Patient Goals for Living with Rheumatoid Arthritis: A Qualitative Study

Rheumatoid arthritis is highly individualized in terms of its flare ups and periods of remission. Each patient's unique experience requires a high level of personalization in terms of treatment making it necessary to understand what their goals for living are. This study explores patient perceptions on how the burden of RA shapes patients' goals for living and their preferences for symptom and side-effect management within the United States. Fifteen patients diagnosed with RA with varying lengths of diagnosis were interviewed. A thematic analysis was conducted to construct a conceptual framework. Emerging themes identified disease burdens as: (1) inability to perform essential needs, (2) negative feelings about disease, and (3) its influence on relationships. These burdens shaped desired goals for living which guided the symptom and side-effect priorities the patient wanted managed. Practitioners should consider patient goals and preferences in conjunction with disease progression when engaging in treatment decisions.

0240 Investigating the Potential for Actigraphy as a Complementary Clinical Tool for Evaluation of Sleep in Patients with Rheumatoid Arthritis

Introduction

Poor sleep is a common complaint among patients with rheumatoid arthritis (RA), but few actively recognize the problem or discuss it with their rheumatologist during the clinical visit. Challenges to identification of sleep issues include a lack of standardized sleep measures used within clinical care and lack of confidence on the part of patients’ articulating how sleep is affected by RA. Clinical management is further complicated by insufficient evidence between sleep quality and disease symptomology. The objective of this study was to identify correlations between sleep measures assessed through self-report and actigraphy with disease activity for patients with RA.

Methods

In a prospective, cross-sectional study, a sample of 15 participants diagnosed with RA were recruited through convenience sampling. Consenting participants self-reported sleep quality and disease activity using Pittsburgh Sleep Quality Index (PSQI) and Routine Assessment of Patient Index Data 3 (RAPID-3). Participants’ sleep quality was also measured using actigraphy which monitors wrist movement by wearing a watch. Daily actigraphy measures of sleep efficiency, latency, and fragmentation were averaged over 6 nights. Actigraphy measures were correlated to the PSQI and RAPID-3 through Spearman correlations.

Results

The sample was mostly Caucasian women with an average age of 55 years, generally reflective of the population with RA. The results demonstrated weak, nonsignificant correlations between self-reported measures of sleep and average sleep efficiency (0.12, p=0.66), latency (0.10, p=0.72), and fragmentation (-0.13, p=10). Additionally, weak, nonsignificant correlations existed between disease activity and average sleep efficiency (0.09, p=0.75), latency (0.35, p=0.19), and fragmentation (-0.12, p=65).

Conclusion

This study’s implications suggest actigraphy may provide complementary information to self-reported measures of sleep. Such information may support patients’ articulation of sleep issues to the rheumatologist. Further research is necessary to understand how actigraphy measures can be effectively summarized for use by the patient and rheumatologist to discuss sleep issues during the clinical encounter as well as their ability to support clinical diagnosis of sleep disorders.

Support (If Any)

Support: Prisma Health Upstate Seed Grant 2019-2020. University of South Carolina Magellan Scholar & Apprentice Programs funding Shelby Rader. Furman University Center for Engaged Learning for summer internship funding for Ava Cox.

0682 Evaluation Of An Incentive-based Intervention To Improve 90-day Adherence In Pap-naive Patients

Introduction

Although PAP therapy is the gold standard treatment for obstructive sleep apnea, adherence to treatment is suboptimal. Without sustained therapy adherence, patients are at risk of serious negative health outcomes. The objective of this study was to test whether a digitally delivered monetary and social reward program helped patients new to PAP therapy. Financial incentive schemes are effective in helping patients adhere to difficult medication or therapy plans. Additionally, there is an abundance of evidence that social support is a critical component to long-term health behavior change.

Methods

This prospective, randomized, single site pilot is evaluating the effectiveness of an app-based intervention in helping patients adhere to PAP therapy. The financial incentive design leverages loss aversion, and the social incentive design leverages the strength of close ties and variable reinforcement. The primary endpoint is mean PAP usage at 3 months. Secondary endpoints include Medicare compliance, change in functional status, and baseline scores of perceived disease severity, claustrophobia, coping skills, and health literacy as moderators of the intervention’s effectiveness. Study recruitment is ongoing, with an expected sample size of 150 subjects.

Results

Of the 132 subjects enrolled, 56% are male, 61% are Caucasian, and 65% are married. The mean age is 49.6 ± 12.0 years and mean BMI is 32.4 ± 8.4 kg/m2. Additional demographics such as income level, education level, and number of children along with the primary and secondary endpoints will be presented. A subgroup analysis of the primary endpoint will be generated for subjects identified as strugglers within the first 3 days of usage.

Conclusion

The results of this study will provide insight into methods such as financial and social incentives delivered via a smartphone on initial compliance with PAP therapy, as well as provide more information on the behavioral change associated with beginning PAP therapy.

Support

ResMed

Design and implementation of a randomized controlled social and mobile weight loss trial for young adults (project SMART)

PURPOSE

To describe the theoretical rationale, intervention design, and clinical trial of a two-year weight control intervention for young adults deployed via social and mobile media.

METHODS

A total of 404 overweight or obese college students from three Southern California universities (M(age) = 22( ± 4) years; M(BMI) = 29( ± 2.8); 70% female) were randomized to participate in the intervention or to receive an informational web-based weight loss program. The intervention is based on behavioral theory and integrates intervention elements across multiple touch points, including Facebook, text messaging, smartphone applications, blogs, and e-mail. Participants are encouraged to seek social support among their friends, self-monitor their weight weekly, post their health behaviors on Facebook, and e-mail their weight loss questions/concerns to a health coach. The intervention is adaptive because new theory-driven and iteratively tailored intervention elements are developed and released over the course of the two-year intervention in response to patterns of use and user feedback. Measures of body mass index, waist circumference, diet, physical activity, sedentary behavior, weight management practices, smoking, alcohol, sleep, body image, self-esteem, and depression occur at 6, 12, 18, and 24 months. Currently, all participants have been recruited, and all are in the final year of the trial.

CONCLUSION

Theory-driven, evidence-based strategies for physical activity, sedentary behavior, and dietary intake can be embedded in an intervention using social and mobile technologies to promote healthy weight-related behaviors in young adults.