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Effect of digital monitoring and counselling on self-management ability in patients with rheumatoid arthritis: a randomised controlled trial

For people with rheumatoid arthritis (RA), self-management refers to their ability to manage the symptoms and treatments associated with living with a chronic disease [1, 2]. It requires individuals engaging in self-care activities, such as balancing physical activity with rest and sleep [3] and knowing when to seek help from healthcare providers [4]. To achieve better health outcomes, people with RA need to be aware of their symptoms and have the ability and confidence to practice self-care; that is, to be an activated patient [5, 6].

Hibbard et al. [5] describe activated patients as individuals who believe they play a key role in self-managing and are ready to collaborate with their healthcare providers to maintain their wellbeing. Several studies have assessed interventions for enhancing self-management ability—also known as patient activation [5]—in people with inflammatory arthritis, but the results were mixed. Mollard and Michaud [7] tested a self-monitoring app for people with RA and found no effect on the Patient Activation Measure (PAM-13) [6]. In a 12-month randomized controlled trial (RCT) of 157 patients with RA, Zuidema et al. [8] observed no difference in PAM-13 between those who participated in a 12-month online self-management program and the controls. Similar results were reported by Fortin et al. [9] in 541 patients with systemic lupus erythematosus after using a self-paced online self-management program for three months. These findings diverge from the evidence supporting the use of digital tools to enhance participation in self-care activities and improve health outcomes [10]. Interestingly, interventions tailored to the patient’s needs appeared to have an effect on improving patient activation [11–14]. These studies, however, used either a non-randomized design [11] or a short intervention duration [12]. In an RCT of a 6-week tailored education program with a nurse, the initial post-intervention improvement in PAM-13 did not persist at 12 months [13].

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