title: Interactive sections of an Internet-based intervention increase empowerment of chronic back pain patients: randomized controlled trial.
abstract: BACKGROUND
  Chronic back pain (CBP) represents a significant public health problem. As one of the most common causes of disability and sick leave, there is a need to develop cost-effective ways, such as Internet-based interventions, to help empower patients to manage their disease. Research has provided evidence for the effectiveness of Internet-based interventions in many fields, but it has paid little attention to the reasons why they are effective.
  
  
  OBJECTIVE
  This study aims to assess the impact of interactive sections of an Internet-based self-management intervention on patient empowerment, their management of the disease, and, ultimately, health outcomes.
  
  
  METHODS
  A total of 51 patients were recruited through their health care providers and randomly assigned to either an experimental group with full access to the Internet-based intervention or a control group that was denied access to the interactive sections and knew nothing thereof. The intervention took 8 weeks. A baseline, a mid-term after 4 weeks, and a final assessment after 8 weeks measured patient empowerment, physical exercise, medication misuse, and pain burden.
  
  
  RESULTS
  All patients completed the study. Overall, the intervention had a moderate effect (F1.52=2.83, P=.03, η(2)=0.30, d=0.55). Compared to the control group, the availability of interactive sections significantly increased patient empowerment (midterm assessment: mean difference=+1.2, P=.03, d=0.63; final assessment: mean difference=+0.8, P=.09, d=0.44) and reduced medication misuse (midterm assessment: mean difference=-1.5, P=.04, d=0.28; final assessment: mean difference=-1.6, P=.03, d=-0.55) in the intervention group. Both the frequency of physical exercise and pain burden decreased, but to equal measures in both groups.
  
  
  CONCLUSIONS
  Results suggest that interactive sections as part of Internet-based interventions can positively alter patients' feelings of empowerment and help prevent medication misuse. Detrimental effects were not observed.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02114788; http://www.clinicaltrials.gov/ct2/show/NCT02114788 (Archived by WebCite at http://www.webcitation.org/6ROXYVoPR).
authors.affiliation: Institute of Communication and Health, Università della Svizzera italiana, Lugano, Switzerland. silvia.riva@usi.ch.
authors.forename: Silvia
authors.identifier: http://orcid.org/0000-0003-2153-0169
authors.initials: S
authors.lastname: Riva
authors.forename: Anne-Linda
authors.identifier: http://orcid.org/0000-0002-2316-6228
authors.initials: AL
authors.lastname: Camerini
authors.forename: Ahmed
authors.identifier: http://orcid.org/0000-0003-0871-1977
authors.initials: A
authors.lastname: Allam
authors.forename: Peter J
authors.identifier: http://orcid.org/0000-0002-0405-2284
authors.initials: PJ
authors.lastname: Schulz
mesh_terms: D000328:Adult; D001416:Back Pain / Q000523:psychology / Q000628:therapy*; D059350:Chronic Pain; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011209:Power, Psychological; D012648:Self Care / Q000379:methods*; D012959:Socioeconomic Factors
keywords: Internet-based intervention; chronic back pain; decision; gamification; health; health outcomes; interactivity; medication misuse; pain burden; patient empowerment; physical activity