The evidence base for psychological interventions for rheumatoid arthritis: A systematic review of reviews

Prothero, Louise; Barley, Elizabeth; Galloway, James; Georgopoulou, Sofia; Sturt, Jackie

doi:10.1016/j.ijnurstu.2018.03.008

Cited by 75 publications

(65 citation statements)

References 42 publications

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“…The overarching principle in the field of rheumatology is that patient education should enable people to manage their life with IA and optimize their health and well‐being rather than be limited to the disease (Zangi et al, ). This overarching principle is similar for other chronic diseases as well (Prothero, Barley, Galloway, Georgopoulou, & Sturt, ; Stenberg, Haaland‐Overby, Haaland‐Øverby, Fredriksen, Westermann, & Kvisvik, ).…”

Section: Introductionmentioning

confidence: 67%

“…Data were collected at baseline in the RCT (T0 = 2008–2009), 12 months later (final follow‐up in the RCT) and 5 years later (T2 = 2015–2016). The data consisted of demographic information, disease characteristics and domains that patient education may influence (Prothero et al, ) such as physical function, disease symptoms (pain, tiredness and disease activity), psychological status (well‐being, anxiety and depression) and self‐management (patient activation and self‐efficacy). An objective measure of disease activity, the disease activity score (DAS28‐3) using 28 tender and swollen joints counts (van Riel & Renskers, ), was only collected in the RCT and not in the five‐year follow‐up study.…”

Section: Methodsmentioning

confidence: 99%

“…al ). However, there is a need for longitudinal studies examining whether improvements in psychological status produce carry‐over effects on physical outcomes and which strategies that enhance patients' long‐term adherence to such programmes (Prothero et al, ). Therefore, the aim of this study was to investigate changes in self‐management and health status among patients with IA that had participated in an RCT on nurse‐led patient education 5 years earlier; secondly, to study associations between disease‐related factors, health status, demographics and self‐efficacy in the same sample of patients with IA.…”

Section: Introductionmentioning

confidence: 99%

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Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

2019

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AimThe aim of this study was to investigate changes in patients' self‐management and health status five years after nurse‐led patient education.DesignA longitudinal study.MethodsWe collected self‐reported data on physical function, pain, tiredness, disease activity, psychological status, patient activation and self‐efficacy from a sample of Norwegian‐speaking adults with inflammatory arthritis that had participated in a randomised controlled study investigating the effects of nurse‐led patient education. Changes and associations in patients' health status and self‐management were analysed with paired sample t tests and multivariable linear regression analyses, respectively.ResultsExcept from a small deterioration in patients' physical function, there were no changes in patients' health status 5 years after the nurse‐led patient education. Patients' self‐management skills were improved after 5 years. Self‐efficacy was positively associated with female gender, patient activation, less tiredness and less psychological distress.

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Section: Introductionmentioning

confidence: 67%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

2019

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“…Psychological interventions specifically targeting RA-related fatigue have been identified as an under-researched area, with researchers encouraged to include cost evaluation in future work. 20,127 To better understand the importance of change in fatigue impact, further research could usefully establish the level of change in fatigue impact (BRAF-NRS impact) that is meaningful for patients. There is evidence that the impact of fatigue is particularly problematic in early RA 2 and the current trial population had a mean of 10-year disease duration; therefore, any improvements in fatigue impact from the RAFT programme may have greater potential for translating into improved quality of life and economic benefit in a more recently diagnosed cohort.…”

Section: Implications For Future Researchmentioning

confidence: 99%

Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

Hewlett

Almeida

Ambler

et al. 2019

Health Technol Assess

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Background Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for the clinical effectiveness of cognitive–behavioural therapy (CBT) delivered by clinical psychologists, but few rheumatology units have psychologists. Objectives To compare the clinical effectiveness and cost-effectiveness of a group CBT programme for RA fatigue [named RAFT, i.e. Reducing Arthritis Fatigue by clinical Teams using cognitive–behavioural (CB) approaches], delivered by the rheumatology team in addition to usual care (intervention), with usual care alone (control); and to evaluate tutors’ experiences of the RAFT programme. Design A randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of the seven centres. A nested qualitative evaluation was undertaken. Setting Seven hospital rheumatology units in England and Wales. Participants Adults with RA and fatigue severity of ≥ 6 [out of 10, as measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS)] who had no recent changes in major RA medication/glucocorticoids. Interventions RAFT – group CBT programme delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care – brief discussion of a RA fatigue self-management booklet with the research nurse. Main outcome measures Primary – fatigue impact (as measured by the BRAF-NRS) at 26 weeks. Secondary – fatigue severity/coping (as measured by the BRAF-NRS); broader fatigue impact [as measured by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)]; self-reported clinical status; quality of life; mood; self-efficacy; and satisfaction. All data were collected at weeks 0, 6, 26, 52, 78 and 104. In addition, fatigue data were collected at weeks 10 and 18. The intention-to-treat analysis conducted was blind to treatment allocation, and adjusted for baseline scores and centre. Cost-effectiveness was explored through the intervention and RA-related health and social care costs, allowing the calculation of quality-adjusted life-years (QALYs) with the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Tutor and focus group interviews were analysed using inductive thematic analysis. Results A total of 308 out of 333 patients completed 26 weeks (RAFT, n/N = 156/175; control, n/N = 152/158). At 26 weeks, the mean BRAF-NRS impact was reduced for the RAFT programme (–1.36 units; p < 0.001) and the control interventions (–0.88 units; p < 0.004). Regression analysis showed a difference between treatment arms in favour of the RAFT programme [adjusted mean difference –0.59 units, 95% confidence interval (CI) –1.11 to –0.06 units; p = 0.03, effect size 0.36], and this was sustained over 2 years (–0.49 units, 95% CI –0.83 to –0.14 units; p = 0.01). At 26 weeks, further fatigue differences favoured the RAFT programme (BRAF-MDQ fatigue impact: adjusted mean difference –3.42 units, 95% CI –6.44 to – 0.39 units, p = 0.03; living with fatigue: adjusted mean difference –1.19 units, 95% CI –2.17 to –0.21 units, p = 0.02; and emotional fatigue: adjusted mean difference –0.91 units, 95% CI –1.58 to –0.23 units, p = 0.01), and these fatigue differences were sustained over 2 years. Self-efficacy favoured the RAFT programme at 26 weeks (Rheumatoid Arthritis Self-Efficacy Scale: adjusted mean difference 3.05 units, 95% CI 0.43 to 5.6 units; p = 0.02), as did BRAF-NRS coping over 2 years (adjusted mean difference 0.42 units, 95% CI 0.08 to 0.77 units; p = 0.02). Fatigue severity and other clinical outcomes were not different between trial arms and no harms were reported. Satisfaction with the RAFT programme was high, with 89% of patients scoring ≥ 8 out of 10, compared with 54% of patients in the control arm rating the booklet (p < 0.0001); and 96% of patients and 68% of patients recommending the RAFT programme and the booklet, respectively, to others (p < 0.001). There was no significant difference between arms for total societal costs including the RAFT programme training and delivery (mean difference £434, 95% CI –£389 to £1258), nor QALYs gained (mean difference 0.008, 95% CI –0.008 to 0.023). The probability of the RAFT programme being cost-effective was 28–35% at the National Institute for Health and Care Excellence’s thresholds of £20,000–30,000 per QALY. Tutors felt that the RAFT programme’s CB approaches challenged their usual problem-solving style, helped patients make life changes and improved tutors’ wider clinical practice. Limitations Primary outcome data were missing for 25 patients; the EQ-5D-5L might not capture fatigue change; and 30% of the 2-year economic data were missing. Conclusions The RAFT programme improves RA fatigue impact beyond usual care alone; this was sustained for 2 years with high patient satisfaction, enhanced team skills and no harms. The RAFT programme is < 50% likely to be cost-effective; however, NHS costs were similar between treatment arms. Future work Given the paucity of RA fatigue interventions, rheumatology teams might investigate the pragmatic implementation of the RAFT programme, which is low cost. Trial registration Current Controlled Trials ISRCTN52709998. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 57. See the NIHR Journals Library website for further project information.

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“…Mindfulness has been found to reduce anxiety, stress and depression in individuals with chronic physical and mental health conditions [25]. It reduces fatigue and pain, increases quality of life and self-efficacy, and positively impacts various biological and immunological markers in autoimmune disorders such as arthritis, heart disease, diabetes, cancer and asthma [26][27][28][29].…”

Section: Current Treatmentsmentioning

confidence: 99%

Mindfulness Based Therapies for Autoimmune Diseases and Related Symptoms

Penberthy¹,

Chhabra²,

Avitabile³

et al. 2018

obm icm

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Over the past few decades, there have been minimal advances in effective new behavioral or psychotherapeutic interventions for people living with autoimmune diseases such as systematic lupus erythematosus. This is problematic due to the severe, debilitating and potentially lifethreatening nature of these diseases. Mindfulness based interventions, such as Mindfulness Based Stress Reduction, have demonstrated effectiveness in a wide range of patient populations and we hypothesize such treatment would also benefit patients with autoimmune disorders and related symptoms. We further hypothesize that these therapies will work by impacting physiological mechanisms, such as inflammatory markers, associated with such disease symptoms. We present our findings below.

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The evidence base for psychological interventions for rheumatoid arthritis: A systematic review of reviews

Cited by 75 publications

References 42 publications

Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

Health status and self‐management in patients with inflammatory arthritis—A five‐year follow‐up study after nurse‐led patient education

Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

Mindfulness Based Therapies for Autoimmune Diseases and Related Symptoms

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