Effect of computer support on younger women with breast cancer Examination of program exposure across intervention delivery modes: face-to-face versus internet Using Internet technology to deliver a behavioral weight loss program. Interapy: a controlled randomized trial of the standardized treatment of posttraumatic stress through the internet. A Field Test of a Web-Based Workplace Health Promotion Program to Improve Dietary Practices, Reduce Stress, and Increase Physical Activity: Randomized Controlled Trial Overcoming Depression on the Internet (ODIN): A Randomized Controlled Trial of an Internet Depression Skills Intervention Program Effectiveness of a Web-Based Self-Help Intervention for Symptoms of Depression, Anxiety, and Stress: Randomized Controlled Trial Improving Patient-Clinician Communication About Chronic Conditions: Description of an Internet-Based Nurse E-Coach Intervention Effectiveness of an Internet-based program for reducing risk factors for eating disorders. Randomized control trial of a behavioral intervention for overweight women: impact on depressive symptoms. The diabetes network internet-based physical activity intervention: a randomized pilot study. Randomized Controlled Trial of Internet-Based Cognitive Behavior Therapy for Distress Associated With Tinnitus Web-based Cognitive Behavior Therapy: Analysis of Site Usage and Changes in Depression and Anxiety Scores Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. Online psychoeducational support for infertile women: a randomized controlled trial. Design and Implementation of an Interactive Website to Support Long-Term Maintenance of Weight Loss A pilot-study to identify the feasibility of an Internet-based coaching programme for changing the vascular risk profile of high-risk patients. Internet-Based Chronic Disease Self-Management: A Randomized Trial An internet-based approach to enhance self-management of chronic low back pain in the Italian-speaking population of Switzerland: results from a pilot study Retention in a computer-based outreach intervention for chronically ill rural women. A randomized controlled trial of a commercial internet weight loss program. Controlled trial of Internet-based treatment with telephone support for chronic back pain Print versus website physical activity programs: a randomized trial. A controlled trial of self-help treatment of recurrent headache conducted via the Internet. Do Internet-Based Support Interventions Change Perceptions of Social Support?: An Experimental Trial of Approaches for Supporting Diabetes Self-Management Clinical trial of an Internet-based case management system for secondary prevention of heart disease. E‐Mailed Standardized Cognitive Behavioural Treatment of Work‐Related Stress: A Randomized Controlled Trial Evaluation of an interactive, Internet-based weight loss program: a pilot study. An online family intervention to reduce parental distress following pediatric brain injury. A randomized controlled trial of an internet-based treatment for chronic headache. Web-based tailored nutrition education: results of a randomized controlled trial. A randomized controlled study to evaluate the efficacy of an Internet-based intervention in reducing HIV risk behaviors among men who have sex with men in Hong Kong Rural women with chronic illness: computer use and skill acquisition. Internet-based treatment for insomnia: a controlled evaluation. Internet Telehealth for Pediatric Asthma Case Management: Integrating Computerized and Case Manager Features for Tailoring a Web-Based Asthma Education Program The Feasibility of Using Internet Support for the Maintenance of Weight Loss Computerized behavior therapy for opioid-dependent outpatients: a randomized controlled trial. Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial Internet-based treatment of headache: does telephone contact add anything? Maintenance of weight loss in overweight middle-aged women through the Internet.
Abstract OBJECTIVE : Assess impact of a computer-based patient support system on quality of life in younger women with breast cancer , with particular emphasis on assisting the underserved . DESIGN : R and omized controlled trial conducted between 1995 and 1998 . SETTING : Five sites : two teaching hospitals ( Madison , Wis , and Chicago , Ill ) , two nonteaching hospitals ( Chicago , Ill ) , and a cancer re source center ( Indianapolis , Ind ) . The latter three sites treat many underserved patients . PARTICIPANTS : Newly diagnosed breast cancer patients ( N=246 ) under age 60 . INTERVENTIONS : Experimental group received Comprehensive Health Enhancement Support System ( CHESS ) , a home-based computer system providing information , decision-making , and emotional support . MEASUREMENTS AND MAIN RESULTS : Pretest and two posttest surveys ( at two- and five-month follow-up ) measured aspects of participation in care , social/information support , and quality of life . At two-month follow-up , the CHESS group was significantly more competent at seeking information , more comfortable participating in care , and had greater confidence in doctor(s ) . At five-month follow-up , the CHESS group had significantly better social support and also greater information competence . In addition , experimental assignment interacted with several indicators of medical underservice ( race , education , and lack of insurance ) , such that CHESS benefits were greater for the disadvantaged than the advantaged group . CONCLUSIONS : Computer-based patient support systems such as CHESS may benefit patients by providing information and social support , and increasing their participation in health care . These benefits may be largest for currently underserved population Background There has been increasing interest in the ability of the internet to produce behaviour change . The focus of this study was to describe program exposure across three intervention groups from a r and omised trial ( RT ) comparing traditional face-to-face , internet-mediated ( combined internet plus face-to-face ) , and internet-only program delivery . Methods Baseline and immediately post-intervention survey data , and exposure rates from participants that commenced the RT were included ( n = 192 ) . Exposure was defined as either face-to-face attendance , website usage , or a combination of both for the internet-mediated group . Characteristics of participants who were exposed to at least 75 % of the program material were explored . Descriptive analysis and logistical regression were used to examine differences between groups for program exposure . Results All groups showed decrease in program exposure over time . Differences were also observed ( χ2 = 10.37 , p < 0.05 ) , between intervention groups . The internet-mediated ( OR = 2.4 , 95 % CI 1.13–5.1 ) and internet-only ( OR = 2.96 , 95 % CI 1.38–6.3 ) groups were more likely to have been exposed to at least 75 % of the program compared to the face-to-face group . Participants with high physical activity self-efficacy were 1.82 ( 95 % CI 1.15–2.88 ) times more likely to have been exposed to 75 % of the program , and those allocated to the face-to-face group were less likely to have attended 75 % of the face-to-face sessions if they were classified as obese ( OR = 0.21 95 % CI 0.04–0.96 ) . Conclusion These results suggest that the internet groups were as effective as the face-to-face delivery mode in engaging participants in the program material . However , different delivery methods may be more useful to different sub- population s. It is important to explore which target groups that internet-based programs are best suited , in order to increase their impact CONTEXT Rapid increases in access to the Internet have made it a viable mode for public health intervention . No controlled studies have evaluated this re source for weight loss . OBJECTIVE To determine whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site . DESIGN R and omized , controlled trial conducted from April to December 1999 . SETTING AND PARTICIPANTS Ninety-one healthy , overweight adult hospital employees aged 18 to 60 years with a body mass index of 25 to 36 kg/m(2 ) . Analyses were performed for the 65 who had complete follow-up data . INTERVENTIONS Participants were r and omly assigned to a 6-month weight loss program of either Internet education ( education ; n = 32 with complete data ) or Internet behavior therapy ( behavior therapy ; n = 33 with complete data ) . All participants were given 1 face-to-face group weight loss session and access to a Web site with organized links to Internet weight loss re sources . Participants in the behavior therapy group received additional behavioral procedures , including a sequence of 24 weekly behavioral lessons via e-mail , weekly online su bmi ssion of self-monitoring diaries with individualized therapist feedback via e-mail , and an online bulletin board . MAIN OUTCOME MEASURES Body weight and waist circumference , measured at 0 , 3 , and 6 months , compared the 2 intervention groups . RESULTS Repeated- measures analyses showed that the behavior therapy group lost more weight than the education group ( P = .005 ) . The behavior therapy group lost a mean ( SD ) of 4.0 ( 2.8 ) kg by 3 months and 4.1 ( 4.5 ) kg by 6 months . Weight loss in the education group was 1.7 ( 2.7 ) kg at 3 months and 1.6 ( 3.3 ) kg by 6 months . More participants in the behavior therapy than education group achieved the 5 % weight loss goal ( 45 % vs 22 % ; P = .05 ) by 6 months . Changes in waist circumference were also greater in the behavior therapy group than in the education group at both 3 months ( P = .001 ) and 6 months ( P = .005 ) . CONCLUSIONS Participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites . Thus , the Internet and e-mail appear to be viable methods for delivery of structured behavioral weight loss programs Online therapy offers many advantages over face-to-face therapy . Interapy includes psychoeducation , screening , effect measures , and a protocol -driven treatment via the Internet for people suffering from posttraumatic stress . The present article reports the results of a controlled trial on the Internet-driven treatment of posttraumatic stress and grief in a group of people who manifested mild to relatively severe trauma symptoms . Participants in the treatment condition ( n=69 ) improved significantly more than participants in the waiting-list control condition ( n=32 ) on trauma-related symptoms and general psychopathology . The effect sizes were large . On most subscales , more than 50 % of the treated participants showed reliable change and clinical ly significant improvement , with the highest percentages being found for depression and avoidance Background Most work sites engage in some form of health promotion programming design ed to improve worker health and reduce health care costs . Although these programs have typically been delivered through combinations of seminars and print material s , workplace health promotion programs are increasingly being delivered through the Internet . Objective The purpose of this research was to evaluate the effectiveness of a Web-based multimedia health promotion program for the workplace , design ed to improve dietary practice s , reduce stress , and increase physical activity . Methods Using a r and omized controlled trial design with pretest-posttest comparisons within each group , 419 employees of a human re sources company were r and omly assigned to the Web-based condition or to a condition that provided print material s on the same topics . All subjects were assessed at pretest and posttest through an online question naire containing multiple measures of health behavior and attitudes . The test period was 3 months . Question naire data were analyzed mainly by analysis of covariance and t tests . Results Retention rates were good for both groups—85 % for the Web-based group and 87 % for the print group . Subjects using the Web-based program performed significantly better than the print group on Attitudes Toward a Healthful Diet ( F1,415 = 7.104 , P = .008 ) and Dietary Stage of Change ( F1,408 = 6.487 , P = .01 ) , but there were no significant group differences on the five other dietary measures . Both groups also showed improvement from pretest to posttest on most dietary measures , as indicated by significant t tests . Within the Web-based group , dosage analyses showed significant effects of the number of times the subject accessed the program on measures of Dietary Self-Efficacy ( F2,203 = 5.270 , P = .003 ) , Attitudes Toward a Healthful Diet ( F2,204 = 2.585 , P = .045 ) , and Dietary Stage of Change ( F2,200 = 4.627 , P = .005 ) . No significant differences were found between the two groups on measures of stress or physical activity , although t tests of pretest-posttest changes indicated that both groups improved on several of these measures . The Web-based group gave significantly higher ratings to the program material s than the print group on all health topics and in their overall evaluation ( F1,410 = 9.808 , P = .002 ) . Conclusions The Web-based program was more effective than print material s in producing improvements in the areas of diet and nutrition but was not more effective in reducing stress or increasing physical activity . The higher ratings given to the Web-based program suggest that workers preferred it to the print material s. Both groups showed numerous pretest-posttest improvements in all health topics , although such improvements might be attributable in part to a Hawthorne effect . Results suggest that a multimedia Web-based program can be a promising means of delivering health promotion material to the workforce , particularly in the area of diet and nutrition Background Psychoeducational programs are increasingly being delivered over the Internet . We created an Internet-based , cognitive therapy , self-help program to be used as a st and -alone intervention for mild-to-moderate depression , or as an adjunct to traditional services for more severe depression . Objective To evaluate the effectiveness of a web-based intervention program to reduce depression in a r and omized , controlled trial Methods In a private , nonprofit health maintenance organization , we mailed recruitment brochures to two population s : depressed adults ( n = 6994 ) who received traditional medical services for depression , and an age/gender matched sample of nondepressed adults ( n = 6996 ) . Participants consenting to the study were r and omized to either the experimental Web site ( n = 144 ) , or a no-access control group ( n = 155 ) . Participants in both groups were free to obtain nonexperimental , usual care services for their depression . All participants completed an on-line version of the Center for Epidemiological Studies Depression Scale ( CES-D ) at enrollment and at 4- , 8- , 16- and 32-weeks after enrollment . Mean intake scores were in the severely depressed range . 74 % of participants completed at least one follow-up assessment . Unfortunately , most intervention participants accessed the Internet site infrequently . Results We failed to find an effect for the Internet program across the entire sample . However , post-hoc , exploratory analyses revealed a modest effect among persons reporting low levels of depression at intake . Conclusions The negative results might have result ed from infrequent patient use of the Internet site , or a more seriously depressed sample than the intervention was intended to help . Future studies should focus on recruiting persons with mild to moderate levels of depression , and on increasing participant use of the Internet site Background Self-help therapies are often effective in reducing  mental health problems .  We developed a new Web-based self-help intervention based on problem-solving therapy , which may be used for people with different types of comorbid problems : depression , anxiety , and work-related stress . Objective The aim was to study whether a Web-based self-help intervention is effective in reducing depression , anxiety , and work-related stress ( burnout ) . Methods A total of 213 participants were recruited through mass media and r and omized to the intervention ( n = 107 ) or a waiting list control group ( n = 106 ) . The Web-based course took 4 weeks . Every week an automated email was sent to the participants to explain the contents and exercises for the coming week . In addition , participants were supported by trained psychology students who offered feedback by email on the completed exercises . The core element of the intervention is a procedure in which the participants learn to approach solvable problems in a structured way . At pre-test and post-test , we measured the following primary outcomes : depression ( CES-D and MDI ) , anxiety ( SCL-A and HADS ) , and work-related stress ( MBI ) . Quality of life ( EQ-5D ) was measured as a secondary outcome . Intention-to-treat analyses were performed . Results Of the 213 participants , 177 ( 83.1 % ) completed the baseline and follow-up question naires ; missing data were statistically imputed . Of all 107 participants in the intervention group , 9 % ( n = 10 ) dropped out before the course started and 55 % ( n = 59 ) completed the whole course . Among all participants , the intervention was effective in reducing symptoms of depression ( CES-D : Cohen ’s d = 0.50 , 95 % confidence interval ( CI ) 0.22 - 0.79 ; MDI : d = 0.33 , 95 % CI 0.03 - 0.63 ) and anxiety ( SCL-A : d = 0.42 , 95 % CI 0.14 - 0.70 ; HADS : d = 0.33 , 95 % CI 0.04 - 0.61 ) as well as in enhancing quality of life ( d = 0.31 , 95 % CI 0.03 - 0.60 ) . Moreover , a higher percentage of patients in the intervention group experienced a significant improvement in symptoms ( CES-D : odds ratio [ OR ] = 3.5 , 95 % CI 1.9 - 6.7 ; MDI : OR = 3.7 , 95 % CI 1.4 - 10.0 ; SCL-A : OR = 2.1 , 95 % CI 1.0 - 4.6 ; HADS : OR = 3.1 , 95 % CI 1.6 - 6.0 ) . Patients in the intervention group also recovered more often ( MDI : OR = 2.2 ; SCL-A : OR = 2.0 ; HADS < 8) , although these results were not statistically significant . The course was less effective for work-related stress , but participants in the intervention group recovered more often from burnout than those in the control group ( OR = 4.0 , 95 % CI 1.2 - 13.5 ) . Conclusions We demonstrated statistically and clinical ly significant effects on symptoms of depression and anxiety . These effects were even more pronounced among participants with more severe baseline problems and for participants who fully completed the course . The effects on work-related stress and quality of life were less clear . To our knowledge , this is the first trial of a Web-based , problem-solving intervention for people with different types of ( comorbid ) emotional problems . The results are promising , especially for symptoms of depression and anxiety . Further research is needed to enhance the effectiveness for work-related stress . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) Background : Studies show that patients who have higher self-efficacy and participate actively in their care have better disease management . Patient-provider Internet portals offer an exciting new venue for empowering and engaging patients in better management of chronic conditions . Objectives : To describe development of an Internet-based health coaching intervention . Approach : An Internet-based health coaching intervention to enhance patient-provider communication regarding three common conditions , chronic pain , depression , and impaired mobility , was developed . Using principles of self-management , the intervention aim ed to engage and empower patients to collaborate with their primary care physician in managing their health conditions . Delivered online by nurse electronic coaches ( e-coaches ) , the intervention involved a st and ardized set of e-mails and worksheets targeting self-efficacy , patient education , and motivation to improve health . Results : Participants in the intervention ( N = 121 ) primarily used the automated elements of the program , although 35 % exchanged e-mails with the nurse e-coach . Most patients ( 88 % ) who contacted the e-coach were interested in further coaching . Patients who viewed the online worksheets did so repeatedly ; 42 patients opened the worksheets 107 times prior to the visit . Discussion : The Internet-based coaching intervention departs substantially from usual nursing care but warrants further study given its potential to offer considerable benefits to large numbers of patients . Several challenges were identified to providing patient coaching and self-management support via the Internet , but this efficient and low-cost approach offers an innovative opportunity to improve patient-clinician partnerships in managing chronic conditions . As patients become more accustomed to electronic communication , nurses can play an important role , joining efforts to develop this new realm to promote patients as partners in managing their health conditions This study evaluated an Internet-delivered computer-assisted health education ( CAHE ) program design ed to improve body satisfaction and reduce weight/shape concerns -- concerns that have been shown to be risk factors for the development of eating disorders in young women . Participants were 60 women at a public university r and omly assigned to either an intervention or control condition . Intervention participants completed the  CAHE program Student Bodies .  Measures of body image and disordered eating attitudes were assessed at baseline , postintervention , and 3-month follow-up . At follow-up , intervention participants , compared with controls , reported a significant improvement in body image and a decrease in drive for thinness . This program provides evidence for the feasibility and effectiveness of providing health education by means of the Internet Phone and Internet-based interventions can improve the management of depression in primary care , and interventions using these communication channels are increasingly used to improve behaviors such as diet and physical activity . Increased physical activity has been shown to improve depressive symptoms , but to date there are no reports of the effects of a phone and Internet diet and exercise intervention on symptoms of depression in patients seen in primary care . This study assessed  depressive symptoms in 401 participants in a r and omized control trial of a 12-month primary care , phone and Internet-based behavioral intervention for overweight women . A one-way analysis of variance examining the mean change in Center for Epidemiological Studies Depression ( CESD ) score from baseline to 12 months , controlling for age , education , marital status , and employment showed that those receiving the intervention significantly decreased their CESD scores ( P=.03 ) more than those receiving st and ard care . Although the intervention did not target depressed individuals or present material relating to mood management , those with probable depression ( 27 % of the whole sample ) showed clinical ly important improvements-a mean five-point change on the CESD short form . Participants who engaged more readily with the intervention were more likely to reduce their depression scores . A 1-year primary care based phone and Internet diet and exercise intervention can improve depressive symptoms in overweight women . Given the promise of phone and Internet-based interventions to improve both depression and lifestyle-related behaviors , and given that such interventions could extend the reach of primary care to many individuals at relatively low cost , these results suggest the need for further research , including the effects of additional mood management components OBJECTIVE Because of other competing priorities ,  physical activity ( PA ) is seldom addressed in a consistent way in either primary care or diabetes education . This 8-week pilot study evaluated the short-term benefits of an Internet-based supplement to usual care that focused on providing support for sedentary patients with type 2 diabetes to increase their PA levels . RESEARCH DESIGN AND METHODS A total of 78 type 2 diabetic patients ( 53 % female , average age 52.3 years ) were r and omized to the Diabetes Network ( D-Net ) Active Lives PA Intervention or an Internet information-only condition .  The intervention condition received goal - setting and personalized feedback , identified and developed strategies to overcome barriers , received and could post messages to an on-line " personal coach , " and were invited to participate in peer group support areas . Key outcomes included minutes of PA per week and depressive symptomatology . RESULTS There was an overall moderate improvement in PA levels within both intervention and control conditions , but there was no significant improvement in regard to condition effects . There was substantial variability in both site use and outcomes within the intervention and control conditions . Internal analyses revealed that among intervention participants , those who used the site more regularly derived significantly greater benefits , whereas those in the control condition derived no similar benefits with increased program use . CONCLUSIONS Internet-based self-management interventions for  PA and other regimen areas have great potential to enhance the care of diabetes and other chronic conditions . We conclude that greater attention should be focused on methods to sustain involvement with Internet-based intervention health promotion programs over time Objective The aim of this study was to investigate if cognitive behavior therapy ( CBT ) provided via the Internet results in significant decreases of distress in individuals with tinnitus . Methods Participants were recruited through Web pages and newspaper articles and thereafter r and omly allocated to a CBT self-help manual in six modules or to a waiting-list control group ( WLC ) . All treatment and contact with participants were conducted via the Internet with Web pages and E-mail correspondence . Participants were 117 individuals with tinnitus of duration of more than 6 months . In the first r and omized controlled phase of the study , 26 completed all stages of treatment ( 51 % dropout ) , and 64 of the WLC group completed measures . At 1-year follow-up , all participants had been offered the program and 96 provided outcome measures ( 18 % dropout rate from baseline ) . Tinnitus-related problems were assessed before and after treatment and at the 1-year follow-up . Daily diary ratings were included for 1 week before and 1 week following the treatment period . Results Tinnitus-related distress , depression , and diary ratings of annoyance decreased significantly . Immediately following the r and omized controlled phase ( with a WLC ) , significantly more participants in the treatment group showed an improvement of at least 50 % on the Tinnitus Reaction Question naire . At the uncontrolled follow-up , 27 ( 31 % ) of all participants had achieved a clinical ly significant improvement . Conclusions CBT via the Internet can help individuals decrease annoyance associated with tinnitus . High dropout rates or delay in completing treatment can be a characteristic of treatment studies using the Internet but should be contrasted with the cost effectiveness and accessibility of the Internet Background Cognitive behavior therapy is well recognized as an effective treatment and prevention for depression when delivered face-to-face , via self-help books ( bibliotherapy ) , and through computer administration . The public health impact of cognitive behavior therapy has been limited by cost and the lack of trained practitioners . We have developed a free Internet-based cognitive behavior therapy intervention ( MoodGYM , http://moodgym.anu.edu.au ) design ed to treat and prevent depression in young people , available to all Internet users , and targeted to those who may have no formal contact with professional help services . Objective To document site usage , visitor characteristics , and changes in depression and anxiety symptoms among users of MoodGYM , a Web site delivering a cognitive-behavioral-based preventive intervention to the general public . Methods All visitors to the MoodGYM site over about 6 months were investigated , including 2909 registrants of whom 1503 had completed at least one online assessment . Outcomes for 71 university students enrolled in an Abnormal Psychology course who visited the site for educational training were included and examined separately . The main outcome measures were ( 1 ) site-usage measures including number of sessions , hits and average time on the server , and number of page views ; ( 2 ) visitor characteristics including age , gender , and initial Goldberg self-report anxiety and depression scores ; and ( 3 ) symptom change measures based on Goldberg anxiety and depression scores recorded on up to 5 separate occasions . Results Over the first almost-6-month period of operation , the server recorded 817284 hits and 17646 separate sessions . Approximately 20 % of sessions lasted more than 16 minutes . Registrants who completed at least one assessment reported initial symptoms of depression and anxiety that exceeded those found in population -based surveys and those characterizing a sample of University students . For the Web-based population , both anxiety and depression scores decreased significantly as individuals progressed through the modules . Conclusions Web sites are a practical and promising means of delivering cognitive behavioral interventions for preventing depression and anxiety to the general public . However , r and omized controlled trials are required to establish the effectiveness of these interventions CONTEXT Weight loss programs on the Internet appear promising for short-term weight loss but have not been studied for weight loss in individuals at risk of type 2 diabetes ; thus , the longer-term efficacy is unknown . OBJECTIVE To compare the effects of an Internet weight loss program alone vs with the addition of behavioral counseling via e-mail provided for 1 year to individuals at risk of type 2 diabetes . DESIGN , SETTING , AND PARTICIPANTS A single-center r and omized controlled trial conducted from September 2001 to September 2002 in Providence , RI , of 92 overweight adults whose mean ( SD ) age was 48.5 ( 9.4 ) years and body mass index , 33.1 ( 3.8 ) . INTERVENTIONS Participants were r and omized to a basic Internet ( n = 46 ) or to an Internet plus behavioral e-counseling program ( n = 46 ) . Both groups received 1 face-to-face counseling session and the same core Internet programs and were instructed to su bmi t weekly weights . Participants in e-counseling su bmi tted calorie and exercise information and received weekly e-mail behavioral counseling and feedback from a counselor . MAIN OUTCOME MEASURES Measured weight and waist circumference at 0 and 12 months . RESULTS Intent-to-treat analyses showed the behavioral e-counseling group lost more mean ( SD ) weight at 12 months than the basic Internet group ( -4.4 [ 6.2 ] vs -2.0 [ 5.7 ] kg ; P = .04 ) , and had greater decreases in percentage of initial body weight ( 4.8 % vs 2.2 % ; P = .03 ) , body mass index ( -1.6 [ 2.2 ] vs -0.8 [ 2.1 ] ; P = .03 ) , and waist circumference ( -7.2 [ 7.5 ] vs -4.4 [ 5.7 ] cm ; P = .05 ) . CONCLUSION Adding e-mail counseling to a basic Internet weight loss intervention program significantly improved weight loss in adults at risk of diabetes BACKGROUND The study goal was to develop and test the effectiveness of a brief online education and support program for female infertility patients . METHODS A r and omized-controlled trial was conducted . Using a Solomon-four group design , 190 female patients were recruited from three US fertility centers and were r and omized into two experimental and two no-treatment control groups . The psychological outcomes assessed included infertility distress , infertility self-efficacy , decisional conflict , marital cohesion and coping style . Program dosage and satisfaction were also assessed at four weeks follow-up . RESULTS Women exposed to the online program significantly improved in the area of social concerns ( P = 0.038 ) related to infertility distress , and felt more informed about a medical decision with which they were contending ( P = 0.037 ) . Trends were observed for decreased global stress(P = 0.10 ) , sexual concerns ( P = 0.059 ) , distress related to child-free living ( P = 0.063 ) , increased infertility self-efficacy ( P = 0.067 ) and decision making clarity ( P = 0.079 ) . A dosage response was observed in the experimental groups for women who spent > 60 min online for decreased global stress ( P = 0.028 ) and increased self efficacy ( P = 0.024 ) . CONCLUSIONS This evidence -based eHealth program for women experiencing infertility suggests that a web-based patient education intervention can have beneficial effects in several psychological domains and may be a cost effective re source for fertility practice Background For most individuals , long-term maintenance of weight loss requires long-term , supportive intervention . Internet-based weight loss maintenance programs offer considerable potential for meeting this need . Careful design processes are required to maximize adherence and minimize attrition . Objective This paper describes the development , implementation and use of a Web-based intervention program design ed to help those who have recently lost weight sustain their weight loss over 1 year . Methods The weight loss maintenance website was developed over a 1-year period by an interdisciplinary team of public health research ers , behavior change intervention experts , applications developers , and interface design ers . Key interactive features of the final site include social support , self-monitoring , written guidelines for diet and physical activity , links to appropriate websites , supportive tools for behavior change , check-in accountability , tailored reinforcement messages , and problem solving and relapse prevention training . The weight loss maintenance program included a reminder system ( automated email and telephone messages ) that prompted participants to return to the website if they missed their check-in date . If there was no log-in response to the email and telephone automated prompts , a staff member called the participant . We tracked the proportion of participants with at least one log-in per month , and analyzed log-ins as a result of automated prompts . Results The mean age of the 348 participants enrolled in an ongoing r and omized trial and assigned to use the website was 56 years ; 63 % were female , and 38 % were African American . While weight loss data will not be available until mid-2008 , website use remained high during the first year with over 80 % of the participants still using the website during month 12 . During the first 52 weeks , participants averaged 35 weeks with at least one log-in . Email and telephone prompts appear to be very effective at helping participants sustain ongoing website use . Conclusions Developing interactive websites is expensive , complex , and time consuming . We found that extensive paper prototyping well in advance of programming and a versatile product manager who could work with project staff at all levels of detail were essential to keeping the development process efficient . Trial Registration clinical trials.gov OBJECTIVE To evaluate the feasibility of a web-based coaching programme for vascular risk factor treatment , to describe the patterns of use and to measure changes in risk factors . METHODS Patients with a clinical manifestation of arterial disease and Internet access were asked to participate in the nurse-led Internet-based risk factor management programme . At the first clinic visit , a personalized action plan was made for the treatment of risk factors . Patients were instructed on communication with a specialized nurse through Internet and encouraged to enter self-measured risk factor levels at their personalized website . The nurse practitioner replied on working days and gave feedback , support , and recommendations on lifestyle and medical treatment . After 6 months , risk factors were re-measured . RESULTS Fifty patients participated , 70 % were overweight , 64 % had hypertension , 42 % hyperlipidemia , and 24 % smoked at baseline . During 6 months , the log-in average at the individual website was 35 times per patient ( 1.3 log-ins/week ) ; while the nurse practitioner logged-in at the overall website 23 times/week . The website was hardly used by five patients . Most e-mail messages were sent by patients for hypertension ( 211 times ) and obesity ( 203 times ) , whereas the nurse practitioner sent nearly twice as many e-mail messages for hypertension ( 400 times ) and obesity ( 455 times ) . The level of most risk factors decreased and the fraction of achieved treatment goals increased ( blood pressure from 36 to 58 % , LDL-cholesterol from 58 to 64 % , glucose from 64 to 82 % ) . CONCLUSIONS A web-based vascular risk factor intervention programme is feasible ; it is frequently used by patients and suitable to decrease the level of several risk factors . It has the promise of being an efficacious intervention for risk factor sanitation in patients with symptomatic vascular disease . PRACTICE IMPLICATION S An Internet-based individualised risk management programme could make patients aware of their self-management capability and may contribute to risk factor reduction Background : The small-group Chronic Disease Self-Management Program ( CDSMP ) has proven effective in changing health-related behaviors and improving health statuses . An Internet-based CDSMP was developed to reach additional chronic-disease patients . Objectives : We sought to determine the efficacy of the Internet-based CDSMP . Design : We compared r and omized intervention participants with usual-care controls at 1 year . We compared intervention participants with the small-group CDSMP at 1 year . Subjects : Nine-hundred fifty-eight patients with chronic diseases ( heart , lung , or type 2 diabetes ) and Internet and e-mail access were r and omized to intervention ( 457 ) or usual care control ( 501 ) . Measures : Measures included 7 health status variables ( pain , shortness of breath , fatigue , illness intrusiveness , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 3 utilization variables ( physician visits , emergency room visits , and nights in hospital ) , and self-efficacy . Results : At 1 year , the intervention group had significant improvements in health statuses compared with usual care control patients . The intervention group had similar results to the small-group  CDSMP participants . Change in self-efficacy at 6 months was found to be associated with better health status outcomes at 1 year . Conclusions : The Internet-based CDSMP proved effective in improving health statutes by 1 year and is a viable alternative to the small-group Chronic Disease Self Management Program Summary Objective : To illustrate the development and pilot evaluation of a website design ed to enhance self-management of chronic low back pain for the Italian-speaking population of Switzerl and . Methods : 20 patients affected by chronic low back pain used a website – specifically created for the project – for a period of five months , under the monitoring of a team of health professionals . Evaluation was carried out by means of a telephone question naire administered at baseline and at the end of the intervention , and intermediate online user-testing performed in the fourth month of the intervention . A control group of 15 patients was created to assist the evaluation . Results : Compared to the control group , results from the pilot evaluation suggest a decrease in the intensity of back pain in people with access to the website ; an increase in physical activity ; a reduction in both medical consultation and the use of painkillers , and a gain in declarative and procedural knowledge . This coincides with a general positive assessment of the website . Conclusion : The study supports the need to test the proposed approach on a wider scale The study 's purpose was to examine retention factors in a computer intervention with 158 chronically ill rural women . After a 22-week intervention , 18.9 % of the women had dropped out . A Cox regression survival analysis was performed to assess the effects of selected covariates on retention . Reasons for dropping out were tallied and categorized . Major reasons for dropping out were as follows : lack of time , decline in health status , and nonparticipation in study activities . Four covariates predicted survival time : level of computer skills , marital status , work outside the home , and impact of social events on participants ' lives . Retention-enhancing strategies are suggested for implementation OBJECTIVE To assess , in a 1-year r and omized controlled trial , the efficacy of eDiets.com ( a commercial Internet weight loss program ) in improving weight , cardiovascular health , and quality of life . RESEARCH METHODS AND PROCEDURES Participants were 47 women with a mean age of 43.7 + /- 10.2 ( SD ) years and a mean BMI of 33.5 + /- 3.1 kg/m2 . They were r and omly assigned to either : 1 ) eDiets.com , a commercial Internet-based program available to the public ; or 2 ) a weight loss manual ( i.e. , LEARN Program for Weight Control 2000 ) . At baseline , participants in both groups met briefly with a psychologist who instructed them to follow the components of their program as closely as possible . Additional brief visits were provided at weeks 8 , 16 , 26 , and 52 to review their progress . Change in weight was the main outcome measure . RESULTS At week 16 , participants in eDiets.com lost 0.9 + /- 3.2 % of initial weight compared with 3.6 + /- 4.0 % for women assigned to the weight loss manual . At week 52 , losses increased to 1.1 + /- 4.0 % and 4.0 + /- 5.1 % , respectively . Results of a last-observation-carried-forward analysis found that women in the manual group lost significantly ( p < 0.05 ) more weight ( at both times ) than those treated by eDiets.com . ( Results , however , of baseline-carried-forward and completers analyses did not reach statistical significance . ) There were no significant differences between groups in changes in cardiovascular risk factors or quality of life . DISCUSSION This study provides consumers with important information about the probable benefits they can expect from participating in a popular Internet-based weight loss program Abstract The purpose of this study was to investigate the effects of an Internet‐based cognitive‐behavioral intervention with telephone support for chronic back pain . Participants who met the criteria for chronic back pain ( N=56 ) were r and omly assigned to either an Internet‐based cognitive behavioral self‐help treatment or to a waiting‐list control condition . The study period lasted 8 weeks and consisted of 1 week of self‐monitoring prior to the intervention , 6 weeks of intervention , and 1 week of post‐intervention assessment . Treatment consisted of education , cognitive skill acquisition , behavioral rehearsal , generalization and maintenance . The dropout rate was 9 % ( N=5 ) . Results showed statistically significant improvements in catastrophizing , control over pain and ability to decrease pain . Some improvement was found in both the control group and the treatment group . A follow‐up of 3 months after treatment termination was completed in 92 % ( N=47 ) of the participants who completed the treatment intervention . Follow‐up results showed that some improvement was maintained . Findings indicate that Internet‐based self‐help with telephone support , based on established psychological treatment methods , holds promise as an effective approach for treating disability in association with pain BACKGROUND Mediated physical activity interventions can reach large numbers of people at low cost . Programs delivered through the mail that target the stage of motivational readiness have been shown to increase activity . Communication technology ( websites and e-mail ) might provide a means for delivering similar programs . METHODS R and omized trial conducted between August and October 2001 . Participants included staff at an Australian university ( n=655 ; mean age=43 , st and ard deviation , 10 years ) . Participants were r and omized to either an 8-week , stage-targeted print program ( Print ) or 8-week , stage-targeted website ( Web ) program . The main outcome was change in self-reported physical activity . RESULTS There was no significant increase in total reported physical activity within or between groups when analyzed by intention to treat ( F [1,653]=0.41 , p=0.52 ) . There was a significant increase in total physical activity reported by the Print participants who were inactive at baseline ( t [1,173]=-2.21 , p=0.04 ) , and a significant decrease in the average time spent sitting on a weekday in the Web group ( t [1,326]=2.2 , p=0.03 ) . CONCLUSIONS There were no differences between the Print and Web program effects on reported physical activity . The Print group demonstrated slightly larger effects and a higher level of recognition of program material The Internet can reach a large number of people at a low cost and offers the opportunity for 2-way communication . The present study was design ed to evaluate the effects of applied relaxation and problem solving in the treatment of recurrent headache when implemented via the Internet and E-mail . A group of 102 headache sufferers were r and omized to 2 conditions : a 6-week treatment condition or a waiting-list control . The dropout was proportionately large ( 56 % ) , and at the end of the study there were 20 participants in the treatment condition and 25 participants in the control condition . Results showed statistically significant reductions in headache for the treated participants . In 50 % of these , the reduction was clinical ly significant . The Internet has the potential to serve as a complement in the treatment of recurrent headache and deserves further study Internet-based support groups are a rapidly growing segment of mutual aid programs for individuals with chronic illnesses and other challenges . Previous studies have informed us about the content of online exchanges between support group members , but we know little about the ability of these interventions to change participants ' perceptions of support . A r and omized trial of 160 adult Type 2 diabetes patients provided novice Internet users with computers and Internet access to 1 of 4 conditions :  (  a ) diabetes information only , ( b ) a personal self-management coach , ( c ) a social support intervention , or ( d ) a personal self-management coach and the support intervention . After 3 months , individuals in the 2 support conditions reported significant increases in support on a diabetes-specific support measure and a general support scale . Participants ' age was significantly related to change in social support , but intervention effects were still significant after accounting for this relationship . This report is a critical first step in evaluating the long-term effects of  Internet-based support for diabetes self-management . The discussion identifies directions for future research PURPOSE Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction , only 11 % to 38 % of eligible patients with cardiovascular disease ( CVD ) participate in cardiac rehabilitation programs .  Women and older adults are particularly less likely to participate in cardiac rehabilitation . In an effort to broaden access to cardiac rehabilitation , the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training , risk factor education , and monitoring services to patients with CVD . METHODS The evaluation consisted of a r and omized , clinical trial involving 104 patients with CVD , 53 of whom used the program as a special intervention ( SI ) for 6 months and 51 of whom received usual care ( UC ) .  RESULTS The results indicate that fewer cardiovascular events occurred among the SI subjects ( 15.7 % ) than among the UC subjects ( 4.1 % ) ( P = .053 ) , result ing in a gross cost savings of $ 1418 US dollars per patient . With a projected program cost of $ 453 USD per patient , the return on investment is estimated at 213 % . More weight loss occurred in the SI group ( -3.68 pounds ) than in the UC group ( + .47 pounds ) ( P = .003 ) . The differences between the two groups in terms of blood pressure , lipid levels , depression scores , minutes of exercise , and dietary habits were not statistically significant . CONCLUSION An Internet-based case management system could be used as a cost-effective intervention for patients with CVD , either independently or in conjunction with traditional cardiac rehabilitation The aim of this study was to assess the effects of a 7‐week st and ardized cognitive behavioural treatment of work‐related stress conducted via e‐mail . A total of 342 people applied for treatment in reaction to a newspaper article . Initial screening reduced the sample to a heterogeneous ( sub ) clinical group of 239 participants . Participants were assigned r and omly to a waiting list condition ( n = 62 ) , or to immediate treatment ( n = 177 ) . A follow‐up was conducted 3 years after inception of the treatment . The outcome measures used were the Depression Anxiety Stress Scales ( DASS‐42 ) and the Emotional Exhaustion scale of the Maslach Burnout Inventory – General Survey ( MBI‐GS ) . Fifty participants ( 21 % ) dropped out . Both groups showed statistically significant improvements . Intention‐to‐treat analysis of covariance ( ANCOVAs ) revealed that participants in the treatment condition improved significantly more than those in the waiting control condition ( 0.001<p⩽0.025 ) . In the treatment group , the effects were large to moderate ( 0.9 (stress)⩾d⩾0.5 ( anxiety ) ) . The between‐group effects ranged from d = 0.6 ( stress ) to d = 0.1 ( anxiety ) . At follow‐up , the effects were more pronounced , but this result requires replication in view of high attrition at follow‐up . The results warrant further research on Internet‐driven st and ardized cognitive behavioural therapy for work‐related stress . Such research should include the direct comparison of this treatment with face‐to‐face treatment , and should address the optimal level of therapist contact in Internet‐driven treatment The Internet can access a large number of consumers in a more cost-effective manner than other information delivery channels . In this pilot study , we assessed whether an online weight reduction program including dietary advice plus exercise ( ED ) was more effective in reducing weight than an exercise-only program ( EX ) > 12 weeks . Participants were r and omized to either the ED or EX group and attended a center for anthropometric measurements and dietary assessment .  Both groups wore a pedometer and set weekly goals to increase daily steps through an interactive Web site . The ED group set weekly dietary goals via the Web site and received tailored e-mail assistance .  Seventy-three participants commenced and 53 ( 73 % ) completed the study [ EX n = 26 ; ED n = 27 ; body mass index-mean ( st and ard deviation ) : 29.7 ( 2.5 ) kg m(-2 ) , age 46.3 ( 10.8 ) ; 21 % male ] . Percent weight changes were EX , 2.1 (0.6)% and ED , 0.9 (0.6)% ( P = 0.15 ) . Both groups increased their daily steps with no difference between groups . Only the ED group significantly reduced their energy intake . Despite a greater fall in energy intake reported by the ED group and a similar increase in physical activity in both groups , setting individual dietary goals did not enhance weight loss This study examined whether an online problem-solving intervention could improve  parental adjustment  following pediatric traumatic brain injury ( TBI ) . Families of children with moderate-to-severe TBI were recruited from the trauma registry of a large children 's hospital and r and omly assigned to receive online family problem solving therapy ( FPS ; n = 20 )  or Internet re sources ( IRC ; n = 20 ) in addition to usual care . The FPS group reported significantly less global distress , depressive symptoms , and anxiety at follow-up than did the IRC group after controlling for baseline symptoms . The FPS group also reported significant improvements in problem-solving skills , although the groups did not differ significantly at follow-up . Findings suggest that an online , skill-building approach can be effective in facilitating parental adaptation after TBI Chronic headache is a significant public health problem in Western nations . Although controlled trials demonstrate the efficacy and cost-effectiveness of face-to-face behavioral therapy , most headache sufferers have limited access to these treatments . Delivery of behavioral interventions using Internet technology has the potential to reach a larger number of headache sufferers and reduce the burden of disease . This r and omized controlled study evaluated an Internet-delivered behavioral regimen composed of progressive relaxation , limited biofeedback with autogenic training , and stress management versus a symptom monitoring waitlist control . Treatment led to a significantly greater decrease in headache activity than symptom monitoring alone . Thirty-nine percent of treated individuals showed clinical ly significant improvement on self-report measures of headache symptoms at post-treatment . At two-month follow-up , 47 % of participants maintained improvement . Treatment had a significant impact on general headache symptoms and headache-related disability . There was a 35 % within-group reduction of medication usage among the treated subjects . The Internet program was more time-efficient than traditional clinical treatment . Treatment and follow-up dropout rates , 38.1 % and 64.8 % , respectively , were typical of behavioral self-help studies . This approach to self-management of headache is promising ; however , several method ological and ethical challenges need to be addressed There is ample evidence that printed , computer-tailored nutrition education is a more effective tool for motivating people to change to healthier diets than general nutrition education . New technology is now providing more advanced ways of delivering tailored messages , e.g. via the World Wide Web ( WWW ) . Before disseminating a tailored intervention via the web , it is important to investigate the potential of web-based tailored nutrition education . The present study investigated the immediate impact of web-based computer-tailored nutrition education on personal awareness and intentions related to intake of fat , fruit and vegetables . A r and omized controlled trial , with a pre-test-post-test control group design was conducted . Significant differences in awareness and intention to change were found between the intervention and control group at post-test . The tailored intervention was appreciated better , was rated as more personally relevant , and had more subjective impact on opinion and intentions to change than the general nutrition information . Computer literacy had no effect on these ratings . The results indicate that interactive , web-based computer-tailored nutrition education can lead to changes in determinants of behavior . Future research should be aim ed at longer-term ( behavioral ) effects and the practicability of distributing tailored interventions via the WWW Abstract A r and omized controlled study evaluated an Internet-based HIV behavioral intervention for men who have sex with men ( MSM ) . Hong Kong Chinese men aged ≥18 having engaged in oral or anal MSM behaviors in the last six months were r and omly allocated into the intervention ( n=140 ) and the control groups ( n=140 ) . Participants were interviewed anonymously at the baseline and after six months . Interventions included periodic HIV information dissemination , monitoring of risk behaviors and interactive feedback , online peer counseling and provision of a hotline . The control group only received some educational material s. Efficacy of the intervention was not supported as no statistically significant between-group differences in background characteristics , HIV risk behaviors and perceptions were observed both at the baseline and after the 6-month period . Effectiveness of online interventions should not be taken for granted and evidence -based approach is warranted Chronically ill rural women must manage complex illness without easy access to health care re sources including support and health information . The Women to Women project is a technology-based program with an overarching aim to assist rural women in the day-to-day management of their illnesses . An important aspect of the Women to Women program is teaching the women how to use the Internet to meet their support and informational needs . The purpose s of this article are to examine changes in 1 ) the level of computer skills , 2 ) degree of comfort in using the computer , and 3 ) knowledge of Internet functions for the participants in the Women to Women computer-based intervention .  Results of the initial analysis of data from 63 women ( intervention group n = 29 , control group n = 34 ) indicate that women participating in the intervention reported greater computer skills and computer comfort and greater knowledge of specific aspects of Internet use than women in the control group . These findings were further strengthened considering that intervention and control group differentials were sustained 8 months after the end of the women 's participation in the computer intervention . With the attainment of computer and Internet skills , it is expected that these rural women will have a sustained ability to access quality Internet information that will allow them to better manage and adapt to their chronic illnesses This study investigated the effects of an Internet-based intervention for  insomnia . Participants who met criteria for insomnia ( N = 109 ) were r and omly assigned to either a cognitive-behavioral self-help treatment or a waiting list control condition . The 5-week intervention mainly consisted of sleep restriction , stimulus control , and cognitive restructuring .  Sleep diary data were collected for 2 weeks at baseline and at posttreatment . The dropout rate was 24 % ( n = 28 ) . Results showed statistically significant improvements in the treatment group on many outcome measures , including total sleep time , total wake time in bed , and sleep efficiency . However , improvements were also found in the control group . Overall , between-groups effect sizes were low , with the exception of the Beliefs and Attitudes About Sleep Scale ( Cohen 's d = .81 ) This article reports on the development of a personalized , Web-based asthma-education program for parents whose 4- to 12-year-old children have moderate to severe asthma . Personalization includes computer-based tailored messages and a human coach to build asthma self-management skills . Computerized features include the Asthma Manager , My Calendar/Reminder , My Goals , and a tailored home page . These are integrated with monthly asthma-education phone calls from an asthma-nurse case manager . The authors discuss the development process and issues and describe the current r and omized evaluation study to test whether the year-long integrated intervention can improve adherence to a daily asthma controller medication , asthma control , and parent quality of life to reduce asthma-related healthcare utilization . Implication s for health education for chronic disease management are raised This pilot study examined the acceptability and feasibility of conducting a weight loss maintenance intervention over the Internet . Obese adults participated in a 15-week behavioral weight control intervention and were then r and omly assigned to one of the following three maintenance conditions : ( a ) in-person , therapist-led ( TL ) ; ( b ) Internet , therapist-led ( I ) ; and ( c ) control ( C ) . Both maintenance interventions met biweekly for 22 weeks using the same program content . Results showed that TL participants were more likely to attend their meetings and feel more satisfied with their group assignment . Ho wever , there were no differences between the TL and I groups in overall attrition or number of peer support contacts made . There was also no significant difference in weight loss between the groups . Thus , the Internet may hold promise as a method for maintaining contact with patients to facilitate long-term behavior change The authors evaluated the efficacy of an interactive , computer-based behavioral therapy intervention , grounded in the community reinforcement approach ( CRA ) plus voucher-based contingency management model of behavior therapy . Our r and omized , controlled trial was conducted at a university-based research clinic . Participants comprised 135 volunteer adult out patients who met DSM-IV criteria for opioid dependence . All participants received maintenance treatment with buprenorphine and were r and omly assigned to one of three treatments : ( a ) therapist-delivered CRA treatment with vouchers , ( b ) computer-assisted CRA treatment with vouchers , or ( c ) st and ard treatment . The therapist-delivered and computer-assisted CRA plus vouchers interventions produced comparable weeks of continuous opioid and cocaine abstinence ( M = 7.98 and 7.78 , respectively ) and significantly greater weeks of abstinence than the st and ard intervention ( M = 4.69 ; p < .05 ) , yet participants in the computer-assisted CRA condition had over 80 % of their intervention delivered by an interactive computer program . The comparable efficacy obtained with computer-assisted and therapist-delivered therapy may enable more widespread dissemination of the evidence -based CRA plus vouchers intervention in a manner that is cost-effective and ensures treatment fidelity This study investigates utilization of the Internet in the rehabilitation of people on long-term sick leave with chronic pain and /or burnout . Fifty-five people were r and omly assigned to two groups : a treatment group ( n=27 ) that participated in a rehabilitation course over the Internet and a waiting list group ( n=28 ) . The goals were to improve participants ' health and increase quality of life , and , for those who were not on permanent disability pensions , to increase work capacity , if possible . A 20-week program , based on 19 films on different themes , was supplemented with written material and a Socratic dialogue over the Internet . Upon completion of the rehabilitation course , statistically significant improvements were observed in the treatment group in comparison to the waiting list group , for variables such as depression , pain , vitality , social function , performance problems involving work or other activities due to physical illness and the presence of stress symptoms . Thirteen of 23 individuals ( 57 % ) also increased their work capacity . The number needed to treat regarding recovering from anxiety and depression was 2 . For increased work capacity , the number needed to treat was 3 . Rehabilitation of people on long-term sick leave carried out over the Internet is a good complement to other rehabilitation programs . Die vorliegende Studie befasst sich mit der Nutzung des Internets bei der Rehabilitation von Langzeitkranken mit chronischen Schmerzen und/oder Burnout-Syndrom .  Zwei Gruppen wurden insgesamt 55 Studienteilnehmer r and omisiert zugeordnet , d. h. einer Therapiegruppe ( n=27 ) , die an einem Internet-basierten Reha-Kurs teilnahm , und einer Wartelistengruppe ( n=28 ) . Die Ziele waren die gesundheitliche Verbesserung der Teilnehmer und die Steigerung der Lebensqualität und – für diejenigen , die nicht permanent eine Erwerbsunfähigkeitsrente bezogen – nach Möglichkeit eine Steigerung der Arbeitsleistung . Ein 20-Wochen-Programm auf der Grundlage von 19 Filmen zu unterschiedlichen Themen wurde durch schriftliches Material und einen sokratischen Dialog per Internet ergänzt . Nach Beendigung des Reha-Kurses wurden in der Therapiegruppe verglichen mit der Wartelistengruppe statistisch signifikante Verbesserungen bei Variablen wie Depression , Schmerzen , Lebenskraft , gesellschaftliche Funktion , Leistungsprobleme bei der Arbeit oder and eren Aktivitäten infolge von körperlicher Krankheit und das Vorh and ensein von Stresssymptomen beobachtet . Dreizehn von 23 Teilnehmern ( 57 % ) steigerten zudem ihre Arbeitsleistung . Wegen der Rekonvaleszenz von Angstgefühlen und Depression mussten insgesamt zwei Teilnehmer beh and elt werden , bei der Steigerung der Arbeitsleistung lag die Zahl bei drei . Mit einer Internet-basierten Rehabilitation von Langzeitkranken lassen sich and ere Reha-Programme gut ergänzen . Este estudio investiga la utilización de Internet en la rehabilitación de individuos con ausencia prolongada al trabajo por enfermedad , por padecer dolor crónico o el síndrome del desgaste profesional , o ambos . Se distribuyeron a 55 individuos al azar en dos grupos : un grupo de tratamiento ( n=27 ) , quienes participaron en un curso de rehabilitación impartido mediante Internet , y un grupo en lista de espera ( n=28 ) . Los objetivos fueron mejorar la salud y calidad de vida de los participantes y , para aquellos que no estaban percibiendo pensión de invalidez permanente , aumentar la capacidad de trabajo , de ser posible . Se aplicó un programa de 20 semanas , por Internet , en el que se emplearon 19 películas sobre diferentes temas , complementadas con material es escritos y un diálogo socrático . Al terminar el curso de rehabilitación se hallaron mejorías estadísticamente significativas en el grupo sometido a tratamiento , a diferencia del grupo en la lista de espera , en relación con variables tales como la depresión , el dolor , la vitalidad , la función social , problemas de rendimiento en el trabajo o al realizar otras actividades debido a la presencia de enfermedades orgánicas , y la presencia de síntomas de estrés . Trece de los 23 individuos ( 57 % ) mejoraron su capacidad de trabajo . De estas personas , 2 recibieron el tratamiento como alivio a la ansiedad y depresión que padecían ; y 3 para mejorar su capacidad de trabajo . La rehabilitación de individuos con ausencia prolongada al trabajo por enfermedad , mediante Internet , es un buen complemento al resto de los programas de rehabilitación empleados . Cette étude s'intéresse à l'utilisation de l'Internet pour la rééducation des individus en congé maladie de longue durée souffrant de douleurs chroniques et/ou d'épuisement . Cinquante-cinq personnes ont été réparties de manière aléatoire dans deux groupes ; un groupe de traitement ( n=27 ) , qui a participé au stage de rééducation sur Internet , et un groupe sur liste d'attente ( n=28 ) . Les objectifs étaient d'améliorer la santé et la qualité de vie des participants et , pour les individus ne bénéficiant pas de pensions d'invalidité permanentes , d'accroître la capacité de travail dans la mesure du possible . Un programme sur 20 semaines , reposant sur 19 films consacrés à des thèmes différents , a été complété par des matériaux écrits et un dialogue socratique via l'Internet . À la fin du stage de rééducation , des améliorations statistiquement significatives ont été observées chez le groupe de traitement par rapport au groupe sur liste d'attente , notamment pour les variables comme la dépression , la douleur , la vitalité , la fonction sociale , les problèmes de performances dus à la maladie physique et impliquant le travail ou d'autres activités , et la présence de symptômes de stress . Treize des 23 participants ( 57 % ) ont également augmenté leur capacité de travail . Le nombre d'individus à traiter pour des problèmes d'anxiété et de dépression était de 2 . Pour l'augmentation de la capacité de travail , le nombre à traiter était de 3 . La rééducation des individus en congé maladie de longue durée via l'Internet constitue un bon complément aux autres programmes de rééducation OBJECTIVE To study the contribution of therapist-initiated telephone contact in the treatment of recurrent headache via the Internet . BACKGROUND Internet-based cognitive behavioral self-help is a promising new venue for the treatment of recurrent headache .  While cost-effective , there are indications that this modality may be associated with high dropout rates . DESIGN AND METHODS The role of therapist-initiated contact was investigated in a r and omized controlled trial in which 44 self-recruited headache sufferers were r and omized to either a Web-based self-help program with e-mail support or to a group receiving , in addition , weekly individual telephone calls . An additional 8 control subjects were recruited to receive similar treatment outside of the study . RESULTS Dropout rates were 29 % in the telephone support group and 35 % in the control group , suggesting that the telephone calls did not affect dropout . Results showed significant reductions in headache-related disability , depression , maladaptive coping strategies , and perceived stress but little to indicate any superior performance in the Internet-only group and little improvement in the headache index . In short , therapist-initiated telephone calls did not influence the results . CONCLUSIONS Internet-based treatment for headache is not affected by minimal therapist-initiated telephone contact OBJECTIVE The purpose of this study was to compare weight regain in a group of perimenopausal women ( 48.0+/-4.4 years old ) , r and omized to a 12-month weight maintenance Internet intervention or to self-directed weight maintenance  after a 4-month weight loss treatment . METHODS AND PROCEDURES After a 4-month behavioral weight loss program , 135 women were r and omized to either Internet or self-directed groups . The Internet group ( n=66 ) used a website to gain information and complete logs concerning their weight , diet , and exercise progress over a 12-month follow-up . The 69 self-directed women had no contact with study staff . All women were measured for weight and body composition , and diet intake , and were interviewed using the 7-day physical activity question naires at baseline , 4 months , and 16 months . RESULTS At the end of the 12-month follow-up , the Internet and self-directed groups had regained on average 0.4+/-5.0 kg and 0.6+/-4.0 kg , respectively ( P=0.5 ) . In within-group analyses , Internet diet-log entries were correlated with follow-up weight change ( r=-0.29 ; P<0.05 ) and moderately with change in exercise energy expenditure ( EEE ; r=0.44 ; P<0.01 ) . Follow-up weight change was not correlated with change in dietary intake . DISCUSSION While significant weight loss was maintained over follow-up by both groups of women , Internet use did not surpass self-direction in helping to sustain weight loss . Among Internet users , Internet use was related to weight change and EEE
The objective of this study was to review the evidence about what factors influence  user engagement in  Internet-based behavioral interventions  for chronic illness .