A Systematic Review of Web-Based Interventions for Patient Empowerment and Physical Activity in Chronic Diseases: Relevance for Cancer Survivors

Background: Patient empowerment reflects the ability of patients to positively influence their health and health behavior such as physical activity. While interactive Web-based interventions are increasingly used in various chronic disease settings to enhance empowerment and physical activity, such interventions are still uncommon for cancer survivors. Objective: The objective of this study was to systematically review the literature regarding interactive Web-based interventions. We focused on interventions aimed at increasing patient empowerment and physical activity for various chronic conditions, and explored their possible relevance for cancer survivors. Methods: Searches were performed in PubMed, Embase, and Scopus to identify peer-reviewed papers reporting on randomized controlled trials that studied the effects of Web-based interventions. These interventions were developed for adults with diabetes, cardiovascular disease, chronic obstructive pulmonary disease, heart failure, or cancer. Intervention characteristics, effects on patient empowerment and physical activity, information on barriers to and facilitators of intervention use, users’ experiences, and methodological quality were assessed. Results were summarized in a qualitative way. We used the recommendations of the Institute of Medicine (IOM) regarding cancer survivorship care to explore the relevance of the interventions for cancer survivors. Results: We included 19 papers reporting on trials with 18 unique studies. Significant, positive effects on patient empowerment were reported by 4 studies and 2 studies reported positive effects on physical activity. The remaining studies yielded mixed results or no significant group differences in these outcomes (ie, no change or improvement for all groups). Although the content, duration, and frequency of interventions varied considerably across studies, commonly used elements included education, self-monitoring, feedback/tailored information, self-management training, personal exercise program, and communication (eg, chat, email) with either health care providers or patients. Limited information was found on barriers, facilitators, and users’ experiences. Methodological quality varied, with 13 studies being of moderate quality. The reported Web-based intervention elements appeared to be highly relevant to address the specific needs of cancer survivors as indicated by the IOM. Conclusions: We identified 7 common elements of interactive, Web-based interventions in chronic disease settings that could possibly be translated into eHealth recommendations for cancer survivors. While further work is needed to determine optimal intervention characteristics, the work performed in other chronic disease settings provides a basis for the design of an interactive eHealth approach to improve patient empowerment and physical activity in cancer survivors. This may subsequently improve their health status and quality of life and reduce their need for supportive car

Supporting Lung Cancer Patients With an Interactive Patient Portal:Feasibility Study

BACKGROUND: MyAVL is an interactive portal for cancer patients that aims to support lung cancer patients. OBJECTIVE: We aimed to evaluate the feasibility and usability of the patient portal and generate preliminary evidence on its impact. METHODS: Lung cancer patients currently or recently treated with curative intent could use MyAVL noncommittally for 4 months. Feasibility, usability, and preliminary impact (ie, patient activation, quality of life, and physical activity) were studied by means of questionnaires, a focus group, and analysis of user log data. RESULTS: We included 37 of 123 eligible patients (mean age 59.6 years). The majority of responses (82%) were positive about using MyAVL, 69% saw it as a valuable addition to care, and 56% perceived increased control over their health. No positive effects could be substantiated on the impact measures. CONCLUSIONS: MyAVL appears to be a feasible and user-friendly, multifunctional eHealth program for a selected group of lung cancer patients. However, it needs further improvements to positively impact patient outcomes

eHealth for Breast Cancer Survivors: Use, Feasibility and Impact of an Interactive Portal

Background: MijnAVL is an interactive portal including patient education, overview of appointments, access to the electronic medical records (EMR), patient-reported outcomes, plus feedback and physical activity support. Objective: With this study we aimed to evaluate the use, feasibility, and impact of MijnAVL among breast cancer survivors. Methods: We included survivors currently or recently treated with curative intent, who completed questions on sociodemographics, patient activation (PAM), quality of life (SF-36), and physical activity (IPAQ). MijnAVL could be used noncommittally for four months. Log data were collected retrospectively and participants completed questions on acceptability, satisfaction, and the PAM, SF-36 and IPAQ. Results: Ninety-two women (mean age 49.5 years, 59% on-treatment) participated, with a mean number of logins of 8.7. Overview of appointments (80% of participants) and access to the EMR (90%) were most frequently used and most highly valued. Average website user satisfaction was 3.8 on a 5-point scale. Although participants reported having more knowledge and experiencing more control of their situation after using MijnAVL, PAM scores did not change significantly. Three domains of the SF-36 (role functioning - emotional, mental health, and social functioning) and median vigorous physical activity improved significantly over time. The burden of MijnAVL for professionals was limited. Conclusions: User experiences were positive and exposure to MijnAVL was accompanied by improvements in three quality of life domains and vigorous physical activity. Tailored features may be needed to enhance the usefulness and efficacy of MijnAVL. Research with a controlled design is needed to confirm our findings

Joint Health, Functional Ability and Physical Activity in Haemophilia

In haemophilia outcome measurement has long been strongly focused on the level of body functions and structures while functional outcome and physical activity have been underrepresented. However, the past decade a shift has been made to a more total evaluation of the patients’ functional health status including the assessment of functional ability. Because adequate tools to measure functional ability were lacking, especially for children, the paediatric haemophilia activities list (PedHAL) was developed and tested in a Dutch and Romanian population. The PedHAL has shown to be feasible, valid and reliable. Future studies should be aimed at further refining this instrument. The historical cautiousness of health providers with regard to physical activity in patients with haemophilia may have led to a lack of knowledge in this area. With modern treatment, both participation and intensity of physical activity are increasing and may positively affect joint health and physical fitness; however it is not clear to what extent. A cross sectional study was performed to address this issue. It was found that children with haemophilia were as active as the general population and had normal levels of cardiorespiratory fitness. Children with severe haemophilia participated more in swimming and less in competitive soccer compared to children with non-severe haemophilia. We did not find a clear relation between activity levels, joint health and cardiorespiratory fitness, which might be explained by the relative good joint health status and the questionable reliability of self reported physical activity measure used in this study. Physical activity is increasingly advocated for haemophilic patients both in developed and developing countries. However, no systematic review and appraisal of current knowledge of exercise interventions in patients with haemophilia had been performed. In order to better understand the effects of exercise interventions on patients with haemophilia we conducted a systematic literature review. We included nine articles in a qualitative analysis. Overall the level of evidence and the quality of the included studies was low and therefore the evidence base for exercise interventions was rated as poor for all interventions and outcomes. Moreover, the description of training parameters was generally unsatisfactory and outcome measures used lacked uniformity. Suggestions for improving study methodology and training theory were proposed in order to help this field forward. In addition to late training effects, exercise may also have acute beneficial effects in haemophilia patients. We studied the effect of strenuous physical exercise on the level of clotting factor in patients with mild and moderate haemophilia A. Patients showed consistently increase in FVIII levels after exercise with a median increase of 2.5 times baseline activity. Even though these results are promising, the practical value of these findings requires further study

A power balance model for handcycling.

Purpose To demonstrate the applicability of the power balance model to elite handcycling and to obtain values for gross efficiency (GE). Methods Four members of the Dutch Paralympic team performed trials on a 250-m indoor track. Velocity (v) and power output (PO) were measured in conjunction with physiological measures to obtain values for GE. The data were used to construct and validate a power balance model of handcycling. Results.The empirically derived relationship between PO and velocity was: PO0.20