The Internet-Based Arthritis Self-Management Program: A One-Year Randomized Trial for Patients With Arthritis or Fibromyalgia


Arthritis & Rheumatism (Arthritis Care & Research) Vol. 59, No. 7, July 15, 2008, pp 1009–1017 DOI 10.1002/art.23817 © 2008, American College of Rheumatology

Address correspondence to Philip L. Ritter, PhD, 1000 Welch Road, Suite 204, Palo Alto, CA 94306. E-mail:

Arthritis is the most common cause of disability, a major reason for outpatient visits, and one of the most prevalent chronic conditions (1–3). For older people, arthritis is a common comorbidity that often complicates other chronic conditions such as heart disease and diabetes. For the past 25 years, evidence has been presented for the effectiveness of self-management in the treatment of arthritis-related pain and disability (4 –9). The American College of Rheumatology has called for self-management education in its standard of care for osteoarthritis (OA) (10). In addition, as part of its 2010 Goals for the Nation, the Centers for Disease Control and Prevention has called for an increase in the percentage of people participating in arthritis self-management education (11,12). Our study seeks to reach a group for whom small group programs are not available or, where available, not acceptable. Seventy percent of Americans use the Internet (13), and as of 2003, 93 million Americans (80% of adult Internet users) had searched for health information online (14). Internet-based education provides consistent program delivery, because both the content and process are programmed. This study reports the results of a 1-year randomized trial of the Internet-based Arthritis Self-Management Program (ASMP). This program, offered via a secure Internet site, was built to replicate the original small-group ASMP as closely as possible. The aim of the study was to examine the 6-month and 1-year outcomes (health status, health behavior, self-efficacy, and health care utilization). For the past 28 years we have developed, evaluated, and refined low-cost, community-based self-management programs in English and Spanish for people with arthritis. The format of these programs are similar in that they are taught in 2-hour sessions over several weeks in community sites such as churches, senior centers, and community centers. All programs are facilitated by 2 peer leaders who receive training and use a detailed protocol. These programs have demonstrated significant improvements in health status as well as health-related behaviors, and have reduced health care utilization (4 –9). These programs have reached a relatively large number of patients, and have been replicated by others in studies with similar results (7,15–18). The workshops are based on self-efficacy theory and use the processes of skills mastery (action planning and feedback), modeling as supplied by the facilitators, reinterpretation of symptoms, and group persuasion (19).

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