A randomized clinical trial of a psychoeducational intervention to improve outcomes in systemic lupus erythematosus

Abstract

Objective. In a cross-sectional study, we previously identified 2 potentially modifiable risk factors for adverse outcomes in systemic lupus erythematosus (SLE): self-efficacy and social support. The goal of this study was to evaluate in a randomized controlled trial a theory-based intervention to improve patient selfefficacy and partner support to manage SLE.Methods. Patients with SLE ages 18 years and older who met the American College of Rheumatology criteria and were able to identify a partner (spouse or family member) were recruited from 2 academic medical centers and randomized into an experimental group or a control group. Patients in the experimental group and their partners received an intervention designed to enhance self-efficacy, couples communication about lupus, social support, and problem solving, in the form of a 1-hour session with a nurse educator followed by monthly telephone counseling for 6 months. Patients in the control group and their partners received an attention placebo, including a 45-minute video presentation about lupus, and monthly telephone calls. Measures of physical and mental health status, disease activity, and psychosocial factors were collected at baseline, 6 months, and 12 months. The effect of the intervention on physical and mental health and disease activity at 6 and at 12 months was modeled with linear regression and adjusted for baseline health status, disease activity, sociodemographic factors, treatment change, and psychosocial factors.Results. One hundred twenty-two patients (plus their partners) were enrolled and randomized as follows: 64 to the experimental intervention and 58 to the attention control group. The participants were predominantly white, approximately half were college educated, and the groups were balanced for sociodemographic factors. At 6 months, significantly higher scores for couples communication (P ‫؍‬ 0.01) and problem-focused coping (P ‫؍‬ 0.03) were seen in the experimental group compared with the control group. At 12 months (6 months after the intervention ended), social support was higher (4.4 versus 4.1; P ‫؍‬ 0.03), self-efficacy was higher (7.2 versus 6.2; P ‫؍‬ 0.02), couples communication was higher (3.5 versus 3.1; P ‫؍‬ 0.03), and fatigue was lower (5.1 versus 6.3; P ‫؍‬ 0.02) in the experimental group compared with the control group. Global mental health status at 12 months, as measured by the Short Form 36 survey, was 69 points in the experimental group compared with 58 points in the control group (P ‫؍‬ 0.04). In multivariate models, adjusting for baseline covariates, scores for couple communication (P ‫؍‬ 0.01) were significantly higher at 6 months, and scores for self-efficacy (P ‫؍‬ 0.004) and global mental health status (P ‫؍‬ 0.03) were significantly higher at 12 months in the experimental group compared with the control group, and the mean score for global physical function was higher by 7 points, which was a clinically meaningful

Efficacy of Cognitive Behavioural Therapy for the Treatment of Chronic Stress in Patients with Lupus Erythematosus: A Randomized Controlled Trial

“…This is not a diagnostic instrument, but it does give an indication of the depth of depression in patients with any diagnosis. The scores on this instrument can be classified into the following categories: no depression [10], slight depression [18], moderate depression [25] and severe depression [30]. Spielberger’s State-Trait Anxiety Inventory (STAI) [39], created by Spielberg, Gorsuch and Lushene, contains 2 separate self-evaluation scales that measure 2 independent concepts of anxiety, i.e.…”

“…Some investigations have been carried out which focus on the psychological aspect of lupus, with the aim of reducing the disease’s interference in the daily life of patients [17], improving social support and patients’ levels of self-management [18,19,20] and developing coping skills in patients [21]. However, while considerable research has been carried out on interventions to counter stress in relation to other autoimmune diseases [22,23,24], there is only one study on the effects of reducing stress in lupus patients using cognitive behavioural therapy (CBT) [25].…”

If You Dont Put it in Your Mind, then it Dont Matter: A Phenomenological Study of Coping Self-Efficacy in African American Women Diagnosed with Lupus

“…A strength of this study is its focus on an understudied population which differs from prior studies that had samples composed of predominately Caucasians or Caucasian women [7,11,23,35]. Thus, these findings deepen our understanding of an understudied population with more lupus disease activity and damage, and faster disease progression [7].…”

“…Although evidence from both CDSMP and ASMP indicate promising outcomes for self-efficacy and health-related quality of life for lupus patients, most intervention research among lupus patients has been conducted on white women [20][21][22][23]. This suggests a limited understanding of factors promoting self-efficacy and disease self-management among African American women in the medical literature.…”

Comparison of two statistical models in predicting the outcome of female systemic lupus erythematosus patients in China

“…Some factors of low income, low educational attainment, public health insurance status, social support and social psychology [21] would be associated with therapeutic outcome of female SLE patients. 3) Furthermore, some factors of gene of SLE and corticosteroids level of female SLE body would not be tested.…”