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Background: Psychological distress in rheumatoid arthritis (RA) is associated with severity of disease activity and poor treatment outcomes. Online interventions have the potential to reach large numbers of patients.
Objectives: The aims of this study were to identify online interventions for psychological distress and determine their effectiveness in RA and other long-term conditions.
Methods: The following databases were searched: MEDLINE, EMBASE, CINAHL and PsychINFO Jan 2007-Jul 2017). Inclusion criteria were randomised controlled trials (RCTs) of effectiveness of interventions to address psychological distress in adults. Titles and abstracts were screened independently by 2 reviewers. Methodological quality was assessed by 3 reviewers using Cochrane’s Risk of Bias tool. Data were extracted independently by 4 reviewers. Meta-analysis was not possible due to clinical heterogeneity of the included studies. Effectiveness of interventions is reported with effect sizes based on between-group differences in the primary outcomes at the end of each study.
| Study | Condition | Effectiveness |
|---|---|---|
| Boeschoter 2017 | Multiple sclerosis | Not effective BDI: Effect size d=0.01; p=0.953 |
| Bord 2010 | Diabetes | Effective CESD: Effect size d=0.7; p<0.05 PAID: Effect size d=0.6; p<0.05 |
| Cohr 2014 | Type 2 diabetes | Mixed CESD: Effect size d=-0.44; p=0.05 Diabetes Distress Scale: Effect size not shown |
| Ferwerda 2017 | Rheumatoid arthritis | Effective BDI: Effect size d=0.54; p=0.001 IRGL-Negative mood: Effect size d=0.38; p=0.01 IRGL-Anxiety: Effect size d=0.48; p=0.001 |
| Fischer 2015 | Multiple sclerosis | Effective BDI: Effect size d=0.53; p=0.01 |
| Hurt 2009 | Irritable bowel syndrome | Effective
Anxiety Sensitivity Index -GI: Effect size d=0.63; p<0.01 Anxiety Sensitivity Index -non GI: Effect size d=0.70; p<0.01 |
| Lorig 2008 | Rheumatoid arthritis, osteoarthritis and fibromyalgia | Effective Health Distress Scale RA: d=0.5 Health Distress Scale OA: d=0.4 Health Distress Scale FM: d=0.03 |
| Newby 2017 | Type 1 ard type 2 diabetes | Effective
Patient Health Questionnaire: Effect size g=0.78; p<0.001 PAID: Effect size g=0.80; p=0.01 |
| Nobis 2015 | Type 1 and type 2 diabetes | Effective
CESD: Effect size d=0.89; p<0.001 |
| Rondags 2016 | Type 1 and type 2 diabetes | Not effective Hypoglycaemia Fear Survey: RR=0.80; 95% CI 0.64 to 1.01; (p=0.059). |
| Van Bastelaar 2011 | Type 1 and type 2 diabetes | Effective CESD: Effect size d=0.70; p<0.001. |
Results: The review included 11 RCTs in the following conditions: arthritis,2 multiple sclerosis,2 diabetes6 and irritable bowel syndrome.1 The quality of most RCTs was poor due to attrition, selective reporting and limited follow-up. Eight disease-specific and 3 generic interventions were identified. Cognitive behavioural therapy was the most common intervention type. All interventions were online but support delivery and outcome measures varied significantly, Nine of the 11 interventions were shown to be effective, including 2 for RA. Most interventions were not available outside of the trial.
Conclusions: The findings are inconclusive due to the overall bias of the included studies and insufficient evidence in RA. More good quality RCTs are required to determine effectiveness of online interventions in RA.
Acknowledgements: This study was funded by Arthritis Research UK.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2018-eular.1687