Design, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review

Maclachlan, Liam R., Mills, Kathryn, Lawford, Belinda J., Egerton, Thorlene, Setchell, Jenny, Hall, Leanne M., Plinsinga, Melanie L., Besomi, Manuela, Teo, Pek Ling, Eyles, Jillian P., Mellor, Rebecca, Melo, Luciano, Robbins, Sarah, Hodges, Paul W., Hunter, David J., Vicenzino, Bill, and Bennell, Kim L. (2020) Design, Delivery, Maintenance, and Outcomes of Peer-to-Peer Online Support Groups for People With Chronic Musculoskeletal Disorders: Systematic Review. Journal of Medical Internet Research, 22 (4). e15822.

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Background: Online support groups (OSGs) are one way for people with chronic diseases, their family or friends, and health professionals to communicate, gain information, and provide social support. As the number of peer-to-peer OSGs for chronic musculoskeletal conditions grows, it is important to gain insight into the different designs of groups available, who is accessing them, if and how they may be effective, and what strategies are being used to implement or increase consumer engagement.

Objective: The objectives of this systematic review of people with musculoskeletal conditions were to (1) describe the design features (functions, usage options, moderation, and expert input) of peer-to-peer OSGs, (2) describe the characteristics of the individuals using peer-to-peer OSGs, (3) synthesize the evidence on outcomes of participation, and (4) identify strategies used in the delivery and maintenance of OSGs.

Methods: A search comprising terms related to the population (people with musculoskeletal disorders) and the intervention (peer-to-peer OSGs) was conducted in 6 databases. Results were filtered from 1990 (internet inception) to February 2019. Studies identified in the search were screened according to predefined eligibility criteria using a 2-step process. Quantitative studies were appraised by 2 reviewers using the Risk Of Bias In Non-Randomized Studies of Interventions tool. Qualitative studies were appraised by 2 different reviewers using the Critical Appraisal Skills Programme checklist. Extracted data were synthesized narratively.

Results: We examined 21 studies with low to moderate risk of bias. Of these studies, 13 studies included OSGs hosted on public platforms, 11 studies examined OSGs that were conducted in English, and 6 studies used moderators or peer leaders to facilitate engagement. Studies either reported the number of OSG members (n=1985 across all studies) or the number of posts (range: 223-200,000). The majority of OSG members were females who were not full-time employees and with varied levels of education. There were no randomized controlled trials measuring the efficacy of OSGs. Qualitative and quantitative studies identified empowerment, social support, self-management behavior, and health literacy as primary constructs to measure OSG efficacy. Neutral or marginal improvement was reported in these constructs. Sharing experiences and a greater level of engagement appeared to have an important influence on OSGs efficacy. The extent to which members posted on the website influenced engagement.

Conclusions: Across a diverse range of designs, languages, included features, and delivery platforms, peer-to-peer OSGs for chronic musculoskeletal conditions attract predominantly female participants of all ages and education levels. The level of participation of a member appears to be related to their perceived benefit, health literacy, and empowerment. Future studies are needed to identify which design and maintenance strategies have superior efficacy and whether there are concomitant improvements in health outcomes for people with chronic musculoskeletal conditions resulting from participation in OSGs.

Item ID: 72423
Item Type: Article (Research - C1)
ISSN: 1438-8871
Copyright Information: © Liam R Maclachlan, Kathryn Mills, Belinda J Lawford, Thorlene Egerton, Jenny Setchell, Leanne M Hall, Melanie L Plinsinga, Manuela Besomi, Pek Ling Teo, Jillian P Eyles, Rebecca Mellor, Luciano Melo, Sarah Robbins, Paul W Hodges, David J Hunter, Bill Vicenzino, Kim L Bennell. Originally published in the Journal of Medical Internet Research (, 24.04.2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC Program Grant (APP1091302), NHMRC Centre of Research Excellence Grant (APP1079078), NHMRC Fellowship (APP1102905)
Date Deposited: 19 Apr 2022 23:08
FoR Codes: 42 HEALTH SCIENCES > 4201 Allied health and rehabilitation science > 420106 Physiotherapy @ 100%
SEO Codes: 20 HEALTH > 2001 Clinical health > 200199 Clinical health not elsewhere classified @ 100%
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