study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices.MethodsWe conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis.ResultsAmong patients who had not actively used the platform but had received an explanation, only 35% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback.ConclusionsThe overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy.

Usability of Self-Management for Amputee Rehabilitation using Technology (SMART): An online self-management program for users with lower limb loss.

Individuals with lower limb loss (LLL) need education to adapt to their amputation. Self-management programs provide education and supportive skills to manage health-related physical and psychological challenges. eHealth technologies, such as online platforms, are increasing access to educational resources. We designed an online self-management program for individuals with LLL called Self-Management for Amputee Rehabilitation using Technology (SMART); however, before evaluating its efficacy, we wanted to understand its appropriateness in the target population. To assess the usability of SMART among individuals with LLL. The study used a concurrent and retrospective think-aloud process. Individuals with LLL, aged 18 years or older (n = 9), reviewed the modules during an online video conferencing session with an assessor. SMART included four stakeholder-informed modules with 18 total sections. Participants were asked to think aloud while completing 11 SMART tasks, such as entering SMART, goal setting, finding skin care, and reading the content of 10 sections, including limb care, diet, fatigue, and energy. The interviews were transcribed verbatim and analyzed using directed content analysis. The median age was 58 (range: 30-69) years. Overall, SMART was perceived as straightforward, easy to navigate, and an accessible resource for education and skills. Difficulties were identified with navigation (e.g. skipping the "Foot care for diabetes" section), presentation (e.g. unclear audio), and language (e.g. pistoning and contracture). SMART was redesigned to address the usability issues. The next step is to explore the perceived usefulness of SMART for content and intention to use.

MO1052: Feasibility of ‘Smile-K’, a Remote Randomized Controlled Trial of an Online Self-Management Programme for People Living with Kidney Disease

Abstract BACKGROUND AND AIMS It is desirable for people with non-dialysis chronic kidney disease (ND-CKD) to take an active role in the management of their own health, but this requires the appropriate knowledge, skills and confidence (termed patient activation) to effectively self-manage. Currently, there is a lack of resources available to improve self-management behaviours and actively involve individuals in their own healthcare. Our group has developed a 10-week online self-management programme for people with non-dialysis CKD, called ‘My Kidneys &amp; Me’ (MK&amp;M), currently undergoing evaluation in the ‘SMILE-K’ multi-centre randomized control trial (RCT), which is conducted entirely online (remotely). The primary outcome of ‘SMILE-K’ is patient activation, but to ensure that the full-scale trial protocol is feasible and to minimize methodological weaknesses, we conducted a nested single-blind pilot with feasibility outcomes. Here we report the results of the nested pilot and preliminary usage data for ‘MK&amp;M’. METHOD The ‘SMILE-K’ trial employs an entirely remote recruitment method, with a 2:1 randomization into intervention and control arms. The first 60 participants were included in the nested pilot and followed up for 10-weeks. Assessment surveys, including the Patient Activation Measure, were conducted electronically at baseline (pre-randomization) and 10 weeks later. Progression criteria were set a priori, using the ‘red’ (stop), ‘amber’ (make changes) and ‘green’ (go) system to specify targets for progression, based on recruitment rates, acceptability of recruitment and randomization methods, the feasibility and acceptability of outcome assessments, and engagement with and usage of ‘MK&amp;M’. RESULTS Of the first 128 people approached who expressed interest in ‘SMILE-K’, 77/128 (60%) consented to participate. Of these, 60/77 (78%) completed the baseline outcome survey and were subsequently randomized and included in the pilot. The average age of pilot participants was 63 (range: 20–88) years and 63% (n = 38) were male. Sending study invitations via post was the most common method of recruitment, although additional discussion of the study with potential participants (either face-to-face or via telephone) increased recruitment rates. All of the pre-specified ‘stop’ progression criteria thresholds were exceeded, indicating that the full planned RCT is feasible. Access to and engagement with ‘MK&amp;M’ were high, with 36/41 (88%) participants activating their accounts and logging in. Participants logged into ‘MK&amp;M’ a mean of 35 times during the 10-week follow-up period and spent a mean of 14 min/login. CONCLUSION This nested pilot study provided evidence for the feasibility of the full-scale ‘SMILE-K’ trial. Numerous lessons were learnt from conducting this entirely remote trial design, and from the pilot findings, we identified areas for improvement and have made subsequent small amendments to the trial protocol to improve the delivery of ‘MK&amp;M’ and ‘SMILE-K’. The ‘SMILE-K’ trial is currently ongoing, and we anticipate that the results will be available in 2023.

Online Self-Management for Chronic Burn Pain: Results of a Randomized Controlled Trial

Following burn injury, survivors experience high rates of chronic pain and psychosocial concerns, including post-traumatic stress disorder (PTSD) and depression. Despite long-term pain and distress, survivors have limited access to effective pain psychology treatments after discharge in the United States. The current study compared the efficacy of an online self-management program for chronic pain after burn injuries to a time equivalent education control. The Take Charge of Burn Pain Recovery (TCBR-Pain) program involved seven online chronic pain coping modules based on cognitive-behavioral therapy. Adults at least six months post burn injury hospital discharge and experiencing pain greater than 3/10 severity were recruited and randomized into the TCBR-Pain (N = 47) or Control program (N = 49). Outcomes were assessed at pre-treatment, immediately post-treatment, 2-month, and 5-month follow-up. Full program completion was lower for the TCBR-Pain group (53%) relative to the Control group (90%). Linear models were fit to outcomes, adjusting for pre-treatment scores, adherence, and completion. On average, the TCBR-Pain group reported lower pain intensity relative to the Control group at post-treatment (MTCBR-Pain = 3.2, SDTCBR-Pain = 1.8; MControl = 4.1, SDControl = 1.9; p < .001). Among secondary outcomes, the TCBR-Pain group reported lower pain catastrophizing (MTCBR-Pain = 14.0, SDTCBR-Pain = 10.3; MControl = 17.6, SDControl = 11.8; p = .03) and borderline effects toward lower PTSD symptoms (MTCBR-Pain = 14.0, SDTCBR-Pain = 6.5; MControl = 16.0, SDControl = 6.1; p = .08) at post-treatment relative to the Control group. Although preliminary, these findings suggest online self-management programs can serve a role in delivering effective pain psychology interventions to survivors with chronic burn pain. The TCBR-Pain program attrition rate was higher than the Control program, but lower than typical e-health intervention attrition rates (60–80%). However, future research is needed to improve patient engagement in online pain self-management programs.

Supporting cancer patients to self-manage: Extent of use and perceptions of “trusted” online self-management resources

ObjectivesOnline resources can support patient self-management practices, but are not systematically used in routine clinical practice. We evaluated cancer patients' satisfaction with, and use of, tailored online resources. MethodsPatients completed monthly validated electronic patient reported outcome measures (ePROMs) of distress, unmet needs and symptoms. Patients with ePROM scores above pre-determined thresholds received an email directing them to relevant online self-management resources. Perceptions and experiences with these resources were evaluated via an online survey 3, 6 and 9 months after their initial monthly ePRO; and a subset of patients was also interviewed. Webpage use was monitored through Google Analytics and ClickMeter. ResultsOverall, 221 patients completed evaluation surveys and 31 completed interviews. Patients spent 0–10 min on average accessing resources, with 93% indicating they would reuse them. The most viewed page was physical wellbeing (n = 680); exercise and nutrition resources were most popular; and 69% of patients were satisfied with information content, reporting resources were easy to understand and navigate. ConclusionsOnline resources are perceived as acceptable and useful. Design and delivery recommendations can improve their support of self-management. Practice implicationsIncorporating automated online self-management resources into routine clinical workflows is a viable model to support routine follow up care.

Randomized feasibility trial of the Scleroderma Patient-centered Intervention Network Self-Management (SPIN-SELF) Program

BackgroundThe Scleroderma Patient-centered Intervention Network (SPIN) developed an online self-management program (SPIN-SELF) designed to improve disease-management self-efficacy in people with systemic sclerosis (SSc, or scleroderma). The aim of this study was to evaluate feasibility aspects for conducting a full-scale randomized controlled trial (RCT) of the SPIN-SELF Program.MethodsThis feasibility trial was embedded in the SPIN Cohort and utilized the cohort multiple RCT design. In this design, at the time of cohort enrollment, cohort participants consent to be assessed for trial eligibility and randomized prior to being informed about the trial. Participants in the intervention arm are informed and provide consent, but not the control group. Forty English-speaking SPIN Cohort participants from Canada, the USA, or the UK with low disease-management self-efficacy (Self-Efficacy for Managing Chronic Disease Scale [SEMCD] score ≤ 7) who were interested in using an online self-management program were randomized (3:2 ratio) to be offered the SPIN-SELF Program or usual care for 3 months. Program usage was examined via automated usage logs. User satisfaction was assessed with semi-structured interviews. Trial personnel time requirements and implementation challenges were logged.ResultsOf 40 SPIN Cohort participants randomized, 26 were allocated to SPIN-SELF and 14 to usual care. Automated eligibility and randomization procedures via the SPIN Cohort platform functioned properly, except that two participants with SEMCD scores > 7 (scores of 7.2 and 7.3, respectively) were included, which was caused by a system programming error that rounded SEMCD scores. Of 26 SPIN Cohort participants offered the SPIN-SELF Program, only 9 (35%) consented to use the program. Usage logs showed that use of the SPIN-SELF Program was low: 2 of 9 users (22%) logged into the program only once (median = 3), and 4 of 9 (44%) accessed none or only 1 of the 9 program’s modules (median = 2).ConclusionsThe results of this study will lead to substantial changes for the planned full-scale RCT of the SPIN-SELF Program that we will incorporate into a planned additional feasibility trial with progression to a full-scale trial. These changes include transitioning to a conventional RCT design with pre-randomization consent and supplementing the online self-help with peer-facilitated videoconference-based groups to enhance engagement.Trial registrationclinicaltrials.gov, NCT03914781. Registered 16 April 2019.

Combined online interactive mindfulness and exercise programme (MOVE-Online) compared with a self-management guide for adults with chronic pain: protocol for a randomised controlled feasibility trial

IntroductionOnline pain management programmes (PMP) have growing evidence as effective interventions for individuals with chronic pain (CP). Mindfulness-based stress reduction (MBSR) is a psychological intervention proven to be effective in...

Inflammatory bowel disease nurses' views on taking on a new role to support an online self-management programme for symptoms of fatigue, pain and urgency: a qualitative study to maximise intervention acceptance

Background: Patients can be empowered through self-managing their inflammatory bowel disease (IBD) symptoms. It is important to understand how specialist IBD nurses can practically support patients to do this. Aim: To explore the perceptions of IBD specialist nurses about the implementation of a proposed nurse-guided online cognitive behavioural self-management intervention to manage symptoms of fatigue, pain and urgency. Methods: Five semi-structured focus groups (45 participants) were conducted with IBD nurses, and themes were identified through thematic analysis. Findings: Four themes were identified: (1) role of nurse as a facilitator; (2) nurse competence in facilitating the intervention; (3) nurse perception of patient needs; and (4) intervention implementation. Conclusions: The results of this study helped to refine the proposed guided online intervention with a view to sustainable implementation in clinical practice. Refinements included in-depth training and minimisation of additional workload for nurses through reducing patient contact, including an online messaging system for communication with patients.

Targeting self-efficacy more important than dysfunctional behavioral cognitions in patients with longstanding chronic low back pain; a longitudinal study

BackgroundMultidisciplinary pain management programs based on cognitive behavioral training (CBT) principles have been shown moderately effective in improving daily functioning in patients with chronic low back pain (CLBP). To optimize health-related outcomes as daily functioning, a clear understanding of the working mechanisms of these programs is warranted. Being confident to achieve a desired outcome, i.e. self-efficacy, is suggested to be a more potent determinant for beneficial treatment outcomes than restructuring the patient’s dysfunctional behavioral cognitions (pain catastrophizing and fear of movement [FoM]), but the evidence is scarce. The objective of this study was twofold: 1) to determine whether a two-week pain management program resulted in post-treatment improvements in self-efficacy and decreased dysfunctional behavioral cognitions in patients with CLBP, and 2) to examine the unique contribution of self-efficacy to improvement in post-treatment disability.MethodsA secondary analysis of an historical cohort study was performed, including 524 patients (59% females). Primary outcome: functional status (Oswestry Disability Index v2.1a). Secondary outcomes: catastrophizing (Pain Catastrophizing Scale), FoM (Tampa Scale for Kinesiophobia), and self-efficacy (Pain Self-Efficacy Questionnaire). Assessments: pre-, post-treatment, 1, and 12-months follow-up. Paired Student’s t-tests were applied and clinical relevancy of improvements was described using minimal clinical important changes. Adjusted multivariate linear regression analyses were performed to explore the unique contribution of self-efficacy.ResultsThe mean age of patients was 46 (SD = 9.5) years and they had longstanding CLBP (mean 12.5 [SD = 10.8] years). Mean functional status, self-efficacy, and dysfunctional behavioral cognitions improved significantly at post-treatment, with improvements maintained at 12 months follow-up. Post-treatment relevant improvements in self-efficacy and dysfunctional behavioral cognitions ranged from 62.4% (FoM) to 68.7% (self-efficacy). Post-treatment self-efficacy improved the model explaining post-treatment functional disability (basic model R2 = 0.49, F(6,517) = 83.67, p < 0.001; final model R2 = 0.57, F(8,515) = 85.20, p < 0.001). This was further substantiated by the relative contribution (standardized betas) of self-efficacy: 5.67 times more than catastrophizing and 9.75 times more than FoM.ConclusionsTargeting self-efficacy contributes to fast improvement in functional status for selected and motivated patients with persistent CLBP. In pain management programs and (online) self-management programs for CLBP, targeting patients’ self-efficacy should have a prominent place.

796Is Mindfulness a more effective intervention than Psychoeducation for reducing Bipolar Disorder-related symptoms of depression?

Abstract Background The primary objective is to test the effectiveness of a novel online quality of life (QoL) intervention tailored for people with late stage (≥ 10 episodes) bipolar disorder (BD) compared with psychoeducation. Relative to early stage individuals, this late stage group may not benefit as much from existing psychosocial treatments. Methods An NH&amp;MRC funded international RCT to compare the effectiveness of two 5-week adjunctive online self-management interventions: Mindfulness for Bipolar 2.0 and an active control (Psychoeducation for Bipolar). A total of 300 participants were recruited primarily via social media channels. Evaluations occurred at pre- and post- treatment, and at 3- and 6- months follow-up. A secondary outcome measure was BD-related symptoms (depression). A longitudinal analysis was conducted using random effects mixed models. Results Preliminary results suggest no change in mean QIDS_total over time (p = 0.891). Nor does there appear to be a difference in groups (B coeff= 0.47, 95%CI (-0.60, 1.55), p = 0.613) and no difference in intervention groups over time (p = 0.828). Conclusions The effectiveness of a novel QoL focused, mindfulness based, online guided self-help intervention for late stage BD does not appear to have been any more effective than a psychoeducation intervention for reducing depression. Key messages There may be no significant benefit from using a mindfulness based, online guided self-help intervention over a psychoeducation intervention to reduce the BD symptoms of depression in late stage Bipolar disorder.

Expectations of an Online-Self-Management Program for Rheumatoid Arthritis.

This qualitative descriptive study aimed to explore expectations of patients and healthcare experts for an online self-management program for rheumatoid arthritis. Participants were recruited from rheumatology clinics, medical centers, and universities in Taiwan. Individual face-to-face, semi-structured interviews were conducted with patients (n = 16) and healthcare experts (n = 7). Content analysis of the interview data resulted in five subthemes for expectations of an online self-management program: information about how the disease trajectory would impact future health status, availability of opportunities for self-monitoring, opportunities to interact with fellow patients and healthcare providers, simplicity and ease-of-use of the program, and methods to facilitate patient-motivation. These subthemes formulated two overarching themes: content and format. An online self-management program for patients with rheumatoid arthritis should provide evidence-based information about disease variables and behaviors aligned with the specific needs of the individual and adopt strategies that encourage and increase motivation and confidence.