Chronic disease self-management (CDSM) for people with musculoskeletal and mental health problems: Steppingup-a new flexible web-based system to serve patients, clinicians and organisations.

Abstract

Background Musculoskeletal and concurrent mental health problems are common and complex problems for practitioners across the care continuum. The internet and web-based solutions are increasingly being seen as a viable way to deliver effective care, particularly for patient education programs. Most CDSM programs have not considered best practice in educational theory, flexible learning systems, patient-centred care, evidence-based health psychology practice, and how these should be integrated into flexible system to serve both the patient, practitioner and organization. To fill this gap "Stepping Up - when arthritis or pain gets you down" was developed. Objectives 1. Develop and test a web-based CDSM support system sufficiently flexible to optimally support patients with a wide range of musculoskeletal problems, concurrent mental health problems (ie anxiety, depression) and challenged by physical and socioeconomic isolation 2. Build a CDSM system that emulates how experienced practitioners work with clients - including a wide range of flexible modules and decision support that ensures practitioners are well supported to deliver best-practice in chronic disease self-manage support Methods 40 adults (77% woman) with a range of musculoskeletal conditions took part. Average age was 48 (range: 22 to 85). Many participants reported a mental health diagnosis (33%), and 49% of participants reported multiple chronic conditions. Participants took part in an initial phone interview, and then worked independently through a personalised set of modules over several weeks (4 to 10, depending on their needs and lifestyle). Participants accessed weekly email support as part of the intervention, and took part in a phone review upon conclusion. Outcomes measured included clinician and self-reported improvements in symptoms and health behaviours, and impact on standardised pre-post questionnaires such as the widely used Health Education Impact Questionnaire (heiQ). Results A large number (N=39) of patient-centred modules were developed to allowed extensive tailoring of programs for individual patients. Significant improvements were observed in the Emotional Distress, Skill and Technique Acquisition and Social Integration and Support scales of the heiQ (effect size: -0.55; 0.77; 0.43 respectively, P<0.05 for all). Improvement in Health-related Quality of Life was very large: 0.11 utility units (P<0.01; minimally important difference >0.06 units). Within formal structured interviewes, >50% of participants gave comments of high praise about the program at follow-up, and over 90% listed specific changes in behaviour that they directly attributed to the program. The most frequent response to questioning about helpful aspects of the program was that it was the program as a whole and the way it fitted together. Conclusions The Stepping Up intervention was found to be highly acceptable to patients and clinicins. It can achieve significant improvements in emotional distress, behaviours, skills, and social support in clients.