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Murphy SL, Chen YT, Alore M, Hicks S, Pape A, Hassett AL, Kratz AL, Whibley D, Harper AE, Huang S, Jay G, Bolde S, Khanna D. Effects of a Resilience-Building Energy Management Program on Fatigue and Other Symptoms in Systemic Sclerosis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2024; 76:318-327. [PMID: 37846437 PMCID: PMC10922781 DOI: 10.1002/acr.25253] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE Supported self-management interventions for individuals with systemic sclerosis (SSc) are needed. We examined the effects of a 12-week resilience-building energy management program (called RENEW) for fatigue and other patient-reported outcomes. METHODS Participants, who had physician-diagnosed SSc, moderate to severe fatigue, and were ≥18 years old, were randomly assigned to RENEW or waitlist control in a 2:1 ratio. The RENEW intervention included an educational website/application plus nine virtual peer-led health coaching sessions. The primary outcome was change in the Functional Assessment of Chronic Illness Therapy-Fatigue scale. Secondary outcomes were change in Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms and Connor-Davidson Resilience Scale. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. Multiple imputation was conducted; linear mixed models were used to assess group differences. A three-way interaction with group, time, and SSc duration was examined in each model. RESULTS Among 173 participants (mean ± SD age 54.5 ± 11.7 years; 93% female, 85% White), 47% had diffuse cutaneous SSc; 57% were ≤5 years from diagnosis. At 12 weeks, compared to controls, RENEW participants had a clinically meaningful fatigue improvement (β = -4.7; 95% confidence interval -6.7 to -2.7; P < 0.001) and improvement in all secondary outcomes. Among RENEW participants, individuals with shorter disease duration had greater improvements in fatigue at 12 weeks. CONCLUSION An mHealth supported self-management intervention improved fatigue and other outcomes, particularly in newly diagnosed patients. This program may be broadly scalable for SSc symptom management.
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Affiliation(s)
- Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Yen T. Chen
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mary Alore
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Sheri Hicks
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Adam Pape
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Afton L. Hassett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anna L. Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Daniel Whibley
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Alexandra E. Harper
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Suiyuan Huang
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Gina Jay
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Shannen Bolde
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Murphy SL, Poole JL, Chen YT, Lescoat A, Khanna D. Rehabilitation Interventions in Systemic Sclerosis: A Systematic Review and Future Directions. Arthritis Care Res (Hoboken) 2022; 74:59-69. [PMID: 34165263 PMCID: PMC8695630 DOI: 10.1002/acr.24737] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/13/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To systematically review evidence of rehabilitation interventions for improving outcomes in systemic sclerosis (SSc) and to evaluate evidence quality. METHODS Several electronic databases were searched to identify studies in which rehabilitation professionals delivered, supervised, or participated in interventions for individuals with SSc. Randomized controlled trials (RCTs) or non-randomized trials, one-arm trials, and prospective quasi-experimental studies with interventions were included if they had ≥10 participants. Quality appraisal was conducted by 2 independent raters using the Physiotherapy Evidence Database (PEDro) Scale. RESULTS A total of 16 good or excellent quality studies (15 RCTs, 1 prospective quasi-experimental study) were included. Most rehabilitation interventions focused on hands/upper extremities, followed by multicomponent, orofacial, and directed self-management. Sample sizes varied between 20-267 participants (median 38). In 50% of studies, participants in intervention groups significantly improved compared to controls. Most studies demonstrated within-group improvements in intervention groups. Interventions varied in content, delivery, length, and dose and outcome measures collected. CONCLUSION Existing evidence provides some support for rehabilitation in SSc, such as interventions that focus on hand and upper extremity outcomes or are multicomponent, although there is high study heterogeneity. The evidence base would benefit from interventions testing similar replicable components, use of common outcome measures, and incorporation of delivery modes that enable larger sample sizes. There are challenges in recruiting participants due to the rarity of SSc and high disease burden, as participants' involvement in rehabilitation studies requires active participation over time. Intervention studies designed to reduce participation barriers may facilitate translation of effective interventions into practice.
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Affiliation(s)
- Susan L. Murphy
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- VA Ann Arbor Healthcare System, Geriatric Research Education and Clinical Center, GRECC, Ann Arbor, MI USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Janet L. Poole
- Department of Occupational Therapy, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yen T. Chen
- Department of Physical Medicine & Rehabilitation, University of Michigan, USA
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Alain Lescoat
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine and Clinical Immunology, Rennes University Hospital, Rennes, France
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail) - UMR_S 1085, Rennes, France
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
| | - Dinesh Khanna
- Michigan Scleroderma Program, University of Michigan, Ann Arbor, Michigan, USA
- Division of Rheumatology, University of Michigan, Ann Arbor, Michigan, USA
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Murphy SL, Kratz AL, Whibley D, Poole JL, Khanna D. Fatigue and Its Association With Social Participation, Functioning, and Quality of Life in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2021; 73:415-422. [PMID: 31841268 DOI: 10.1002/acr.24122] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Fatigue is consistently ranked as one of the most problematic symptoms of systemic sclerosis (SSc), but the impact of fatigue on daily life is not well characterized. The purpose of this study was to examine the contribution of fatigue to deficits in social participation, functioning, and quality of life. METHODS Baseline data from a sample undertaking a clinical trial were utilized (n = 267). Fatigue, pain interference, depressive symptoms, physical function, and social participation were assessed by measures from the Patient-Reported Outcomes Measurement Information System. Hierarchical linear regressions were performed to determine the unique contribution of fatigue to social participation, physical function, and quality of life above and beyond the effects of demographic and clinical variables, pain interference, and depressive symptoms. RESULTS The sample was predominantly female (91%), with an average age of 53.7 years, average disease duration of 9 years, and a mean fatigue T score of 58.7. Of all outcomes, fatigue was most strongly associated with deficits in social participation, explaining 48% of the variance beyond demographic and clinical factors, which is similar to the amount of variance contributed by pain interference and depressive symptoms combined (49%). Fatigue also accounted for significant amounts of variance in physical function and quality of life (R2 = 0.27 and 0.33, respectively) above and beyond the effects of demographic and clinical factors. CONCLUSION Fatigue is an important clinical problem in SSc and is strongly associated with decreased participation in social roles and activities. Rehabilitation interventions that focus on fatigue management may be necessary to maximize participation.
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Affiliation(s)
- Susan L Murphy
- University of Michigan and Ann Arbor Veterans Affairs Health Care System, Ann Arbor, USA
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Murphy SL, Krause D, Roll SC, Gandikota G, Barber M, Khanna D. Development of a Musculoskeletal Ultrasound Protocol to Examine Upper Extremity Rehabilitation Outcomes in Systemic Sclerosis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021; 37:13-23. [PMID: 33521795 PMCID: PMC7842414 DOI: 10.1177/8756479320965210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study developed a musculoskeletal ultrasound (MSUS) protocol to evaluate rehabilitation outcomes in systemic sclerosis. MATERIALS & METHODS Three MSUS methods (grey scale, Doppler, strain elastography) and two acquisition techniques (long versus short axis; transducer on skin versus floating on gel) were examined in the forearm before and after rehabilitation treatment. For grey-scale, tissue thickness measures, intra- and inter-rater reliability were calculated (ICCs), and paired t-tests examined differences among techniques. RESULTS Five people with diffuse cutaneous systemic sclerosis participated. The most valid and reliable grey-scale technique was with the transducer in long-axis, floating on gel. Doppler and strain elastography did not detect changes. Both dermal and subcutaneous thickness measurement error was small; intra- and inter-rater reliability was good to excellent. Preliminary data indicate that treatment may lead to dermal thinning. CONCLUSION A replicable protocol was established and may be an adjunct to rehabilitation outcome measurement in systemic sclerosis.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
- VA Ann Arbor Health Care System, Ann Arbor, MI, Geriatric Research Education and Clinical Center (GRECC)
| | - Donnamarie Krause
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | | | - Mary Barber
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Dinesh Khanna
- Rheumatology Division, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
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Richarz NA, Olivé A, García-Patos V, Quirant B, Fernández Figueras MT, Bielsa I. A review of the clinically distinguishing features of nodular or keloidal scleroderma in systemic sclerosis. Australas J Dermatol 2020; 61:e269-e273. [PMID: 31984476 DOI: 10.1111/ajd.13239] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 12/12/2019] [Accepted: 12/23/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nina A Richarz
- Departments of , Department of, Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Alejandro Olivé
- Department of, Reumatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Vicente García-Patos
- Department of Dermatology, Hospital Universitari de Vall d'Hebron, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Bibiana Quirant
- Department of, Immunlogy, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
| | | | - Isabel Bielsa
- Departments of , Department of, Dermatology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
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Sinnathurai P, Schrieber L. Treatment of Raynaud phenomenon in systemic sclerosis. Intern Med J 2013; 43:476-83. [DOI: 10.1111/imj.12082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
Affiliation(s)
- P. Sinnathurai
- Department of Rheumatology; Royal North Shore Hospital; Sydney New South Wales Australia
| | - L. Schrieber
- Department of Rheumatology; Royal North Shore Hospital; Sydney New South Wales Australia
- Sydney Medical School; University of Sydney; Sydney New South Wales Australia
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