Background/Purpose: There is evidence that education programs are effective (e.g. improved disease activity and quality of life) for patients with arthritis, but little is known about the impact of education interventions in axial spondyloarthritis (axSpA). The purpose of this study was to determine the impact of an e-Learning education program on patients’ disease knowledge and self-efficacy, as well as to determine the predictors associated with better self-management.

Methods: The Toronto Western Hospital Spondyloarthritis Program developed an interactive, e-Learning education program for axSpA^1,2. Patients were randomly allocated to either the intervention (e-Learning with usual care) or control (usual care) group. All patients completed the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Knowledge (AS-Q) questionnaire, and the Stanford Exercise and Chronic Disease Self-Efficacy (CDSE) scales at baseline, first follow-up (FU1), and at second follow-up (FU2) 6-12 months after FU1. A linear-based generalized estimating equation for continuous data was used to explore the associations between covariates including group, baseline sociodemographic characteristics (including risk factors for poor disease outcomes) and a main effect for time.

Results: 44 AS and 10 non-radiographic axSpA patients (n = 54) were included in the analyses. Of these, 23 received the intervention and 31 proceeded with usual care. 85.2% had completed college or university and the median number of education sources (i.e. # sources accessed such as internet, pamphlets, physician) prior to the study was 3 (IQR = [2,3]). The mean age was 41.9 years (12.9 SD) and 81.5% were HLA-B27+ with a mean of 17.8 (10.8 SD) years of symptoms. There was a significant increase in disease knowledge over time (p = 0.043) but no group differences for the above outcomes. Three or more education sources were significant (p = 0.014) predictors for an increase in AS-Q in the control group. Allocation to the e-Learning group was a predictor of more confidence in getting help (p = 0.015) from family and friends as per the CDSE. Female gender (p = 0.05) was a predictor of greater confidence in managing disease overall, and symptoms >10 years predicted more confidence in managing both disease (p = 0.018) and depression (p = 0.014).

Conclusion: The e-Learning module shows promising efficacy in improving knowledge, health literacy behaviours, and also serves to benefit individuals with limited access to specialized, tertiary care. There is a need for trials to assess more effective education outcomes and future studies should include characteristics and risk factors (e.g. gender, previous education sources, symptom duration) that were shown to be meaningful in this analysis.

Cited:

1. We Got Your Back! Education Module for People with Ankylosing Spondylitis. 2016. Spondylitis Program, University Health Network. [ONLINE] Available at: https://www.uhnmodules.ca/Modules/Ankylosing-Spondylitis/story_html5.html
2. Kang, R., et al. (2014). Utilization of an informational needs assessment to develop an education program for patients with ankylosing spondylitis and related axial spondyloarthritis. Ann Rheum Dis 72(Suppl 3): A1037-A1038.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/longitudinal-outcomes-and-predictors-of-e-learning-effectiveness-in-patients-with-axial-spondyloarthritis-a-randomized-controlled-trial/