Newly diagnosed with inflammatory arthritis (NISMA)-development of a complex self-management intervention

A self-management intervention for newly diagnosed with inflammatory arthritis: a randomized controlled feasibility and fidelity study

BACKGROUND

Inflammatory arthritis affects approximately 2-3% of adults worldwide. For patients newly diagnosed with arthritis, effective self-management is crucial, as they often face several physiological, emotional, and social challenges. A self-management intervention called NISMA was thus developed to cater to this group. This study aimed to evaluate the feasibility and fidelity of this intervention before conducting a full-scale randomized controlled trial.

METHODS

This feasibility study was conducted as a single-center randomized controlled trial. Twenty participants were expected to be sufficient for assessing the feasibility outcomes. The control group received only the usual care, while the intervention group received the NISMA intervention in addition, which involved individual and group sessions in a multidisciplinary setting. Feasibility was evaluated based on the recruitment, data collection, retention, and randomization processes. The patient-reported outcome measures and clinical measures were collected to review their potential for inclusion in a future randomized controlled trial. Fidelity was assessed by using documentation sheets filled in by the health professionals and audio recordings of the sessions to examine whether the intervention's principles and components were adequately addressed.

RESULTS

Among 47 eligible patients, we recruited 23 participants during a period of 4 months. The recruitment rate was 47% and the retention rate 91%. Randomization, although accepted, led to some disappointment in the control group. Data collection was effective, with only minimal missing data (< 1%). The fidelity was considered as high, as results indicated that nurses effectively engaged in collaborative partnerships with patients, utilizing planned questioning techniques and self-management strategies for problem-solving and resource utilization. However, action planning was inconsistently applied.

CONCLUSION

The study demonstrated the feasibility and the overall high fidelity of delivering the NISMA intervention to patients newly diagnosed with inflammatory arthritis. The insights from the study are useful for identifying the areas that require modifications before initiating a randomized controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT06063252. Registered 02 October 2023 - retrospectively registered.

Knowledge, attitude and practice toward fibromyalgia among fibromyalgia patients: A web-based cross-sectional study in China

BACKGROUND

This study aimed to explore the knowledge, attitude and practice (KAP) of fibromyalgia patients toward fibromyalgia.

METHODS

This web-based cross-sectional study was conducted in China between February and March 2023 among fibromyalgia patients using a self-administered questionnaire.

RESULTS

A total of 401 valid questionnaires were enrolled, including 326 (81.30%) females and with a mean age of 42.42 ± 11.78 years. The mean scores for KAP were 7.14 ± 2.72 (possible range: 0-10), 27.31 ± 4.24 (possible range: 8-40) and 28.08 ± 5.55 (possible range: 10-50), respectively. Multivariate logistic regression analysis showed knowledge (OR = 1.09, 95%CI: 1.04-1.15, P = 0.001) and patient global impression (PGI) on average pain severity in the last week (OR = 0.89, 95%CI: 0.81-0.97, P = 0.011) were independently associated with positive attitude. Attitude (OR = 1.08, 95%CI: 1.02-1.14, P = 0.006), initial consultation in orthopedics (OR = 2.15, 95%CI: 1.24-3.73, P = 0.006) and age (OR = 0.98, 95%CI: 0.96-1.00, P = 0.037) were independently associated with proactive practice. The structural equation model demonstrated that knowledge had a positive effect on attitude (β = 0.21, P = 0.006), and Widespread Pain Index (WPI) exhibited an impact on both knowledge (β = -0.04, P < 0.001) and attitude (β = -0.52, P = 0.001).

CONCLUSION

Fibromyalgia patients showed suboptimal knowledge, moderate attitude and inactive practice toward fibromyalgia. To enhance fibromyalgia patient outcomes, recommendations include targeted education, addressing rural-urban disparities in knowledge, emphasizing early diagnosis, and adopting patient-centered approaches to promote positive attitude and better disease management.

Development of a Multimodal, Physiotherapist-Led, Vocational Intervention for People with Inflammatory Arthritis and Reduced Work Ability: A Mixed-Methods Design Study

PURPOSE

Work ability of people with rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is reduced, but underexamined as a clinical treatment target. The evidence on vocational interventions indicates that delivery by a single healthcare professional (HCP) may be beneficial. Physiotherapist (PT)-led interventions have potential because PTs are most commonly consulted by RA/axSpA patients in the Netherlands. The aim was to develop a PT-led, vocational intervention for people with RA/axSpA and reduced work ability.

METHODS

Mixed-methods design based on the Medical Research Council (MRC) framework for developing and evaluating complex interventions, combining a rapid literature review and six group meetings with: patient representatives (n = 6 and 10), PTs (n = 12), (occupational) HCPs (n = 9), researchers (n = 6) and a feasibility test in patients (n = 4) and PTs (n = 4).

RESULTS

An intervention was developed and evaluated. Patient representatives emphasized the importance of PTs' expertise in rheumatic diseases and work ability. The potential for PTs to support patients was confirmed by PTs and HCPs. The feasibility test confirmed adequate feasibility and underlined necessity of training PTs in delivery. The final intervention comprised work-focussed modalities integrated into conventional PT treatment (10-21 sessions over 12 months), including a personalized work-roadmap to guide patients to other professionals, exercise therapy, patient education and optional modalities.

CONCLUSION

A mixed-methods design with stakeholder involvement produced a PT-led, vocational intervention for people with RA/axSpA and reduced work ability, tested for feasibility and ready for effectiveness evaluation.

Development of a Physiotherapist-Coordinated Interdisciplinary Rehabilitation Intervention for People with Suspected Axial Spondyloarthritis: The SPINCODE Rehabilitation Intervention

Background: People with early axial spondyloarthritis experience a diagnostic delay and a similar disease burden as people with axial spondyloarthritis at a later stage of the disease. In many European countries, patients with early axial spondyloarthritis do not have access to an interdisciplinary rehabilitation team. The objective of this study was to develop a new evidence-based physiotherapist-coordinated interdisciplinary rehabilitation intervention for individuals suspected of axial spondyloarthritis. This development of the rehabilitation intervention is part of the SPINCODE project which focusses on early diagnosis and treatment for people with axial spondyloarthritis. Methods: The development of the intervention encompasses: (i) identifying the evidence base and program theories; (ii) modeling and remodeling the intervention; and (iii) describing the developed intervention. Results: The six-month SPINCODE rehabilitation intervention is a physiotherapist-coordinated, interdisciplinary, outpatient rehabilitation intervention at a specialized rheumatology hospital. The intervention consists of: (i) individual physiotherapist-coordinated consultations with assessment, goal setting, tailored physical activity support, and the defined goals, and coordination across the interdisciplinary team at the hospital and across primary and secondary healthcare levels; (ii) group sessions, encompassing patient education and peer support; and (iii) optional individual support from the interdisciplinary team. Physiotherapists from private care working with the patient enrolled in the SPINCODE study are offered digital support from the hospital-based physiotherapists. Conclusions: The developed physiotherapist-led interdisciplinary SPINCODE rehabilitation intervention is ready for feasibility testing.