Background Effectiveness of pharmacological therapy in rheumatoid arthritis (RA) is limited by inadequate medication adherence. Medication adherence can be influenced by implicit attitudes of personal medication needs and concerns about adverse consequences. We targeted these implicit attitudes using a serious puzzle game. Objectives To assess the effectiveness of a serious game compared to usual care to improve adherence to disease modifying anti-rheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA). Methods A multicentre randomised clinical trial was performed with a 3 month follow-up period.[1] Inclusion criteria were adulthood, RA diagnosis, use of DMARDs and possession of a smartphone/tablet. All participants received usual care. In addition, intervention participants were invited to play the serious puzzle game at will. The game was designed to influence players’ attitudes toward medication.[2] Collected data consisted of serious game play data, Compliance Questionnaire in Rheumatology (CQR), Beliefs about Medication Questionnaire (BMQ), Health Assessment Questionnaire (HAQ) and Rheumatoid Arthritis Disease Activity Index (RADAI). Primary outcome was DMARD implementation adherence at three months assessed as the difference in proportion of non-adherent patients (<80% taking adherence) between intervention and control group using the discriminant function of the CQR using the Chi-squared test. Two sample t-tests and Wilcoxon rank-sum test were performed to test for differences on secondary outcomes between study groups where appropriate. Results 229 participants were randomised and 186 participants completed the study. Of the 85 intervention participants, 70 (82%) played the serious game for at least one hour. The serious game was played a median of 36 sessions with an average playtime of 25 minutes leading to a median overall playtime of 9.7 hours. A total of 59 (69%) intervention participants showed at least 40 days of gaming activity. Control group adherence (54%) and intervention group adherence (63%) based on the dichotomised CQR-score did not differ at three months (p = 0.26) (see Table 1). Neither was there a significant difference in CQR continuous score (p = 0.20), beliefs about medication differential score (p = 0.43) or clinical outcomes (HAQ: p = 0.97; RADAI: p = 0.90) (see Table 1). Table 1. Study outcomes at end-point (3 months) Control group (n=101 ) Intervention group (n=85 ) p-value Primary outcome Adherent no. (% )* 55 (54) 52 (63) 0.26 Secondary medication outcomes CQR continuous mean ± SD 75 ± 12 73 ± 11 0.20 BMQ-Specific NCD score mean ± SD 4.8 ± 4.2 5.3 ± 4.7 0.43 Secondary clinical outcomes RADAI score median [IQR] 2.5 [1.2 – 4.0] 2.5 [1.5 – 4.2] 0.90 HAQ score median [IQR] 0.8 [0.3 – 1.4] 0.6 [0.3 – 1.4] 0.97 Abbreviations: no. – number; SD – standard deviation; CQR – Compliance Questionnaire on Rheumatology; BMQ – Beliefs about Medication questionnaire; IQR – interquartile range * Percentage of the total number of participants excluding missing data. Conclusion This multicentre randomised clinical trial showed that a serious puzzle game aimed at reinforcing a positive attitude towards DMARDs was frequently played during three months. Playing the game did not improve medication adherence nor influenced beliefs about medication or clinical outcomes in RA patients. References [1] https://www.trialregister.nl/trial/7217 [2]Pouls B, Bekker CL, van Dulmen S, Vriezekolk JE, van den Bemt BJF. A serious puzzle game to enhance adherence to anti-rheumatic drugs in rheumatoid arthritis patients: systematic development using Intervention Mapping. JMIR Serious Games. 06/11/2021:31570 (forthcoming/in press) Disclosure of Interests Bart Pouls: None declared, Charlotte Bekker: None declared, Johanna E. Vriezekolk: None declared, Sandra van Dulmen: None declared, Bart van den Bemt Speakers bureau: UCB, Pfizer, Sanofi-Aventis, Galapagos, Amgen en Eli Lilly

Purpose Due to limited health literacy and resulting ineffective communication between healthcare professionals and patients, not all eligible patients are offered breast cancer genetic counseling and testing. We aimed to develop a plain-language guide to increase effective communication about genetic counseling and testing with breast cancer patients with limited health literacy. Methods Together with oncological healthcare professionals, we drafted a list of jargon words frequently used during (breast) cancer genetic counseling. In a focus group interview with breast cancer counselees with limited health literacy, who had received genetic counseling before, we reformulated these words in plain language. Low-literate individuals, who are not familiar with breast cancer care or genetic counseling, reflected on the draft of the guide. Completeness, acceptability, and perceived usability were tested in an online questionnaire among healthcare professionals. Results The result is a plain-language guide for genetic counseling and testing with 33 frequently used jargon words and a reformulation of these words in plain language. Acceptability and perceived usefulness of the guide among healthcare professionals ( n = 58) were high. Conclusion The plain-language guide provides opportunities to facilitate communication about genetic counseling and testing with patients with limited health literacy and could enhance opportunities for patients to make informed decisions to participate in genetic testing. As the intention from healthcare professionals to use the plain-language guide is high, implementation of the guide in a real-life setting seems promising.

Huisartsen spelen een belangrijke rol bij de zorg voor patiënten met somatisch onvoldoende verklaarde lichamelijke klachten (SOLK). Veel huisartsen vinden SOLK-consulten uitdagend en ervaren problemen in de communicatie met patiënten met SOLK. Om te kijken waar huisartsen tegenaan lopen maakten we gebruik van stimulated recall . We filmden consulten, lieten dit aan zowel huisartsen als patiënten zien en interviewden ze.

Background The EAPC consensus concept defines Advance Care Planning (ACP) as enabling persons to identify goals and preferences for future treatments and care, and to discuss, record and review these. However, this concept is defined by professionals. It is unknown how patients and relatives conceptualize ACP, however, this would be useful for (online) information provision on ACP. Aims To explore what patients and relatives consider important in ACP and how they would search for ACP information on the internet. Methods To address our aims, we interviewed 9 patients with chronic diseases and 7 relatives. We used constant comparative analyses to categorize their key elements of ACP. Results Patients and relatives would use search terms such as 'ACP', 'care/treatment plan', 'disease trajectory', 'advance directive' and patient associations. They would appreciate information on ACP and its importance; how to adapt ACP to individual needs; values and quality of life; diseases; treatment and care options; and communication of preferences. Furthermore, interviewees mentioned additional needs, such as how to get support, explanation of persons involved in ACP, encouragement to think about ACP, information for relatives, and peer support. Conclusion(s) Key elements of ACP according to patients and relatives are in line with the EAPC consensus concept according to professionals. However, patients and relatives also mentioned additional elements, indicating their concept of ACP may be broader. Including the elements and search terms in ACP information may enhance online findability and may help meeting information needs. Funding The Netherlands Organisation for Health Research and Development (ZonMw).

Objective: This study aims to explain the earlier findings of a Randomized Controlled Trial (RCT), which showed that rheumatoid arthritis (RA) patients did not benefit from an online self-management program. Moreover, less patients than expected used the program. Methods: As part of an explorative RCT, patients were interviewed to explore their (non) usage of the program. Purposive sampling (n=21) was used to select patients from four groups of patients (n=49): 1) non-users; 2) low users; 3) high users basic; 4) high users plus. Results: The program supported only a small group of patients because: 1) not all patients were motivated to use the program, 2) patients had no clear expectation or had differing expectations of the program, 3) there was a mismatch between individual patients' support needs and the needs included in the program, 4) reminders were only sent to fill in the diaries for pain and fatigue, not to use the program modules. Conclusion: This study offers insights in the (non-) usage of online programs and how usage could be increased in practice. Practical implications: Health professionals should be involved in the implementation of this online programs and should inform patients what the program could bring them. (C) 2019 Elsevier B.V. All rights reserved.

Objective This study aims to explore the contribution of implicit attitudes and associations towards conventional disease-modifying antirheumatic drugs (cDMARDs), alongside explicit measures, on medication-taking behaviour and clinical outcomes in adult patients with rheumatoid arthritis (RA). Methods In this observational study, implicit attitudes (positive-negative) and health-related associations (health-sickness) were measured with Single Category Implicit Association Tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs about Medicines Questionnaire Specific. The primary outcome of this study was medication-taking behaviour subjectively measured by self-report (i.e. validated Compliance Questionnaire on Rheumatology) and objectively measured with electronic drug monitors over a 3 month period. Spearman rank correlations were used to describe correlations between implicit and explicit outcomes. Nested linear regression models were used to assess the additional value of implicit measures over explicit measures and patient-, clinical-, and treatment-related characteristics. Results Of the 1659 initially-invited patients, 254 patients with RA agreed to participate in this study. Implicit attitudes correlated significantly with necessity-concerns differential (NCD) scores (ρ = 0.13, P = 0.05) and disease activity scores (ρ = -0.17, P = 0.04), whereas implicit health-related associations correlated significantly with mean scores for explicitly reported health-related associations (ρ = 0.18, P = 0.004). Significant differences in age, number of DMARDs, biologic DMARD use, NCD-scores, and self-reported correct dosing were found between the four attitudinal profiles. Nested linear regression models revealed no additional value of implicit measures in explaining self-reported medication-taking behaviour and clinical outcomes, over and above all other variables. Conclusion Implicit attitudes and associations had no additional value in explaining medication-taking behaviour and clinical outcomes over and above often used explicitly measured characteristics, attitudes and outcomes in the studied population. Only age and NCD scores contributed significantly when the dependent variable was correct dosing measured with self-report.

Poor medication adherence is a major factor in the secondary prevention of cardiovascular diseases (CVD) and contributes to increased morbidity, mortality, and costs. Interventions for improving medication adherence may have limited effects as a consequence of self selection of already highly adherent participants into clinical trials. In this retrospective cohort study, existing levels of medication adherence were examined in self-decided participants and non-participants prior to inclusion in a randomized controlled study (RCT), evaluating the effect of an intervention to improve adherence. In addition, the non-participants were further divided into ‘responders’ and ‘non responders’. All individuals had manifest cardiovascular disease and completed a questionnaire with baseline characteristics, the Beliefs about Medicines Questionnaire (BMQ) and the Modified Morisky Scale® (MMS®) as part of a regular screening program. A logistic regression was conducted to examine the relationship between study participation willingness, adherence level and the beliefs about medication. According to the MMS® the adherence level was comparable in all groups. In both (non)-participants groups, 36% was classified as high adherent; 46% participants versus 44% non-participants were classified as medium adherent and 19% of the participants versus 20% of the non-participants were low adherent (p = 0.91. The necessity concern differential (NCD) from the BMQ was 3.8 for participants and 3.4 for non-participants (p = 0.32). This study shows that adherence to medication and beliefs about medication do not differ between participants and non-participants before consenting to participate in an RCT. The study design seems not to have led to greater adherence in the study group.

Background Advance Care Planning (ACP) enables persons to define goals and preferences for future medical treatments and care, to discuss, record and review these. Potentially, web-based programs can support patients in ACP. However, an overview of their effectiveness and feasibility is lacking. Methods To provide an overview of the content, feasibility and effectiveness of web-based, interactive and patient-centered ACP programs, we systematically searched in 7 databases. We extracted data using the EAPC consensus concept of ACP as our framework. Results The search identified 3434 records; 21 studies were included. Three additional studies were identified by hand search. The 24 studies evaluated 11 web-based ACP programs, developed in the USA (10) and Ireland (1). Most programs addressed exploration of goals, values and preferences, and ACP communication. Users considered programs as easy to use (7/7 studies) and not burdensome (7/8 studies). Users were satisfied with the programs (10/10 studies). ACP communication (11/11 studies) and ACP documentation (14/16 studies) increased. Two studies evaluated concordance between preferred and provided care. Designs of 10 studies allowed comparison before/after completing ACP programs or between study groups. Conclusion(s) Most web-based ACP programs contain the important elements of ACP. Studies reported that programs tended to be effective and feasible. Evaluations of concordance between preferred and provided care are scarce. Web-based programs have potential to support patients, and scale up ACP. However, since many studies did not assess differences before/after or between groups, outcomes should be interpreted with caution. Funding The Netherlands Organisation for Health Research and Development (ZonMw).

Background E-health programs have potential to support RA patients in self-management. However, many of these programs are developed without involving patients. As a consequence, patient preferences for program use are not well known and these programs may not well suit patient’s needs for self-management support. We developed a tailored e-health self-management program for patients with RA with the help of a patient panel. While self-management interventions are complex interventions, it is informative to perform an explorative RCT before embarking on a larger trial. Objectives 1) Evaluate the potential effectiveness in patients with RA of a 12 month tailored e-health self-management program, versus ‘usual care’, on self-management behaviour, self-efficacy, general health status, focus on fatigue and the level of pain and fatigue; 2) exploration of floor and ceiling effects of the potential outcome measures at baseline and effect sizes at 6 and 12 months after baseline were used to identify outcome measures most likely to capture potential benefits Methods The RCT was performed in out-patients from two hospitals in the Netherlands. Inclusion criteria were RA patients 18 years or older, being able to speak and read Dutch and having access to internet. Patients were randomised to ‘e-health’ in addition to ‘usual care’ or to ‘usual care’ alone. The ‘e-health’ group received 12 months access to the online self-management program. Assessment of outcomes occurred at baseline, 6 and 12 months. Outcome measures included self-management behaviour (PAM-13, SMAS-S), self-efficacy (RASE, PEPPI-5), general health status (RAND-36), focus on fatigue (MPCI-F), pain and fatigue (NRS scales). A linear mixed model for repeated measures, using the intention to treat principle was used to study differences between intervention and control groups. A sensitivity analysis was performed to study the influence of high and low compliance in the intervention group Results In total 157 patients (n=78 intervention group versus n=79 control group) were included in the study. A statistically significant (p<0.05) between-group difference was only shown for the RAND-36 vitality after 12 months, in favour of the ‘e-health’ group. Effect sizes were low. Compared with the patients with non or low compliance, patients with a high compliance to the intervention scored statistically significant better on RAND-36 perception after 12 months. Here also, effect sizes were low. Floor and ceiling effects were not apparent in the outcomes used. Conclusions Based on these results it is not possible to conclude on possible positive effects of the intervention: for all outcomes the effect sizes were low. Consequently, it is not possible to select outcome measures to be regarded as primary/main secondary outcomes for a larger trial. A process evaluation should be performed to give an explanation for the findings of this study. Disclosure of Interest None declared

BACKGROUND:It is currently not known when in the consultation GPs label symptoms as medically unexplained and what triggers this.AIM:To establish the moment in primary care consultations when a GP labels symptoms as medically unexplained and to explore what triggers them to do so.DESIGN AND SETTING:This was a qualitative study. Data were collected in the Netherlands in 2015.METHOD:GPs' consultations were video-recorded. GPs stated whether the consultation was about medically unexplained symptoms (MUS). The GP was asked to reflect on the video-recorded consultation and to indicate the moment when they labelled symptoms as MUS. Qualitative interviewing and analysis were performed to explore the triggers GPs perceived that caused them to label the symptoms as MUS.RESULTS:A total of 43 of the 393 video-recorded consultations (11%) were labelled as MUS. The mean time until GPs labelled symptoms as medically unexplained was about 4 minutes for newly presented symptoms and 2 minutes for symptoms for which the patients had already visited the GP before. GPs were triggered to label symptoms as MUS in the consultation by: the way patients presented their symptoms; the symptoms not fitting into a specific pattern; patients attributing the symptoms to a psychosocial context; and a discrepancy between symptom presentation and objective findings.CONCLUSION:Most GPs labelled the presented symptoms as medically unexplained soon after the start of the consultation. GPs are triggered to label symptoms as medically unexplained by patients' symptom presentation, symptom patterns, and symptom attribution. This suggests that non-analytical reasoning was a central component in their thought process.

Background: Medication adherence to conventional disease modifying anti-rheumatic drugs (cDMARDs) is suboptimal in patients with rheumatoid arthritis (RA) with medication adherence rates ranging from 30 to 80% [1]. Since existing interventions are only partially effective, identifying (modifiable) factors associated with non-adherence might help to find targets for more effective adherence-improving interventions. There is growing evidence that not only explicit attitudes (conscious responses) are responsible for behaviour, but also implicit attitudes (unconscious responses) might be involved [2]. Objectives: The aim of this study is to examine implicit and explicit attitudes of RA patients towards cDMARDs, and their association with medication adherence. Methods: A multicenter observational cohort study in two rheumatology specialized centres was initiated to examine implicit and explicit attitudes of 254 consecutive adult RA patients (ACR 2010 criteria) treated with at least one cDMARD for a minimum period of one year. Prior to their regular consultation, patient’s implicit attitudes were measured with the Single Category Implicit Association Test and explicit attitudes were evaluated with a bipolar evaluative adjective scale and the validated Beliefs about Medicines Questionnaire (BMQ-specific). Primary outcome was self-reported medication adherence measured with the validated Compliance Questionnaire on Rheumatology. Results: Implicitly, more patients displayed negative attitudes (49.0%) and sickness related associations (60.9%) than explicitly (21.3% and 23.5% respectively). Only significant correlations between explicit attitudes and associations of RA patients and beliefs about medicines were found. The lowest levels (48.8%) of self-reported adherence were found in patients who displayed congruent negative (implicit and explicit) attitudes. The highest levels (71.4%) of self-reported adherence were found in patients who displayed congruent (implicit and explicit) health (versus sickness) related associations. Conclusions: Implicit attitudes and associations of RA patients were not always congruent with explicit attitudes and associations. Slightly higher adherence rates were found in patients who displayed positive explicit attitudes and associations. However, implicit and explicit attitudes and associations of RA patients towards cDMARDs and their adherence should be further investigated with MEMS (medication event monitoring system) devices. References 1] BJF van den Bemt, et al. Expert Rev Clin Immunol2012May;8(4):337–51. doi:10.1586/eci.12.23 2] Linn, et al. Front Pharmacol. 2016Aug 10;7:233. doi:10.3389/fphar.2016.00233. eCollection 2016 Disclosure of Interest: None declared

Estimation of the parameters of the power generators are important part of a power system modeling and simulation. A reliable estimation of a synchronous generator parameters can be done using waveforms measured directly on the terminals of the machine. The waveforms are recorded during a carefully chosen disturbance tests of the generating unit. One of the quantities necessary to determine the generator parameters is the deviation of the generator angular speed. However, because of the safety reasons, it is very difficult to get access to the direct measurement of this quantity on a operating generating unit. Angular speed estimation based on a generator stator voltage seems to be an alternative solution to the problem.The aim of the paper is to find a computationally efficient and accurate method of indirect angular speed estimation of a synchronous generator which is based on the recording of its stator voltage during a load rejection test. The algorithms evaluated in the paper are based on Prony’s estimator, zero-crossing detection, least-square data fitting and layer recurrent neural network. Paper contains literature survey, mathematical model of the considered generator, analysis of its stator voltage recorded in a power plant, description of the selected algorithms and results of the algorithms estimation using a signal with known frequency variation. Performed algorithms evaluation allows to choose the best solution in terms of accuracy and computational effort.

Background The number of patients with prostate cancer is increasing, which puts additional pressure on health care. GP-led follow up may help reduce costs, travel time for patients, and workload for urologists and improve continuity of care. Aim To test the feasibility and acceptability of a new clinical pathway for GP-led prostate cancer follow-up. Design & setting A feasibility pilot study was performed in cooperation with six GP practices in the Dutch region of Amersfoort. Method The study included 20 patients with prostate cancer in a stable phase, who were aged ≥65 years and with comorbidity. Follow-up for prostate cancer was transferred to the GP for one year. Participating GPs and urologists jointly developed a protocol. Patient satisfaction was measured at 0 and 12 months with the ‘personalised care’ subscale of the Consumer Quality (CQ) index 'general practice care'. Next, patients, GPs, and urologists were interviewed about their experiences. The clinical pathway was considered successful if no patients were referred back to the urologist, except for an increase in prostate-specific antigen (PSA), and if the majority of patients and participating urologists and GPs were satisfied. Results Of the 20 patients included in the study, three were referred back to the urologist because of increasing PSA levels and one died (unrelated to prostate cancer). Most patients (73%) were satisfied with the transfer of care, indicated by a score of ≥3 on the ‘personalised care’ subscale. GPs and urologists had confidence in the ability of GPs to provide follow-up care and preferred to continue this. Conclusion The new clinical pathway was successful, warranting a larger study to provide evidence for the (cost-)effectiveness of GP-led prostate cancer follow-up.

Background: Because of the large impact of cardiovascular risk (CVR), there is a growing interest in self-management for patients with CVR. To support self-management behaviorfor patients with CVR, an e-health self-management program has been developed. In thisstudy, we will evaluate the feasibility of the ehealth self-management program and estimateimportant outcome measures in an explorative randomized controlled trial.The objectives of this study are: 1) to pilot test an e-health self-management support program for patients with CVR; 2) to explore effectiveness and effect size of the e-health selfmanagement selfmanagement support program; 3) identify outcome measures most likely to capture potential benefit; 4) evaluate continued participation or dropping out of the intervention; 5) explore nurses’ changing roles and activities in the light of e-health intervention.Materials and methods: Mixed methods were used: an explorative randomized controlledtrial with a 6 and 12 month follow-up from baseline and qualitative interviews at12 months follow-up were held. 200 patients with cardiovascular risk, 18 years of age and older, ability to speak and read the Dutch language were eligible for inclusion. Patients were stratified for diagnoses randomized to the intervention or control group. All nurses at the outpatient clinics were included.Intervention: The intervention consists of six modules and strategies to support the behavioural change and maintenance of self-management behaviour.Outcome: We measured self-management behaviour (PAM-13), quality of life (Rand-36), illness perception((IPQ-causes of my illness), self-efficacy for coping with CVR indaily life, medication adherence (MMAS-8), and patient’s attitude to prescription medicines(BMQ), lifestyle for patients with CVR (FTND, AUDIT, IPAQ and DHD-index) andcommunication (PEPPI-5). The process of the intervention was evaluated on actual use andadded value of the e-health self-management support program and dropping out of theintervention. Both patients and nurses were part of the evaluation. Patient’s characteristicswill be assessed together with the baseline outcome measures, via an online questionnaireand medical file. Repeated measures will be executed at 6 months and 12 months afterbaseline. Semi-structured interviews will be executed with patients and nurses.Results: The inclusion of CVR patients started in September 2015 and the follow-up will last1 year. At this moment an amount of 100 patients are using the online program.Conclusion: This study will provide insight into the potential effectiveness of the onlineself-management support program for CVR patients.

Background To support individual behavioral change by self-management interventions, behavioral change techniques (BCT) may be helpful to induce behavior change [1]. Conditions for effectivity of BCT9s are that they fit to experienced problems in self-management and that the conditions under which they work (parameters) are taken into account. So important steps in the development of self-management programs are 1) identifying the self-management behavioral problems and factors (determinants) affecting these problems in patients, 2) link BCT techniques to these behavioral problems and determinants, 3) identifying parameters of the BCT9s and 4) implement BCT techniques into the intervention [2]. Objectives Development of an online self-management program for Rheumatoid Arthritis (RA) patients. Methods A panel of 5 RA patients and 5 health professionals identified self-management behavioral problems and prioritized them. Determinants of these behavioral problems were identified in literature and confirmed by patients. Two independent researchers coded techniques from a list of BCT9s linked to the determinants of the identified problems with the panel and discussed, which led to consensus [3]. Afterwards, parameters of BCT9s where identified from literature. Lastly, RA patients9 input during a meeting was used to implement the techniques into the intervention. Results In total 9 behavioral problems related to self-management were mentioned, namely: balancing rest and activity, setting boundaries in daily life, asking for help and supportuse of medicines, communication with health professionals, use of assistive devices, performing physical exercises, coping with worries, and coping with RA. Determinants of these problems were: knowledge, awareness, risk perception, social influence, attitude, self-efficacy, and habits. To change patients9 self-management behavior, 15 BCT9s were identified, for example persuasive communication, guided practice and self-monitoring. After identifying, the BCT9s were linked to the determinants of behavioral problems and parameters where identified.An example of the BCT modeling, linked to a low self-efficacy an parameters, is presented in table 1. Conclusions Although the BCT taxonomy was helpful as a starting point to induce behavioral change in self-management, firstly the problems related to self-management and their determinants must be clear. Afterwards, the parameters of the BCTs and patients9 preferences need to be taken into account when translating these techniques into the self-management program. References Abraham, C., & Michie, S. (2008). A taxonomy of behavior change techniques used in interventions. Health Psychol, 27(3), 379–387. doi: 10.1037/0278-6133.27.3.379. Kok, G., Schaalma, H., Ruiter, R. A. C., Van Empelen, P., & Brug, J. (2004). Intervention mapping: A protocol for applying health psychology theory to prevention programmes. Journal of Health Psychology, 9(1), 85–98. doi: 10.1177/1359105304038379. De Bruin, M., Kok. G., Schaalma, H., Hospers, H. (2007). Coding manual for behavioral change techniques http://www.biomedcentral.com/content/supplementary/1748-5908-7-92-S2.pdf. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is a chronic autoimmune disease, which redominantly affects the joints. Many RA patients face physical problems such as pain, stiffness, and fatigue which cause difficulties in everyday life.1 Every day RA patients have to make many decisions about managing their disease. An online self-management program has been developed to support these patients and has been evaluated. To do this we dentified outcomes and process measures that were relevant to the program objectives. We also conducted qualitative interviews with nurses, users, and nonusers of the program. Materials and methods: Mixed methods were used, alongside an exploratory RCT, qualitative interviews were performed in 2 hospitals in the Netherlands. 190 eligible RA patients were included and randomized to the intervention or control group. The control group received care as usual; the intervention group got access to the online program in addition to receiving care as usual. The online program was a theory based ehealth self-management support program consisting of nine health related problem modules. We developed the program with RA-patients and healthcare professionals according the six intervention mapping steps. The content of the modules is tailored to the user’s self-efficacy, and patients can use the online program as often as they want, working through a module or modules at their own speed. Objective This feasibility study aims to evaluate the potential effectiveness of the online program and determine effect sizes for the various outcomes: 1) the Patient Activation Measurement; 2) the health-related quality of life survey; 3) the Rheumatoid Arthritis Self-Efficacy scale; 4) the Perceived Efficacy in Patient-Physician Interactions; 5) the short version of the selfmanagement ability scale; 6) A scale to assess the focus on fatigue; 7) the pain and fatigue Numeric Rating Scales. All instruments will be administered at baseline (T0) and after 6 (T1) and 12 months (T2). In the process evaluation we used the framework of Saunders et al.2 to evaluate feasibility of the online program. Parallel to the RCT interviews were held with patients and nurses. Results The inclusion of RA patients started in January 2015 and the follow-up will last until June 2016. At this moment an amount of 76 patients are using the online program. Conclusion This study will provide insight into the potential effectiveness of the online program for RA patients. 1 Krishnan E, Fries J. Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998:a longitudinal study of 3035 patients. Am J Med. 2003 Oct 1;115 (5):371–376. 2 Saunders RP, Evans MH, Joshi P. Developing a process-evaluation plan for assessing health promotion program implementation: a how-to guide. Health Promot 2005 Apr;6 (2):134–47.

Introduction For three long-term care patient groups e-health self-management support programs (patients with cardiovascular risk (abstract 1) rheumatoid arthritis (abstract 2) and severe mental illness (abstract 3)) have been developed according to the six steps of Intervention Mapping: 1) needs assessment; 2) define proximal program objectives: 3) selection of theory and evidence based methods and practical strategies; 4) produce and write the program components; 5) develop an implementation plan; 6) evaluate the program. In this symposium the development of the three feasibility studies will be presented with the preliminary results. These studies aimed to evaluate the potential effectiveness of the ehealth self-management support programs and determine effect sizes for the various outcomes, identify outcome measures most likely to capture potential patient benefits and evaluate long-term participation and attrition rates for the e-health self-management support programs. Aim This symposium aims to present insight into the reach and boundaries of e-health selfmanagement support programs for patients with a chronic condition and nurses’ role and activities in the light of e-health interventions.

- Good communication is important for patients and can elicit placebo effects: true psychobiological effects not attributable to the medical-technical intervention.- It is, however, often unclear which communication behaviours influence specific patient outcomes.- In this article we present insights into the potential effect of specific communication, via specific mechanisms, on specific patient outcomes, including patients' perception of pain.- A recent systematic review and additional literature demonstrate that (a) manipulating patients' expectations, (b) demonstrating empathy, and (c) providing procedural information, might influence patient outcomes.- These placebo effects probably occur via (a) neurobiological responses comparable to the effects of pain medication, (b) reduction of anxiety and stress, and

Relevance: The primary aim of modern healthcare systems is to realize optimal health outcomes for patients and populations and to deliver services that are of the highest possible quality. High quality healthcare has been defined as care that is safe, timely, equitable, effective, efficient, and patient-centered. In 2013 the Royal Dutch Society for Physical Therapy (KNGF) started the development and implementation of their national quality program ‘Quality in Motion’. The rationale behind this program was the desire to establish a quality system that would stimulate patient-centered care and improve the effectiveness of care.