An internet-based cognitive-behavioral self-management intervention for patients with hand osteoarthritis or fibromyalgia – Two randomized controlled trials

Internet Interventions, vol. 43, pp. 100908

Abstract

Rheumatic and musculoskeletal diseases have a high burden. We aimed to evaluate the effectiveness of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) on pain coping and secondary physical, psychological, and disease impact outcomes in hand osteoarthritis and fibromyalgia. Two single-center, parallel-group, superiority randomized controlled trials were performed. In one study, 70 adults with hand osteoarthritis visiting a Dutch hospital were randomized to care-as-usual or care-as-usual plus iCBT (each group n = 35; ClinicalTrials.gov : NCT05872633 ). In another study, 70 adults with fibromyalgia visiting a Dutch fibromyalgia-specialized center were randomized to iCBT ( n = 34) or a waitlist ( n = 36; ClinicalTrials.gov : NCT06322485 ). Standardized self-report questionnaires were used at baseline, post-intervention, 6-week, and 3-month follow-up and analyzed with statistician-masked intention-to-treat linear mixed models. The primary endpoint was pain coping at post-intervention. In patients with hand osteoarthritis (mean age = 62.4 ± 7.6), no between-group effect on pain coping was found at post-intervention ( p = 0.187; Cohen's d = 0.14), while a small to medium effect favored iCBT at 6-week follow-up ( p = 0.039; d = 0.41). In patients with fibromyalgia (mean age = 46.4 ± 11.8), a medium to large improvement in pain coping favoring iCBT at post-intervention ( p = 0.003; d = 0.60) was not sustained at follow-up. Between-group small to large improvements were found in secondary outcomes (e.g., well-being, osteoarthritis disability, fibromyalgia pain and impact), predominantly at 3-month follow-up ( p ≤ 0.047; 0.30 ≤ d ≤ 0.98). ICBT improved pain coping in fibromyalgia at the primary endpoint, whereas the hand osteoarthritis trial was negative at the primary endpoint. Exploratory secondary findings suggest potential benefits for both conditions but warrant replication, particularly in subgroups with a high disease impact. • Internet-based CBT was studied in hand osteoarthritis and fibromyalgia. • The primary outcome was between-group pain coping at post-treatment. • Fibromyalgia: between-group pain coping improved post-treatment, not at follow-up. • Hand osteoarthritis: no post-treatment pain coping effect; modest 6-week effect • Exploratory benefits were found in secondary outcomes, mostly at 3-month follow-up.

Authors 7

1. Jessy A. Terpstra corresponding Aachen Department of Rheumatology, Leiden University Medical Center Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, C1-R, PO Box 9600, 2300 RC, Leiden, the Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands

2. Sylvia van Beugen Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands

3. Rosalie van der Vaart Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University · The Hague University of Applied Sciences

   Affiliation as printed

   Centre of Expertise Health Innovation, The Hague University of Applied Sciences, Johanna Westerdijkplein 75, 2521 EN, The Hague, the Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands

4. Roxy A. van Eersel Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands

5. Elise Dusseldorp Aachen Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University

   Affiliation as printed

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands

6. M. Kloppenburg Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, C1-R, PO Box 9600, 2300 RC, Leiden, the Netherlands

7. Andrea W.M. Evers Aachen Department of Psychiatry, Leiden University Medical Center Health Medical and Neuropsychology Unit Institute of Psychology, Leiden University

   Leiden University · Leiden University Medical Center · Medical Delta

   Affiliation as printed

   Department of Psychiatry, Leiden University Medical Center, B1-P, PO Box 9600, 2300 RC, Leiden, the Netherlands

   Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands

   Medical Delta, Huismansingel 4, 2629 JH, Delft, the Netherlands