Maaike Ferwerda*, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Saskia Spillekom, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Henriët van Middendorp, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Sylvia van Beugen*, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Wietske Kievit, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Jaap Fransen, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Henk Visser, Rijnstate Hospital, Arnhem, Netherlands Piet van Oijen, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, Netherlands Erik Taal, University of Twente, Enschede, Netherlands Piet van Riel, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Elke de Jong, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Peter van de Kerkhof, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Mart van der Laar, University of Twente, Medisch Spectrum Twente, Nijmegen, Netherlands Andrea Evers, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands Track: Research Presentation Topic: e-Coaching Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2013-09-25

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Background: The popularity of E-health is rising and research has shown that E-health interventions can be effective. However, they also offer new challenges and questions in clinical practice and research, for example about the role of the patient-therapist relationship. In face-to-face treatments, a better patient-therapist relationship has often been reported as a predictor for improved treatment outcome.

Objectives: In an E-health cognitive-behavioral treatment for patients with rheumatoid arthritis and psoriasis, the patient-therapist relationship was assessed and related to patient-reported outcomes.

Methods: After a face-to-face intake with one of five therapists, all patient-therapist contact was through e-mail with this therapist on a weekly basis. The treatment under study was tailored to the specific complaints of the patients with possible treatment modules aimed at different consequences of the chronic disease such as pain, itch, problems in social functioning, negative mood and fatigue. As a consequence, treatment duration and content varied. Patients rated the patient-therapist relationship pre and post treatment using the Working Alliance Inventory and internet-specific relationship questions. After treatment, patients were asked to rate improvement in symptoms and coping with these symptoms. Paired samples t-tests (patient-therapist relationship change during treatment) and regression analyses (association patient-therapist relationship and patient-reported outcome) were performed in a subsample of patients who had completed treatment (N=31, 18 men, mean age: 54,4,age range: 29-71).

Results: The patient-therapist relationship was rated positively at the beginning of treatment and increased during treatment (p <.05) as generally found in face to face treatments. Both a better patient-therapist relationship and the specific internet related aspects (e.g., having time to think about the reply to the therapist) predicted patient-reported improvement in coping with disease problems, such as pain and fatigue (p-values < .05). At the end of treatment both relationship aspects are related to improvements in symptoms and coping with these symptoms (all p-values <.05). In this sample, no differences were found in the presented results for men or women, different education levels or age.

Conclusions: These preliminary results indicate that the patient-therapist relationship is a possible predictor for self-reported improvements in E-health treatments, similar to the role of this patient-therapist relationship in face-to-face treatments. The evaluation of specific internet aspects such as following the treatment from home or having time to think about a reply to the therapist could be especially relevant to the E-health literature, yet further research is needed to support the current findings. Future results need to demonstrate whether the patient-therapist relationship also contributes to the (cost-)effectiveness of this E-health treatment in two randomized controlled trials.