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Sibilia J, Berna F, Bloch JG, Scherlinger M. Mind-body practices in chronic inflammatory arthritis. Joint Bone Spine 2024; 91:105645. [PMID: 37769800 DOI: 10.1016/j.jbspin.2023.105645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 10/03/2023]
Abstract
Mind-body practices are complementary approaches recognized by the World Health Organization (WHO). While these practices are very diverse, they all focus on the interaction between mind and body. These include mindful meditation, yoga, Tai Chi, sophrology, hypnosis and various relaxation techniques. There is growing interest in incorporating these strategies in the management of chronic rheumatic diseases including rheumatoid arthritis. The aim of this review is to describe the main mind-body practices and analyze the existing evidence in chronic rheumatic diseases. In rheumatoid arthritis, the Mindfulness-Based Stress Reduction program, yoga, Tai Chi and relaxation may improve patient-reported outcomes, but the benefit on inflammation and structural progression is unclear. In spondyloarthritis, very few studies are available but similar evidence exist. Further evaluations of these practices in chronic rheumatic diseases are needed since their risk/benefit ratio appears excellent.
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Affiliation(s)
- Jean Sibilia
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
| | - Fabrice Berna
- Service de Psychiatrie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Gérard Bloch
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Marc Scherlinger
- Service de Rhumatologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; UMR INSERM 1109, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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Johnson E, Corrick S, Isley S, Vandermeer B, Dolgoy N, Bates J, Godfrey E, Soltys C, Muir C, Vohra S, Tandon P. Mind-body internet and mobile-based interventions for depression and anxiety in adults with chronic physical conditions: A systematic review of RCTs. PLOS DIGITAL HEALTH 2024; 3:e0000435. [PMID: 38261600 PMCID: PMC10805319 DOI: 10.1371/journal.pdig.0000435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024]
Abstract
This review summarizes the effectiveness of scalable mind-body internet and mobile-based interventions (IMIs) on depression and anxiety symptoms in adults living with chronic physical conditions. Six databases (MEDLINE, PsycINFO, SCOPUS, EMBASE, CINAHL, and CENTRAL) were searched for randomized controlled trials published from database inception to March 2023. Mind-body IMIs included cognitive behavioral therapy, breathwork, meditation, mindfulness, yoga or Tai-chi. To focus on interventions with a greater potential for scale, the intervention delivery needed to be online with no or limited facilitation by study personnel. The primary outcome was mean change scores for anxiety and depression (Hedges' g). In subgroup analyses, random-effects models were used to calculate pooled effect size estimates based on personnel support level, intervention techniques, chronic physical condition, and survey type. Meta-regression was conducted on age and intervention length. Fifty-six studies met inclusion criteria (sample size 7691, mean age of participants 43 years, 58% female): 30% (n = 17) neurological conditions, 12% (n = 7) cardiovascular conditions, 11% cancer (n = 6), 43% other chronic physical conditions (n = 24), and 4% (n = 2) multiple chronic conditions. Mind-body IMIs demonstrated statistically significant pooled reductions in depression (SMD = -0.33 [-0.40, -0.26], p<0.001) and anxiety (SMD = -0.26 [-0.36, -0.17], p<0.001). Heterogeneity was moderate. Scalable mind-body IMIs hold promise as interventions for managing anxiety and depression symptoms in adults with chronic physical conditions without differences seen with age or intervention length. While modest, the effect sizes are comparable to those seen with pharmacological therapy. The field would benefit from detailed reporting of participant demographics including those related to technological proficiency, as well as further evaluation of non-CBT interventions. Registration: The study is registered with PROSPERO ID #CRD42022375606.
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Affiliation(s)
- Emily Johnson
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
| | - Shaina Corrick
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
| | - Serena Isley
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
| | - Ben Vandermeer
- Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Naomi Dolgoy
- Faculty of Rehabilitation Science, Edmonton, Alberta
| | - Jack Bates
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Elana Godfrey
- Faculty of Science, University of Toronto, Toronto, Ontario
| | - Cassidy Soltys
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Conall Muir
- Faculty of Science, University of Alberta, Edmonton, Alberta
| | - Sunita Vohra
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Puneeta Tandon
- Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta
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Duarte C, Spilker RLF, Paiva C, Ferreira RJO, da Silva JAP, Pinto AM. MITIG.RA: study protocol of a tailored psychological intervention for managing fatigue in rheumatoid arthritis randomized controlled trial. Trials 2023; 24:651. [PMID: 37803467 PMCID: PMC10559483 DOI: 10.1186/s13063-023-07692-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Despite remarkable medical advances in the treatment of rheumatoid arthritis (RA), a subset of patients fails to achieve complete clinical remission, as the Patient Global Assessment (PGA) of disease activity remains above 1, even after the inflammatory process is brought under control. This so-called state of 'PGA-near-remission' negatively impacts individuals' functioning and potentiates inadequate care. Fatigue is a distressing and disabling symptom frequently reported by patients in PGA-near-remission, and its management remains challenging. While classic cognitive-behavioural interventions show some benefits in managing fatigue, there is potential for improvement. Recently, contextual-cognitive behavioural therapies (CCBT), like mindfulness, acceptance, and compassion-based interventions, have shown promising results in fatigue-associated disorders and their determinants. This study primarily aims to examine the efficacy of the Compassion and Mindfulness Intervention for RA (MITIG.RA), a novel intervention combining different components of CCBT, compared to treatment-as-usual (TAU) in the management of RA-associated fatigue. Secondary aims involve exploring whether MITIG.RA produces changes in the perceived impact of disease, satisfaction with disease status, levels of depression, and emotion-regulation skills. METHODS This is a single center, two-arm parallel randomized controlled trial. Patients will be screened for eligibility and willingness to participate and will be assessed and randomized to the experimental (MITIG.RA + TAU) or control condition (TAU) using computer randomization. MITIG.RA will be delivered by a certified psychologist and comprises eight sessions of 2 h, followed by two booster sessions. Outcomes will be assessed through validated self-report measures, including fatigue (primary outcome), perceived impact of disease, depressive symptoms, mindfulness, self-compassion, safety, and satisfaction (secondary outcomes). Assessment will take place at baseline, post-intervention, before the first and second booster sessions (weeks 12 and 20, respectively), and at 32 and 44 weeks after the interventions' beginning. DISCUSSION We expect MITIG.RA to be effective in reducing levels of RA-associated fatigue. Secondarily, we hypothesize that the experimental group will show improvements in the overall perceived impact of disease, emotional distress, and emotion regulation skills. Our findings will contribute to determine the benefits of combining CCBT approaches for managing fatigue and associated distress in RA. TRIAL REGISTRATION ClinicalTrials.gov NCT05389189. Registered on May 25, 2022.
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Affiliation(s)
- Cátia Duarte
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal.
| | | | - Cláudia Paiva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Ricardo J O Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Lisbon, Portugal
| | - José A Pereira da Silva
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Ana M Pinto
- Centre for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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McCracken LM. Personalized pain management: Is it time for process-based therapy for particular people with chronic pain? Eur J Pain 2023; 27:1044-1055. [PMID: 36755478 DOI: 10.1002/ejp.2091] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Psychological treatments for chronic pain have helped many people around the world. They are among the most researched and best evidenced treatments a person can receive when they have persistent, disabling and distressing pain. At the same time, improvements in the effectiveness of these treatments appear to be at a standstill. This may be due to an inherent lack of generalizability from aggregated group data to the individual, limited utility of our current schemes for categorizing people with pain conditions, faced with their inherent heterogeneity, our relatively coarse categories of treatment types and focus on treatment packages rather than individual methods, and our current failures to find adequate predictors of outcome, or to assign people their best-suited treatment methods, based on group data. In this review, it is argued that the development and examination of truly personalized treatment is a next logical step to create progress and improve the results people achieve. METHODS Key research studies pertaining to psychological treatments, treatment outcome, heterogeneity in chronic pain, prediction of treatment outcome, subtyping and treatment tailoring are reviewed. RESULTS AND CONCLUSION It is suggested that development of future treatments for chronic pain ought to incorporate an idiographic, process-based approach, focused on evidence-based mechanisms of change, individually and dynamically addressed, based on contextually sensitive ongoing assessment. Knowledge and practical solutions needed to make process-based therapy for chronic pain happen are discussed. SIGNIFICANCE Psychological approaches to chronic pain have been highly successful in the past but improvement in the effectiveness of these over time is slow to nonexistent. It is argued here that this has happened due to a failure to adequately consider the individual. Future psychological treatments for chronic pain ought to incorporate an idiographic, process-based approach, focused on evidence-based mechanisms of change, individually and dynamically addressed, grounded in ongoing contextually sensitive assessment.
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Affiliation(s)
- Lance M McCracken
- Division of Clinical Psychology, Psychology Department, Uppsala University, Uppsala, Sweden
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Rosser BA, Fisher E, Janjua S, Eccleston C, Keogh E, Duggan G. Psychological therapies delivered remotely for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev 2023; 8:CD013863. [PMID: 37643992 PMCID: PMC10476013 DOI: 10.1002/14651858.cd013863.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Chronic pain (pain lasting three months or more) is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Common types (excluding headache) include back pain, fibromyalgia, and neuropathic pain. Access to traditional face-to-face therapies can be restricted by healthcare resources, geography, and cost. Remote technology-based delivery of psychological therapies has the potential to overcome treatment barriers. However, their therapeutic effectiveness compared to traditional delivery methods requires further investigation. OBJECTIVES To determine the benefits and harms of remotely-delivered psychological therapies compared to active control, waiting list, or treatment as usual for the management of chronic pain in adults. SEARCH METHODS We searched for randomised controlled trials (RCTs) in CENTRAL, MEDLINE, Embase, and PsycINFO to 29 June 2022. We also searched clinical trials registers and reference lists. We conducted a citation search of included trials to identify any further eligible trials. SELECTION CRITERIA We included RCTs in adults (≥ 18 years old) with chronic pain. Interventions included psychological therapies with recognisable psychotherapeutic content or based on psychological theory. Trials had to have delivered therapy remote from the therapist (e.g. Internet, smartphone application) and involve no more than 30% contact time with a clinician. Comparators included treatment as usual (including waiting-list controls) and active controls (e.g. education). DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. MAIN RESULTS We included 32 trials (4924 participants) in the analyses. Twenty-five studies delivered cognitive behavioural therapy (CBT) to participants, and seven delivered acceptance and commitment therapy (ACT). Participants had back pain, musculoskeletal pain, opioid-treated chronic pain, mixed chronic pain, hip or knee osteoarthritis, spinal cord injury, fibromyalgia, provoked vestibulodynia, or rheumatoid arthritis. We assessed 25 studies as having an unclear or high risk of bias for selective reporting. However, across studies overall, risk of bias was generally low. We downgraded evidence certainty for primary outcomes for inconsistency, imprecision, and study limitations. Certainty of evidence ranged from moderate to very low. Adverse events were inadequately reported or recorded across studies. We report results only for studies in CBT here. Cognitive behavioural therapy (CBT) versus treatment as usual (TAU) Pain intensity Immediately after treatment, CBT likely demonstrates a small beneficial effect compared to TAU (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.39 to -0.16; 20 studies, 3206 participants; moderate-certainty evidence). Participants receiving CBT are probably more likely to achieve a 30% improvement in pain intensity compared to TAU (23% versus 11%; risk ratio (RR) 2.15, 95% CI 1.62 to 2.85; 5 studies, 1347 participants; moderate-certainty evidence). They may also be more likely to achieve a 50% improvement in pain intensity (6% versus 2%; RR 2.31, 95% CI 1.14 to 4.66; 4 studies, 1229 participants), but the evidence is of low certainty. At follow-up, there is likely little to no difference in pain intensity between CBT and TAU (SMD -0.04, 95% CI -0.17 to 0.09; 8 studies, 959 participants; moderate-certainty evidence). The evidence comparing CBT to TAU on achieving a 30% improvement in pain is very uncertain (40% versus 24%; RR 1.70, 95% CI 0.82 to 3.53; 1 study, 69 participants). No evidence was available regarding a 50% improvement in pain. Functional disability Immediately after treatment, CBT may demonstrate a small beneficial improvement compared to TAU (SMD -0.38, 95% CI -0.53 to -0.22; 14 studies, 2672 participants; low-certainty evidence). At follow-up, there is likely little to no difference between treatments (SMD -0.05, 95% CI -0.23 to 0.14; 3 studies, 461 participants; moderate-certainty evidence). Quality of life Immediately after treatment, CBT may not have resulted in a beneficial effect on quality of life compared to TAU, but the evidence is very uncertain (SMD -0.16, 95% CI -0.43 to 0.11; 7 studies, 1423 participants). There is likely little to no difference between CBT and TAU on quality of life at follow-up (SMD -0.16, 95% CI -0.37 to 0.05; 3 studies, 352 participants; moderate-certainty evidence). Adverse events Immediately after treatment, evidence about the number of people experiencing adverse events is very uncertain (34% in TAU versus 6% in CBT; RR 6.00, 95% CI 2.2 to 16.40; 1 study, 140 participants). No evidence was available at follow-up. Cognitive behavioural therapy (CBT) versus active control Pain intensity Immediately after treatment, CBT likely demonstrates a small beneficial effect compared to active control (SMD -0.28, 95% CI -0.52 to -0.04; 3 studies, 261 participants; moderate-certainty evidence). The evidence at follow-up is very uncertain (mean difference (MD) 0.50, 95% CI -0.30 to 1.30; 1 study, 127 participants). No evidence was available for a 30% or 50% pain intensity improvement. Functional disability Immediately after treatment, there may be little to no difference between CBT and active control on functional disability (SMD -0.26, 95% CI -0.55 to 0.02; 2 studies, 189 participants; low-certainty evidence). The evidence at follow-up is very uncertain (MD 3.40, 95% CI -1.15 to 7.95; 1 study, 127 participants). Quality of life Immediately after treatment, there is likely little to no difference in CBT and active control (SMD -0.22, 95% CI -1.11 to 0.66; 3 studies, 261 participants; moderate-certainty evidence). The evidence at follow-up is very uncertain (MD 0.00, 95% CI -0.06 to 0.06; 1 study, 127 participants). Adverse events Immediately after treatment, the evidence comparing CBT to active control is very uncertain (2% versus 0%; RR 3.23, 95% CI 0.13 to 77.84; 1 study, 135 participants). No evidence was available at follow-up. AUTHORS' CONCLUSIONS Currently, evidence about remotely-delivered psychological therapies is largely limited to Internet-based delivery of CBT. We found evidence that remotely-delivered CBT has small benefits for pain intensity (moderate certainty) and functional disability (moderate to low certainty) in adults experiencing chronic pain. Benefits were not maintained at follow-up. Our appraisal of quality of life and adverse events outcomes post-treatment were limited by study numbers, evidence certainty, or both. We found limited research (mostly low to very low certainty) exploring other psychological therapies (i.e. ACT). More high-quality studies are needed to assess the broad translatability of psychological therapies to remote delivery, the different delivery technologies, treatment longevity, comparison with active control, and adverse events.
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Affiliation(s)
| | - Emma Fisher
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
| | - Sadia Janjua
- Cochrane Pain, Palliative and Supportive Care Group, Pain Research Unit, Churchill Hospital, Oxford, UK
| | | | - Edmund Keogh
- Department of Psychology, University of Bath, Bath, UK
| | - Geoffrey Duggan
- Bath Centre for Pain Services, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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Santos EJF, Farisogullari B, Dures E, Geenen R, Machado PM. Efficacy of non-pharmacological interventions: a systematic review informing the 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2023; 9:e003350. [PMID: 37604639 PMCID: PMC10445356 DOI: 10.1136/rmdopen-2023-003350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To identify the best evidence on the efficacy of non-pharmacological interventions in reducing fatigue in people with inflammatory rheumatic and musculoskeletal diseases (I-RMDs) and to summarise their safety in the identified studies to inform European Alliance of Associations for Rheumatology recommendations for the management of fatigue in people with I-RMDs. METHODS Systematic review of randomised controlled trials (RCTs) including adults with I-RMDs conducted according to the Cochrane Handbook. Search strategy ran in Medline, Embase, Cochrane Library, CINAHL Complete, PEDro, OTseeker and PsycINFO. Assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. Data were pooled in meta-analyses. RESULTS From a total of 4150 records, 454 were selected for full-text review, 82 fulfilled the inclusion criteria and 55 RCTs were included in meta-analyses. Physical activity or exercise was efficacious in reducing fatigue in rheumatoid arthritis (RA) (standardised mean differences (SMD)=-0.23, 95% CI=-0.37 to -0.1), systemic lupus erythematosus (SLE) (SMD=-0.54, 95% CI=-1.07 to -0.01) and spondyloarthritis (SMD=-0.94, 95% CI=-1.23 to -0.66); reduction of fatigue was not significant in Sjögren's syndrome (SMD=-0.83, 95% CI=-2.13 to 0.47) and systemic sclerosis (SMD=-0.66, 95% CI=-1.33 to 0.02). Psychoeducational interventions were efficacious in reducing fatigue in RA (SMD=-0.32, 95% CI=-0.48 to -0.16), but not in SLE (SMD=-0.19, 95% CI=-0.46 to 0.09). Follow-up models in consultations (SMD=-0.05, 95% CI=-0.29 to 0.20) and multicomponent interventions (SMD=-0.20, 95% CI=-0.53 to 0.14) did not show significant reductions of fatigue in RA. The results of RCTs not included in the meta-analysis suggest that several other non-pharmacological interventions may provide a reduction of fatigue, with reassuring safety results. CONCLUSIONS Physica activity or exercise and psychoeducational interventions are efficacious and safe for managing fatigue in people with I-RMDs.
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Affiliation(s)
- Eduardo José Ferreira Santos
- School of Health, Polytechnic University, Viseu, Portugal
- Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | - Bayram Farisogullari
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, Ankara, Turkey
| | - Emma Dures
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, Netherlands
| | - Pedro M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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Tao TJ, Lim TK, Yeung ETF, Liu H, Shris PB, Ma LKY, Lee TMC, Hou WK. Internet-based and mobile-based cognitive behavioral therapy for chronic diseases: a systematic review and meta-analysis. NPJ Digit Med 2023; 6:80. [PMID: 37117458 PMCID: PMC10141870 DOI: 10.1038/s41746-023-00809-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/30/2023] [Indexed: 04/30/2023] Open
Abstract
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
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Affiliation(s)
- Tiffany Junchen Tao
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Teck Kuan Lim
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Ernest Tsun Fung Yeung
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China
| | - Phoenix Bibha Shris
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Lawrence Ka Yin Ma
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China
| | - Tatia Mei Chun Lee
- State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
- Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong SAR, China
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, The Education University of Hong Kong, Hong Kong SAR, China.
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Chew MT, Chan C, Kobayashi S, Cheng HY, Wong TM, Nicholson LL. Online pain management programs for chronic, widespread musculoskeletal conditions: A systematic review with meta-analysis. Pain Pract 2023. [PMID: 37051894 DOI: 10.1111/papr.13227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/09/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
Face-to-face pain management programs demonstrate positive clinical outcomes in the chronic pain population by improving pain intensity and attitudes, depression, and functional disability scores. The effects of this modality carried out online is less known, particularly in subgroups of chronic pain. This systematic review assessed the effects of online pain management programs in chronic, widespread musculoskeletal conditions on pain measurements (intensity, interference, coping, and catastrophizing), health-related quality of life, depression, and anxiety scores immediately post-intervention. Five electronic databases (Embase, Medline, CINAHL, Scopus, and PEDro) were searched with 3546 studies identified. Eighteen randomized controlled trials fulfilled the inclusion criteria. Included studies had moderate methodological quality (using the Effective Public Health Practice Project (EPHPP) quality assessment tool) but high risk of bias (using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2)). There were significant improvements in pain intensity (11 studies, 1397 participants, SMD -0.30, 95% CI -0.50 to -0.10, p = 0.004), health-related quality of life (eight studies, 1054 participants, SMD 0.41, 95% CI 0.08 to 0.75, p = 0.02), and depression (nine studies, 1283 participants, SMD -0.32, 95% CI -0.55 to -0.08, p = 0.008). However, effect sizes were small and did not meet their respective measure's minimal clinically important change score. Guided interventions (regular interaction with an instructor) appeared to be superior to self-completed interventions. Future research should standardize outcome measures for assessing pain, use active control groups, and analyze other outcome measures such as cost and long-term effects. This study was registered with Prospero on August 15, 2021 (CRD42021267565).
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Affiliation(s)
- Min Tze Chew
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Cliffton Chan
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Sarah Kobayashi
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Hoi Yan Cheng
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Tsz Ming Wong
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Leslie L Nicholson
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Azizoddin D, Olmstead R, Anderson KA, Hirz AE, Irwin MR, Gholizadeh S, Weisman M, Ishimori M, Wallace D, Nicassio P. Socioeconomic Status, Reserve Capacity, and Depressive Symptoms Predict Pain in Rheumatoid Arthritis: An Examination of the Reserve Capacity Model. RESEARCH SQUARE 2023:rs.3.rs-2758092. [PMID: 37066198 PMCID: PMC10104260 DOI: 10.21203/rs.3.rs-2758092/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
Background Guided by the reserve capacity model, we examined the roles of socioeconomic status (SES), reserve capacity, and negative emotions as determinants of pain in patients with Rheumatoid Arthritis (RA). Methods The study used cross-sectional baseline data from 106 adults in a clinical trial comparing behavioral treatments for RA. Structural equation modeling evaluated the direct effects of SES, reserve capacity (helplessness, self-efficacy, social support) and negative emotions (stress and depressive symptoms) on pain, and the indirect effects of SES as mediated by reserve capacity and negative emotions. Results Results showed that low SES contributed to greater pain, through lower reserve capacity and higher negative emotions. Mediational analyses showed that reserve capacity and negative emotions partially mediated the effect of SES on pain. Conclusions The findings indicate that interventions that target negative emotions in patients with low SES may facilitate better pain control with RA. Trial registration clinicaltrials.gov NCT00072657; 02/2004.
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Nagy Z, Szigedi E, Takács S, Császár-Nagy N. The Effectiveness of Psychological Interventions for Rheumatoid Arthritis (RA): A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:life13030849. [PMID: 36984004 PMCID: PMC10057722 DOI: 10.3390/life13030849] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Rheumatoid arthritis (RA) is a long-term disorder that significantly impairs somatic, emotional, and psychological functioning. The objective of this review is to identify, appraise, and synthesize the effects of psychological interventions (e.g., cognitive behavioral therapy (CBT), emotional disclosure (ED), group therapy (GT), mindfulness (M), patient education (PE), and relaxation (R)) on biopsychosocial outcomes in the treatment of rheumatoid arthritis (RA). A systematic search of all relevant existing randomized clinical trials (RCTs) was conducted using the following online bibliographic databases: JSTOR, PubMed, PsycNET, and The Cochrane Library. Reference lists were searched for additional reports. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the risk of bias in the included studies. After the selection process, 57 articles were included and 392 were excluded. Three separate meta-analyses were conducted involving psychological interventions as the main variables, showing: (1) significant positive medium effect sizes for average values (Hedges-g = 0.399, Z = 0.399, p = 0.009); (2) significant positive large effect sizes for maximum values (Hedges-g = 0.856, Z = 4.223, p < 0.001); and (3) non-significant results for minimum values (Hedges-g = -0.047, Z = -0.335, p = 0.738). These results demonstrate that, when grouped, psychological interventions are, on average, moderately effective in treating RA. Overall, this review shows consistent, supportive evidence that psychological interventions can significantly contribute to the standard medical care of RA patients. However, more high-quality, large-sample RCTs still need to confirm these findings.
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Affiliation(s)
- Zsófia Nagy
- Psychosomatic Outpatient Clinic, 1037 Budapest, Hungary
| | | | - Szabolcs Takács
- General Psychology and Methodology, Faculty of Humanities, Károli Gáspár University of the Reformed Church, Bécsi Str. 324, 1037 Budapest, Hungary
| | - Noémi Császár-Nagy
- Psychosomatic Outpatient Clinic, 1037 Budapest, Hungary
- Department of Public Organization and Information Technology, Faculty of Public Governance, and International Studies, University of Public Service, Ludovika Square 2, 1083 Budapest, Hungary
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11
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Tommel J, Evers AWM, van Hamersvelt HW, Jordens R, van Dijk S, Hilbrands LB, Hermans MMH, Hollander DAMJ, van de Kerkhof JJ, Ten Dam MAGJ, van Middendorp H. "What matters to you?": The relevance of patient priorities in dialysis care for assessment and clinical practice. Semin Dial 2023; 36:131-141. [PMID: 35388533 DOI: 10.1111/sdi.13080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Dialysis patients are confronted with numerous, complex problems, which make it difficult to identify individual patient's most prominent problems. The objectives of this study were to (1) identify dialysis patients' most prominent problems from a patient perspective and (2) to calculate disease-specific norms for questionnaires measuring these problems. METHODS One hundred seventy-five patients treated with hemodialysis or peritoneal dialysis completed a priority list on several domains of functioning (e.g., physical health, mental health, social functioning, and daily activities) and a set of matching questionnaires assessing patient functioning on these domains. Patient priorities were assessed by calculating the importance ranking of each domain on the priority list. Subsequently, disease-specific norm scores were calculated for all questionnaires, both for the overall sample and stratified by patient characteristics. RESULTS Fatigue was listed as patients' most prominent problem. Priorities differed between male and female patients, younger and older patients, and home and center dialysis patients, which was also reflected in their scores on the corresponding domains of functioning. Therefore, next to general norm scores, we calculated corrections to the general norms to take account of patient characteristics (i.e., sex, age, and dialysis type). CONCLUSIONS Results highlight the importance of having attention for the specific priorities and needs of each individual patient. Adequate disease-specific, norm-based assessment is not only necessary for diagnostic procedures but is an essential element of patient-centered care: It will help to better understand and respect individual patient needs and tailor treatment accordingly.
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Affiliation(s)
- Judith Tommel
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands.,Medical Delta, Leiden University, TU Delft and Erasmus University, The Netherlands
| | - Henk W van Hamersvelt
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Rien Jordens
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud Institute for Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - Marc M H Hermans
- Department of Internal Medicine, Division of Nephrology, VieCuri Medical Center, Venlo, The Netherlands
| | - Daan A M J Hollander
- Department of Nephrology, Ravenstein Dialysis Centre, Ravenstein, The Netherlands
| | | | - Marc A G J Ten Dam
- Department of Internal Medicine, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
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12
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eHealth to Improve Psychological Functioning and Self-Management of People With Chronic Kidney Disease: A Randomized Controlled Trial. Psychosom Med 2023; 85:203-215. [PMID: 36662615 PMCID: PMC9924966 DOI: 10.1097/psy.0000000000001163] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Psychological distress is common among patients with chronic kidney disease and can interfere with disease self-management. We assessed the effectiveness of the personalized E-GOAL electronic health care pathway with screening and cognitive-behavioral therapy including self-management support, aimed to treat psychological distress and facilitate self-management among people with chronic kidney disease not on dialysis ( N = 121). METHODS Primary outcome of the open two-arm parallel randomized controlled trial in four Dutch hospitals was psychological distress at posttest directly after the intervention and at 3-month follow-up. Secondary outcomes were physical and mental health-related quality of life, self-efficacy, chronic disease self-management, and personalized outcomes, that is, perceived progress compared with the previous time point on functioning (e.g., mood or social functioning) and self-management (e.g., dietary or medication adherence) outcomes that were prioritized by each individual. RESULTS Linear mixed-effects analyses showed no significant time-by-group interaction effects for psychological distress, health-related quality of life, self-efficacy, and chronic condition self-management, whereas analyses of covariance showed significantly more perceived progress in the intervention group at posttest on personally prioritized areas of functioning ( b = 0.46, 95% confidence interval = 0.07-0.85) and self-management ( b = 0.55, 95% confidence interval = 0.16-0.95), with Cohen d values of 0.46 and 0.54 (medium effects), respectively. Effects on personalized outcomes were maintained at follow-up. CONCLUSIONS Compared with regular care only, the electronic health intervention did not reduce psychological distress, whereas personalized outcomes did improve significantly after intervention. Future studies could consider personalized outcomes that reflect individually relevant areas and treatment goals, matching person-tailored treatments. TRIAL REGISTRATION Registered at the Netherlands Trial Register with study number NTR7555 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7555 ).
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13
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Terpstra JA, van der Vaart R, van Beugen S, van Eersel RA, Gkika I, Erdős D, Schmidt J, Radstake C, Kloppenburg M, van Middendorp H, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with chronic pain: A meta-analytic review. Internet Interv 2022; 30:100587. [PMID: 36406977 PMCID: PMC9672957 DOI: 10.1016/j.invent.2022.100587] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Chronic pain has a large individual and societal burden. Previous reviews have shown that internet-based cognitive-behavioral therapy (iCBT) can support patients' pain coping. However, factors related to participant experience of iCBT and effective and safe iCBT delivery for chronic pain have not recently been summarized. OBJECTIVE The aim of this review was to give an overview of the efficacy of guided iCBT for chronic pain on psychological, physical, and impact on daily life outcomes, including factors that inform optimal delivery. METHODS Cochrane, Emcare, Web of Science, PubMed, PsycINFO, and Embase were systematically searched from inception to 11 February 2022. Randomized controlled trials on guided iCBTs for adults with chronic pain were included with a broad range of outcomes. RESULTS The search yielded 7406 studies of which 33 studies were included totaling 5133 participants. ICBT was more effective than passive control conditions for psychological (ES = 0.34-0.47), physical (ES = 0.26-0.29), and impact outcomes (ES = 0.38-0.41). ICBT was more effective than active control conditions for distress (ES = 0.40), pain acceptance (ES = 0.15), and pain interference after outlier removal (ES = 0.30). Longer treatments were associated with larger effects for anxiety and quality of life than shorter treatments. Mode of therapist contact (synchronous, asynchronous or a mix of both) was not related to differences in effect sizes in most outcomes. However, studies with mixed and synchronous contact modes had higher effects on pain self-efficacy than studies with asynchronous contact modes. Treatment satisfaction was high and adverse events were minor. Dropout was related to time, health, technical issues, and lack of computer skills. CONCLUSIONS Guided iCBT is an effective and potentially safe treatment for chronic pain. Future research should more consistently report on iCBT safety and detail the effectiveness of individual treatment components to optimize iCBT in clinical practice.
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Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB, Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Sylvia van Beugen
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Roxy A. van Eersel
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Ioanna Gkika
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Dorottya Erdős
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Jana Schmidt
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Caroline Radstake
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology, Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands,Medical Delta, Huismansingel 4, 2629 JH Delft, the Netherlands
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14
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Tommel J, Evers AWM, van Hamersvelt HW, van Dijk S, Chavannes NH, Wirken L, Hilbrands LB, van Middendorp H. E-HEalth treatment in Long-term Dialysis (E-HELD): study protocol for a multicenter randomized controlled trial evaluating personalized Internet-based cognitive-behavioral therapy in dialysis patients. Trials 2022; 23:477. [PMID: 35672832 PMCID: PMC9172166 DOI: 10.1186/s13063-022-06392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Kidney failure and dialysis treatment have a large impact on a patient’s life. Patients experience numerous, complex symptoms and usually have multiple comorbid conditions. Despite the multitude of problems, patients often have priorities for improvement of specific aspects of their functioning, which would be helpful for clinicians to become informed of. This highlights a clear need for patient-centered care in this particular patient group, with routine screening as a vital element to timely recognize symptoms and tailored treatment to match individual patients’ needs and priorities. By also providing feedback on patient’s screening results to the patient itself, the patient is empowered to actively take control in one’s mostly uncontrollable disease process. The current paper describes the study design of a multicenter randomized controlled trial evaluating the effectiveness of the “E-HEealth treatment in Long-term Dialysis” (E-HELD) intervention. This therapist-guided Internet-based cognitive-behavioral therapy (ICBT) intervention is focused on and personalized to the myriad of problems that dialysis patients experience and prioritize. Methods After a screening procedure on adjustment problems, 130 eligible dialysis patients will be randomized to care as usual or the E-HELD intervention. Patients will complete questionnaires on distress (primary outcome measure), several domains of functioning (e.g., physical, psychological, social), potential predictors and mediators of treatment success, and the cost-effectiveness of the intervention, at baseline, 6-month follow-up, and 12-month follow-up. In addition, to take account of the personalized character of the intervention, the Personalized Priority and Progress Questionnaire (PPPQ) will be administered which is a personalized instrument to identify, prioritize, and monitor individual problems over time. Discussion The present study design will provide insight in the effectiveness of tailored ICBT in patients with kidney failure who are treated with dialysis. When proven effective, the screening procedure and the subsequent ICBT intervention could be implemented in routine care to detect, support, and treat patients struggling with adjustment problems. Trial registration NL63422.058.17 [Registry ID: METC-LDD] NL7160 [Netherlands Trial Register; registered on 16 July 2018]
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15
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Menzies RE, Sharpe L, Richmond B, Dudeney J, Todd J, Szabo M, Sesel AL, Dear B. Randomised controlled trial of cognitive behaviour therapy versus mindfulness for people with rheumatoid arthritis with and without a history of recurrent depression: study protocol and design. BMJ Open 2022; 12:e056504. [PMID: 35589354 PMCID: PMC9121498 DOI: 10.1136/bmjopen-2021-056504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Psychosocial treatments have been shown to benefit people with rheumatoid arthritis (RA) on various outcomes. Two evidence-based interventions are cognitive behavioural therapy (CBT) and mindfulness-based stress reduction (MBSR). However, these interventions have been compared only once. Results showed that CBT outperformed MBSR on some outcomes, but MBSR was more effective for people with RA with a history of recurrent depression, with efficacy being moderated by history of depressive episodes. However, this was a post-hoc finding based on a small subsample. We aim to examine whether a history of recurrent depression will moderate the relative efficacy of these treatments when delivered online. METHODS AND ANALYSIS This study is a randomised controlled trial comparing CBT and MBSR delivered online with a waitlist control condition. History of recurrent depressive episodes will be assessed at baseline. The primary outcome will be pain interference. Secondary outcomes will include pain intensity, RA symptoms, depressive symptoms and anxiety symptoms. Outcome measures will be administered at baseline, post-treatment and at 6 months follow-up. We aim to recruit 300 participants, and an intention-to-treat analysis will be used. Linear mixed models will be used, with baseline levels of treatment outcomes as the covariate, and group and depressive status as fixed factors. The results will demonstrate whether online CBT and MBSR effectively improve outcomes among people with RA. Importantly, this trial will determine whether one intervention is more efficacious, and whether prior history of depression moderates this effect. ETHICS AND DISSEMINATION The trial has been approved by the Human Research Ethics Committee of the University of Sydney (2021/516). The findings will be subject to publication irrespective of the final results of the study, and based on the outcomes presented in this protocol. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000997853p).
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Affiliation(s)
- Rachel E Menzies
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Bethany Richmond
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Dudeney
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Jemma Todd
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Marianna Szabo
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Amy-Lee Sesel
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Blake Dear
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
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Telemedicine application in patients with chronic disease: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2022; 22:105. [PMID: 35440082 PMCID: PMC9017076 DOI: 10.1186/s12911-022-01845-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 04/11/2022] [Indexed: 01/12/2023] Open
Abstract
Background Telemedicine has been widely used for long-term care and self-management in patients with chronic disease, but there is no consensus regarding the effect of telemedicine on chronic disease management. The aim of this study is to review and analyse the effect of telemedicine on the management of chronic diseases such as hypertension, diabetes, and rheumatoid arthritis using a systematic review and meta-analysis. Methods We performed a comprehensive literature search of the Web of Science, PubMed, MEDLINE, EMBASE, CNKI (Chinese database), VIP (Chinese database), WanFang (Chinese database), and SinoMed (Chinese database) databases from their inception until December 31, 2021. The retrieved literature was screened and assessed independently by two authors. We used the risk-of-bias assessment tool recommended by the Cochrane Handbook for Systematic Reviews of Interventions 5.0.2 for assessing literature quality and Revman 5.3 software to conduct the meta-analysis. Results Fifteen articles were included in this study. The results of the systematic review indicated that telemedicine consultation and telemonitoring are the most commonly used intervention methods. Telemedicine is helpful for improving self-management in patients with rheumatoid arthritis. The results of the meta-analysis showed patients’ index of glycosylated hemoglobin (HbA1c) improved after 12 months of intervention (MD = − 0.84; 95% CI = − 1.53, − 0.16; Z = 2.42; P = 0.02), and no significant differences in fasting blood glucose (FBG) levels were observed after 6 months of intervention (MD = − 0.35; 95% CI = − 0.75,0.06; Z = 1.69; P = 0.09). The results also showed that systolic blood pressure (MD = − 6.71; 95% CI = − 11.40, − 2.02; Z = 2.81; P = 0.005) was reduced after 6 months of intervention. Conclusion Telemedicine had a positive effect on the management of diabetes, hypertension, and rheumatoid arthritis, especially when telemedicine consultation and telemonitoring method were used. When telemedicine was used as a disease management tool for patients with diabetes, the optimal intervention time is 12 months. Telemedicine improved the systolic blood pressure in hypertensive patients while also reducing negative emotions and enhancing medication adherence in rheumatoid arthritis patients.
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Implementation of Online Behavior Modification Techniques in the Management of Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11071806. [PMID: 35407414 PMCID: PMC8999801 DOI: 10.3390/jcm11071806] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023] Open
Abstract
Purpose: The main aim of this systematic review and meta-analysis (MA) was to assess the effectiveness of online behavior modification techniques (e-BMT) in the management of chronic musculoskeletal pain. Methods: We conducted a search of Medline (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioral Collections, from inception to the 30 August 2021. The main outcome measures were pain intensity, pain interference, kinesiophobia, pain catastrophizing and self-efficacy. The statistical analysis was conducted using RStudio software. To compare the outcomes reported by the studies, we calculated the standardized mean difference (SMD) over time and the corresponding 95% confidence interval (CI) for the continuous variables. Results: Regarding pain intensity (vs. usual care/waiting list), we found a statistically significant trivial effect size in favor of e-BMT (n = 5337; SMD = −0.17; 95% CI −0.26, −0.09). With regard to pain intensity (vs. in-person BMT) we found a statistically significant small effect size in favor of in-person BMT (n = 486; SMD = 0.21; 95%CI 0.15, 0.27). With respect to pain interference (vs. usual care/waiting list) a statistically significant small effect size of e-BMT was found (n = 1642; SMD = −0.24; 95%CI −0.44, −0.05). Finally, the same results were found in kinesiophobia, catastrophizing, and self-efficacy (vs. usual care/waiting list) where we found a statistically significant small effect size in favor of e-BMT. Conclusions: e-BMT seems to be an effective option for the management of patients with musculoskeletal conditions although it does not appear superior to in-person BMT in terms of improving pain intensity.
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Effectiveness of Telematic Behavioral Techniques to Manage Anxiety, Stress and Depressive Symptoms in Patients with Chronic Musculoskeletal Pain: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063231. [PMID: 35328917 PMCID: PMC8951553 DOI: 10.3390/ijerph19063231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 01/07/2023]
Abstract
Anxiety, depressive symptoms and stress have a significant influence on chronic musculoskeletal pain. Behavioral modification techniques have proven to be effective to manage these variables; however, the COVID-19 pandemic has highlighted the need for an alternative to face-to-face treatment. We conducted a search of PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, APA PsychInfo, and Psychological and Behavioural Collections. The aim was to assess the effectiveness of telematic behavioral modification techniques (e-BMT) on psychological variables in patients with chronic musculoskeletal pain through a systematic review with meta-analysis. We used a conventional pairwise meta-analysis and a random-effects model. We calculated the standardized mean difference (SMD) with the corresponding 95% confidence interval (CI). Forty-one randomized controlled trials were included, with a total of 5018 participants. We found a statistically significant small effect size in favor of e-BMT in depressive symptoms (n = 3531; SMD = -0.35; 95% CI -0.46, -0.24) and anxiety (n = 2578; SMD = -0.32; 95% CI -0.42, -0.21) with low to moderate strength of evidence. However, there was no statistically significant effect on stress symptoms with moderate strength of evidence. In conclusion, e-BMT is an effective option for the management of anxiety and depressive symptoms in patients with chronic musculoskeletal pain. However, it does not seem effective to improve stress symptoms.
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White V, Linardon J, Stone JE, Holmes-Truscott E, Olive L, Mikocka-Walus A, Hendrieckx C, Evans S, Speight J. Online psychological interventions to reduce symptoms of depression, anxiety, and general distress in those with chronic health conditions: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2022; 52:548-573. [PMID: 32674747 DOI: 10.1017/s0033291720002251] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Over the past 15 years, there has been substantial growth in web-based psychological interventions. We summarize evidence regarding the efficacy of web-based self-directed psychological interventions on depressive, anxiety and distress symptoms in people living with a chronic health condition. METHOD We searched Medline, PsycINFO, CINAHL, EMBASE databases and Cochrane Database from 1990 to 1 May 2019. English language papers of randomized controlled trials (usual care or waitlist control) of web-based psychological interventions with a primary or secondary aim to reduce anxiety, depression or distress in adults with a chronic health condition were eligible. Results were assessed using narrative synthases and random-effects meta-analyses. RESULTS In total 70 eligible studies across 17 health conditions [most commonly: cancer (k = 20), chronic pain (k = 9), arthritis (k = 6) and multiple sclerosis (k = 5), diabetes (k = 4), fibromyalgia (k = 4)] were identified. Interventions were based on CBT principles in 46 (66%) studies and 42 (60%) included a facilitator. When combining all chronic health conditions, web-based interventions were more efficacious than control conditions in reducing symptoms of depression g = 0.30 (95% CI 0.22-0.39), anxiety g = 0.19 (95% CI 0.12-0.27), and distress g = 0.36 (95% CI 0.23-0.49). CONCLUSION Evidence regarding effectiveness for specific chronic health conditions was inconsistent. While self-guided online psychological interventions may help to reduce symptoms of anxiety, depression and distress in people with chronic health conditions in general, it is unclear if these interventions are effective for specific health conditions. More high-quality evidence is needed before definite conclusions can be made.
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Affiliation(s)
- V White
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J Linardon
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria3168, Australia
| | - E Holmes-Truscott
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
| | - L Olive
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - A Mikocka-Walus
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - C Hendrieckx
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
| | - S Evans
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
| | - J Speight
- School of Psychology, Faculty of Health, Deakin University Geelong, Victoria3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Victoria3000, Australia
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Walrabenstein W, van der Leeden M, Weijs P, van Middendorp H, Wagenaar C, van Dongen JM, Nieuwdorp M, de Jonge CS, van Boheemen L, van Schaardenburg D. The effect of a multidisciplinary lifestyle program for patients with rheumatoid arthritis, an increased risk for rheumatoid arthritis or with metabolic syndrome-associated osteoarthritis: the "Plants for Joints" randomized controlled trial protocol. Trials 2021; 22:715. [PMID: 34663431 PMCID: PMC8524903 DOI: 10.1186/s13063-021-05682-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/04/2021] [Indexed: 12/02/2022] Open
Abstract
Low-grade inflammation and metabolic syndrome are seen in many chronic diseases, including rheumatoid arthritis (RA) and osteoarthritis (OA). Lifestyle interventions which combine different non-pharmacological therapies have shown synergizing effects in improving outcomes in patients with other chronic diseases or increased risk thereof, especially cardiovascular disease. For RA and metabolic syndrome-associated OA (MSOA), whole food plant-based diets (WFPDs) have shown promising results. A WFPD, however, had not yet been combined with other lifestyle interventions for RA and OA patients. In this protocol paper, we therefore present Plants for Joints, a multidisciplinary lifestyle program, based on a WFPD, exercise, and stress management. The objective is to study the effect of this program on disease activity in patients with RA (randomized controlled trial [RCT] 1), on a risk score for developing RA in patients with anti-citrullinated protein antibody (ACPA) positive arthralgia (RCT 2) and on pain, stiffness, and function in patients with MSOA (RCT 3), all in comparison with usual care.We designed three 16-week observer-blind RCTs with a waiting-list control group for patients with RA with low to moderate disease activity (2.6 ≤ Disease Activity Score [DAS28] ≤ 5.1, RCT 1, n = 80), for patients at risk for RA, defined by ACPA-positive arthralgia (RCT 2, n = 16) and for patients with metabolic syndrome and OA in the knee and/or hip (RCT 3, n = 80). After personal counseling on diet and exercise, participants join 10 group meetings with 6-12 other patients to receive theoretical and practical training on a WFPD, exercise, and stress management, while medication remains unchanged. The waiting-list control group receives usual care, while entering the program after the RCT. Primary outcomes are: difference in mean change between intervention and control groups within 16 weeks for the DAS28 in RA patients (RCT 1), the RA-risk score for ACPA positive arthralgia patients (RCT 2), and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) score for MSOA patients (RCT 3). Continued adherence to the lifestyle program is measured in a two-year observational extension study.
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Affiliation(s)
- Wendy Walrabenstein
- Amsterdam Rheumatology and Immunology Center, Reade, Dr. Jan van Breemenstraat 2, 1056, AB, Amsterdam, The Netherlands.
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Marike van der Leeden
- Amsterdam Rheumatology and Immunology Center, Reade, Dr. Jan van Breemenstraat 2, 1056, AB, Amsterdam, The Netherlands
- Department of Rehabilitation Medicine, Amsterdam UMC, VU University, De Boelelaan, 1117 1081, HV, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, De Boelelaan, 1085 1081, HV, Amsterdam, The Netherlands
| | - Peter Weijs
- Amsterdam University of Applied Sciences, Dokter Meurerlaan 8, 1067, SM, Amsterdam, The Netherlands
- Department of Nutrition & Dietetics, Amsterdam University Medical Centers, VU University, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Henriët van Middendorp
- Leiden University, Institute of Psychology, Health, Medical, & Neuropsychology unit, Leiden, The Netherlands
| | - Carlijn Wagenaar
- Amsterdam Rheumatology and Immunology Center, Reade, Dr. Jan van Breemenstraat 2, 1056, AB, Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Johanna Maria van Dongen
- Amsterdam Public Health Research Institute, De Boelelaan, 1085 1081, HV, Amsterdam, The Netherlands
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan, 1085 1081, HV, Amsterdam, The Netherlands
| | - Max Nieuwdorp
- Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Catharina Sophia de Jonge
- Departments of Radiology and Nuclear Medicine & Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Laurette van Boheemen
- Amsterdam Rheumatology and Immunology Center, Reade, Dr. Jan van Breemenstraat 2, 1056, AB, Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Dirkjan van Schaardenburg
- Amsterdam Rheumatology and Immunology Center, Reade, Dr. Jan van Breemenstraat 2, 1056, AB, Amsterdam, The Netherlands
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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21
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Nagy G, Roodenrijs NMT, Welsing PMJ, Kedves M, Hamar A, van der Goes MC, Kent A, Bakkers M, Pchelnikova P, Blaas E, Senolt L, Szekanecz Z, Choy EH, Dougados M, Jacobs JW, Geenen R, Bijlsma JW, Zink A, Aletaha D, Schoneveld L, van Riel P, Dumas S, Prior Y, Nikiphorou E, Ferraccioli G, Schett G, Hyrich KL, Mueller-Ladner U, Buch MH, McInnes IB, van der Heijde D, van Laar JM. EULAR points to consider for the management of difficult-to-treat rheumatoid arthritis. Ann Rheum Dis 2021; 81:20-33. [PMID: 34407926 PMCID: PMC8761998 DOI: 10.1136/annrheumdis-2021-220973] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/23/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop evidence-based European Alliance of Associations for Rheumatology (EULAR) points to consider (PtCs) for the management of difficult-to-treat rheumatoid arthritis (D2T RA). METHODS An EULAR Task Force was established comprising 34 individuals: 26 rheumatologists, patient partners and rheumatology experienced health professionals. Two systematic literature reviews addressed clinical questions around diagnostic challenges, and pharmacological and non-pharmacological therapeutic strategies in D2T RA. PtCs were formulated based on the identified evidence and expert opinion. Strength of recommendations (SoR, scale A-D: A typically consistent level 1 studies and D level 5 evidence or inconsistent studies) and level of agreement (LoA, scale 0-10: 0 completely disagree and 10 completely agree) of the PtCs were determined by the Task Force members. RESULTS Two overarching principles and 11 PtCs were defined concerning diagnostic confirmation of RA, evaluation of inflammatory disease activity, pharmacological and non-pharmacological interventions, treatment adherence, functional disability, pain, fatigue, goal setting and self-efficacy and the impact of comorbidities. The SoR varied from level C to level D. The mean LoA with the overarching principles and PtCs was generally high (8.4-9.6). CONCLUSIONS These PtCs for D2T RA can serve as a clinical roadmap to support healthcare professionals and patients to deliver holistic management and more personalised pharmacological and non-pharmacological therapeutic strategies. High-quality evidence was scarce. A research agenda was created to guide future research.
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Affiliation(s)
- György Nagy
- Department of Rheumatology & Clinical Immunology, Semmelweis University, Budapest, Hungary .,Department of Genetics, Cell and Immunobiology, Semmelweis University, Budapest, Hungary
| | - Nadia M T Roodenrijs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Melinda Kedves
- Bács-Kiskun County Hospital, Rheumatology Department, Kecskemét, Hungary
| | - Attila Hamar
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Marlies C van der Goes
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Rheumatology, Meander Medical Center, Amersfoort, The Netherlands
| | - Alison Kent
- Salisbury Foundation Trust NHS Hospital, Wiltshire, UK
| | - Margot Bakkers
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Polina Pchelnikova
- EULAR Standing Committee of People with Arthritis/Rheumatism in Europe (PARE), Zurich, Switzerland
| | - Etienne Blaas
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ladislav Senolt
- Department of Rheumatology, 1st Faculty of Medicine, Charles University and Institute of Rheumatology, Prague, Czech Republic
| | - Zoltan Szekanecz
- Department of Rheumatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ernest H Choy
- CREATE Centre, Section of Rheumatology, School of Medicine, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Maxime Dougados
- Université de Paris Department of Rheumatology - Hôpital Cochin. Assistance Publique - Hôpitaux de Paris INSERM (U1153) Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Johannes Wg Jacobs
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Johannes Wj Bijlsma
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Angela Zink
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Leonard Schoneveld
- Department of Rheumatology, Bravis Hospital, Roosendaal, The Netherlands
| | - Piet van Riel
- Department of Rheumatic Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sophie Dumas
- Department of Pharmacy, Marin Hospital, Asisstance Publique-Hopitaux de Paris, Hendaye, France
| | - Yeliz Prior
- School of Health and Society, Centre for Health Sciences Research, University of Salford, Salford, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK.,Rheumatology Department, King's College Hospital, London, UK
| | | | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University of Erlangen-Nuremberg and Universitatsklinikum Erlangen, Erlangen, Germany
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Justus-Liebig University Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Maya H Buch
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.,Leeds Institute of Rheumatic & Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Iain B McInnes
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | | | - Jacob M van Laar
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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22
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Terpstra JA, van der Vaart R, Ding HJ, Kloppenburg M, Evers AW. Guided internet-based cognitive-behavioral therapy for patients with rheumatic conditions: A systematic review. Internet Interv 2021; 26:100444. [PMID: 34485094 PMCID: PMC8391057 DOI: 10.1016/j.invent.2021.100444] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Rheumatic conditions have a large impact on both patients and society. Many patients experience adjustment problems, such as symptoms of anxiety and depression and sleep problems, contributing to high healthcare costs. Internet-based cognitive-behavioral therapy (iCBT) has shown to support patients with somatic conditions in coping with their disease, with therapist-guided iCBT usually showing larger effects than unguided iCBT. However, the specific relevance of guided iCBT for rheumatic conditions has not been reviewed yet, which could have important implications for implementation. OBJECTIVES The objective of our review was to give an overview of evaluations of guided iCBT for rheumatic conditions, including physical, psychological, and impact on daily life outcomes. METHODS This review is registered with PROSPERO with registration number CRD42020154911. The review followed PRISMA guidelines and included an assessment of risk of bias. PubMed, PsycINFO, Embase, Cochrane Library, Web of Science, and Emcare were searched until 5 October 2020. Inclusion criteria were: patients ≥18 years old with a rheumatic condition, randomized controlled trial, accessible full-text English article, original data, inclusion of psychological, and/or physical and/or impact outcomes, and therapist-guided iCBT. Study and sample characteristics, as well as clinical variables were extracted. RESULTS A systematic search identified 6089 studies, of which 8 trials were included, comprising of 1707 participants in total. Significant medium to large between-group effects were found for psychological outcomes (depression, anxiety, catastrophizing, self-efficacy) and impact on daily life outcomes (impact on daily life, quality of life), whilst results for physical outcomes (pain intensity, fatigue) were mixed. CONCLUSION Whilst more research is warranted, for instance regarding physical outcomes, cost-effectiveness, safety of the intervention, and moderators of iCBT success, our results show that guided iCBT could be an important addition to medical treatment for rheumatic conditions. Guided iCBT can improve psychological and impact on daily life outcomes in patients with rheumatic conditions, which is promising for iCBT implementation in clinical practice.
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Affiliation(s)
- Jessy A. Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands,Corresponding author at: Leiden University, Dpt. of Health, Medical, and Neuropsychology, PO Box 9555, 2300 RB Leiden, the Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - He Jie Ding
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands
| | - Margreet Kloppenburg
- Leiden University Medical Center, Department of Rheumatology, C1-R, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Andrea W.M. Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, PO Box 9555, 2300 RB Leiden, the Netherlands,Leiden University Medical Center, Department of Psychiatry, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands
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23
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Rothmann MJ, Mouritsen JD, Ladefoged NS, Jeppesen MN, Lillevang AS, Laustrup H, Ellingsen T. The use of telehealth in psychological counselling of adult vulnerable patients with rheumatic diseases and diabetes: An explorative study inspired by participatory design (Preprint). JMIR Hum Factors 2021; 9:e30829. [PMID: 35311690 PMCID: PMC8981013 DOI: 10.2196/30829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Mette Juel Rothmann
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Julie Drotner Mouritsen
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Nanna Skov Ladefoged
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | | | - Anna Sofie Lillevang
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Helle Laustrup
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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24
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Cardol CK, Tommel J, van Middendorp H, Ciere Y, Sont JK, Evers AWM, van Dijk S. Detecting and Treating Psychosocial and Lifestyle-Related Difficulties in Chronic Disease: Development and Treatment Protocol of the E-GOAL eHealth Care Pathway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3292. [PMID: 33806724 PMCID: PMC8005221 DOI: 10.3390/ijerph18063292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 01/19/2023]
Abstract
Many patients with lifestyle-related chronic diseases find it difficult to adhere to a healthy and active lifestyle, often due to psychosocial difficulties. The aim of the current study was to develop an eHealth care pathway aimed at detecting and treating psychosocial and lifestyle-related difficulties that fits the needs and preferences of individual patients across various lifestyle-related chronic diseases. Each intervention component was developed by (1) developing initial versions based on scientific evidence and/or the Behavior Change Wheel; (2) co-creation: acquiring feedback from patients and health professionals; and (3) refining to address users' needs. In the final eHealth care pathway, patients complete brief online screening questionnaires to detect psychosocial and lifestyle-related difficulties, i.e., increased-risk profiles. Scores are visualized in personal profile charts. Patients with increased-risk profiles receive complementary questionnaires to tailor a 3-month guided web-based cognitive behavioral therapy intervention to their priorities and goals. Progress is assessed with the screening tool. This systematic development process with a theory-based framework and co-creation methods resulted in a personalized eHealth care pathway that aids patients to overcome psychosocial barriers and adopt a healthy lifestyle. Prior to implementation in healthcare, randomized controlled trials will be conducted to evaluate its cost-effectiveness and effectiveness on psychosocial, lifestyle, and health-related outcomes.
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Affiliation(s)
- Cinderella K. Cardol
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
| | - Judith Tommel
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
| | - Yvette Ciere
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Jacob K. Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Andrea W. M. Evers
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
- Healthy Society, Medical Delta, 2629 JH Delft, The Netherlands
| | - Sandra van Dijk
- Health, Medical and Neuropsychology Unit, Leiden University, 2333 AK Leiden, The Netherlands; (J.T.); (H.v.M.); (Y.C.); (A.W.M.E.); (S.v.D.)
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25
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Martin A, Chopra R, Nicassio PM. Nonpharmacologic Pain Management in Inflammatory Arthritis. Rheum Dis Clin North Am 2021; 47:277-295. [PMID: 33781495 DOI: 10.1016/j.rdc.2020.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This article provides an overview of nonpharmacologic options for the treatment of pain in patients with inflammatory arthritis, such as peripheral spondyloarthritis, psoriatic arthritis, ankylosing spondylitis, and rheumatoid arthritis. The experience of pain in chronic disease is a complex process influenced by multiple domains of health. The discussion focuses on the establishment of a framework for pain control that engages with factors that influence the experience of pain and explores the evidence base that supports specific modalities of nonpharmacologic pain control, such as mindfulness, cognitive behavioral therapy, exercise, massage, splinting, and heat therapy. Rheumatoid and spondyloarthritides are considered separately.
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Affiliation(s)
- Alexander Martin
- Division of Rheumatology, UMass Medical School, 119 Belmont Street, Worcester, MA 01605, USA
| | - Ratnesh Chopra
- Division of Rheumatology, UMass Medical School, 119 Belmont Street, Worcester, MA 01605, USA.
| | - Perry M Nicassio
- Department of Psychiatry, UCLA, 760 Westwood Plaza, C9-402, Los Angeles, CA 90095, USA
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26
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Roodenrijs NMT, Hamar A, Kedves M, Nagy G, van Laar JM, van der Heijde D, Welsing PMJ. Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open 2021; 7:e001512. [PMID: 33419871 PMCID: PMC7798678 DOI: 10.1136/rmdopen-2020-001512] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA. METHODS PubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised. RESULTS Two hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias. CONCLUSIONS This SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management.
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Affiliation(s)
- Nadia M T Roodenrijs
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Attila Hamar
- Rheumatology, University of Debrecen, Debrecen, Hungary
| | - Melinda Kedves
- Rheumatology, Bacs-Kiskun Megyei Korhaz, Kecskemet, Hungary
| | - György Nagy
- Genetics, Cell- and Immunobiology & Rheumatology & Clinical Rheumatology, Semmelweis University, Budapest, Hungary
| | - Jacob M van Laar
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Paco M J Welsing
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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27
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Patient-Centered Care in Psoriatic Arthritis-A Perspective on Inflammation, Disease Activity, and Psychosocial Factors. J Clin Med 2020; 9:jcm9103103. [PMID: 32992983 PMCID: PMC7600723 DOI: 10.3390/jcm9103103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022] Open
Abstract
Psoriatic arthritis (PsA) is a seronegative spondyloarthropathy characterized by skin lesions, dactylitis, and enthesitis. Patients with PsA suffer from a variety of psychosocial difficulties and nonspecific symptoms early on in the disease course and continue to experience progressive disease due to delays in diagnosis and treatment. Symptoms initially viewed as somatization could lead to undertreatment and promote psychological distress, poor coping, and negative patient-provider relationships. Pain and fatigue are important complaints that affect the patient's perception and may need to be addressed with a multidisciplinary approach. Maladaptive cognitive responses can lead to a negative illness perception and impact patient beliefs and concerns over treatment, as well as nonadherence. An underlying inflammatory component in affective disorders has been examined, though whether and how it may interact mechanistically in PsA warrants interest. Cognitive behavioral therapy represents a nonpharmacological treatment modality that can be combined with cytokine-targeted therapy to address both somatic and psychological complaints. Future directions for research include: (1) Elucidating nonspecific manifestations (e.g., subclinical stage, differential with functional syndromes) of PsA and how they impact diagnosis and management; (2) characterizing immune-mediated components of mood disorders in PsA; and (3) whether a bidirectional approach with abrogating inflammation and psychotherapeutic support leads to improved outcomes.
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28
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Schakel L, Veldhuijzen DS, van Middendorp H, Prins C, Drittij AMHF, Vrieling F, Visser LG, Ottenhoff THM, Joosten SA, Evers AWM. An Internet-Based Psychological Intervention With a Serious Game to Improve Vitality, Psychological and Physical Condition, and Immune Function in Healthy Male Adults: Randomized Controlled Trial. J Med Internet Res 2020; 22:e14861. [PMID: 32706667 PMCID: PMC7414409 DOI: 10.2196/14861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 02/05/2020] [Accepted: 02/22/2020] [Indexed: 01/06/2023] Open
Abstract
Background Recently, internet-based cognitive behavioral therapy (ICBT) and serious gaming interventions have been suggested to enhance accessibility to interventions and engagement in psychological interventions that aim to promote health outcomes. Few studies, however, have investigated their effectiveness in the context of simulated real-life challenges. Objective We aimed to examine the effectivity of a guided ICBT combined with a serious gaming intervention in improving self-reported psychophysiological and immunological health endpoints in response to psychophysiological and immune-related challenges. Methods Sixty-nine healthy men were randomly assigned to the intervention condition, receiving ICBT combined with serious gaming for 6 weeks, or the control condition, receiving no intervention. Self-reported vitality was the primary endpoint. Other self-reported psychophysiological and immunological endpoints were assessed following various challenges, including a bacillus Calmette-Guérin vaccination evoking pro-inflammatory responses, 1 and 4 weeks after the intervention period. Results Although the intervention did not affect vitality-associated parameters, self-reported sleep problems (P=.027) and bodily sensations (P=.042) were lower directly after the intervention compared with controls. Furthermore, wellbeing (P=.024) was higher in the intervention group after the psychophysiological challenges. Although no significant group differences were found for the psychophysiological and immunological endpoints, the data provided preliminary support for increased immunoglobulin antibody responses at the follow-up time points (P<.05). Differential chemokine endpoints between conditions were observed at the end of the test day. Conclusions The present study provides some support for improving health endpoints with an innovative ICBT intervention. Future research should replicate and further extend the present findings by consistently including challenges and a wide range of immune parameters into the study design. Trial Registration Nederlands Trial Register NTR5610; https://www.trialregister.nl/trial/5466
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Affiliation(s)
- Lemmy Schakel
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Dieuwke S Veldhuijzen
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands
| | - Corine Prins
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Anne M H F Drittij
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Frank Vrieling
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Tom H M Ottenhoff
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Simone A Joosten
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, Netherlands.,Leiden Institute for Brain and Cognition, Leiden University, Leiden, Netherlands.,Department of Psychiatry, Leiden University Medical Centre, Leiden, Netherlands
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Abstract
Fatigue is highly prevalent in inflammatory arthritis, and people living with the symptom have described it as overwhelming and a challenge to manage. In this article, we explore the experience, impact and non-pharmacological management of fatigue from a multi-disciplinary perspective. We start by presenting qualitative evidence from people living with fatigue, including the physical, cognitive and emotional nature of the symptom and its impact on daily life. This is followed by discussion of current conceptual models of mechanisms and factors that may cause and maintain fatigue, within and between individuals. We then address the issue of fatigue measurement and modes of assessment, which is an integral aspect of management and evaluating support provision. This leads to a review of the research evidence for non-pharmacological interventions to reduce fatigue severity and impact. Finally, we consider implementation of this evidence in clinical practice and we introduce some key practical tools and techniques.
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30
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Cramp F. The role of non-pharmacological interventions in the management of rheumatoid-arthritis-related fatigue. Rheumatology (Oxford) 2020; 58:v22-v28. [PMID: 31682276 PMCID: PMC6827265 DOI: 10.1093/rheumatology/kez310] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/26/2019] [Indexed: 12/12/2022] Open
Abstract
Non-pharmacological interventions may be beneficial in the management of rheumatoid arthritis related fatigue. A narrative review was undertaken, with a focus upon research published in the past 6 years. Seven studies were identified, four focusing upon physical activity, two on psychosocial interventions and one that investigated aromatherapy and reflexology. Findings supported previous evidence that physical activity and psychosocial interventions have potential to produce small to moderate reductions in fatigue related to rheumatoid arthritis. Reflexology and aromatherapy interventions also appeared promising. Limitations to the evidence included lack of consistency in fatigue measurement, and minimal data on long-term outcomes and cost effectiveness. The wide range of physical activity interventions prevent specific recommendations. For psychosocial interventions the strongest evidence is for group-based cognitive behavioural approaches. There was lack of consideration given to fatigue mechanisms and intervention design. Due to the complexity of fatigue, future research exploring personalized approaches is warranted.
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Affiliation(s)
- Fiona Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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Abstract
OBJECTIVE Anxiety disorders are among the most frequent mental disorders and are associated with a range of short- and long-term impairments and disabilities. Relatively little is known about anxiety disorders in patients with somatic diseases, and the present literature review highlights the current research in this field, data about prevalences of anxiety disorders in patients with somatic diseases, and the effectiveness of interventions. This article also introduces a comprehensive model of inpatient treatment and summarizes the evidence pertinent to this approach. METHODS A narrative review is presented with regard to prevalence and treatment of anxiety disorders in patients with somatic diseases. The effects of inpatient treatment are illustrated based on a case report. RESULTS This review indicates that anxiety disorders are more common in patients with somatic diseases, with prevalence estimates ranging from 2.5% to 55%, than in the general population. Several outpatient treatment options exist, with substantial support for the effectiveness of cognitive behavioral therapy, psychodynamic therapy, and pharmacotherapy. We also provide evidence in support of psychosomatic inpatient treatment for patients with anxiety disorders that are comorbid with somatic diseases. CONCLUSIONS Anxiety disorders are common in patients with somatic diseases, and several effective treatment options exist, including cognitive behavioral therapy and pharmacological interventions. We also provide support for the effectiveness of inpatient treatment with unique opportunities for multidisciplinary psychosomatic treatment of anxiety disorders with comorbid somatic diseases.
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Affiliation(s)
- Michaela Henning
- From the Department of Psychosomatic Medicine and Psychotherapy (Henning, Subic-Wrana, Wiltink, Beutel), University Medical Center, Mainz; and Department of Psychosomatics and Psychotherapy (Henning), University Hospital Cologne, University of Cologne, Cologne, Germany
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Shen B, Li Y, Du X, Chen H, Xu Y, Li H, Xu GY. Effects of cognitive behavioral therapy for patients with rheumatoid arthritis: a systematic review and meta-analysis. PSYCHOL HEALTH MED 2020; 25:1179-1191. [PMID: 32129673 DOI: 10.1080/13548506.2020.1736312] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This study aimed to assess the effects of cognitive behavioral therapy on the psychological and physiological health of rheumatoid arthritis patients. An extensive literature search was conducted, using the PubMed, Web of Science, Cochrane Library, Embase, CNKI Scholar, WanFang, and VIP databases, from inception to December2018. The quality of the studies was evaluated by 2 independent authors, according to the basic criteria provided by the Cochrane Handbook for evaluating randomized trials. Meta-analysis was performed with Review Manager 5.3. Six randomized controlled trials met the inclusion criteria of the current study. Using standard mean differences (SMD) and 95% confidence intervals (CI), our results showed that cognitive behavioral therapy could significantly reduce levels of anxiety (SMD = -0.30, 95% CI [-0.52, -0.09], P= 0.005) and depression (SMD = -0.48, 95% CI [-0.70, -0.27], P< 0.00001), and relieve fatigue symptoms (SMD = -0.35, 95% CI [-0.60, -0.10], P= 0.006) in rheumatoid arthritis patients.This is the first known assessment of the efficacy of cognitive behavioral therapy on rheumatoid arthritis patients using meta-analysis. Large-scale randomized controlled trials need to be implemented to further explore this issue.
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Affiliation(s)
- Biyu Shen
- Center for Translational Pain Medicine, Institute of Neuroscience, Soochow University , Suzhou, China.,Nursing School of Soochow University, Soochow University , Suzhou, China.,Department of Nursing, The Second Affiliated Hospital of Nantong University , Nantong, China
| | - Yongchang Li
- Center for Translational Pain Medicine, Institute of Neuroscience, Soochow University , Suzhou, China
| | - Xian Du
- Nursing School of Nantong University, Nantong University , Nantong, China
| | - Haoyang Chen
- Nursing School of Nantong University, Nantong University , Nantong, China
| | - Yucheng Xu
- Center for Translational Pain Medicine, Institute of Neuroscience, Soochow University , Suzhou, China
| | - Huiling Li
- Nursing School of Soochow University, Soochow University , Suzhou, China
| | - Guang-Yin Xu
- Center for Translational Pain Medicine, Institute of Neuroscience, Soochow University , Suzhou, China
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Higgins DM, Buta E, Williams DA, Halat A, Bair MJ, Heapy AA, Krein SL, Rajeevan H, Rosen MI, Kerns RD. Internet-Based Pain Self-Management for Veterans: Feasibility and Preliminary Efficacy of the Pain EASE Program. Pain Pract 2020; 20:357-370. [PMID: 31778281 DOI: 10.1111/papr.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/06/2019] [Accepted: 11/25/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To develop and test the feasibility and preliminary efficacy of a cognitive behavioral therapy-based, internet-delivered self-management program for chronic low back pain (cLBP) in veterans. METHODS Phase I included program development, involving expert panel and participant feedback. Phase II was a single-arm feasibility and preliminary efficacy study of the Pain e-health for Activity, Skills, and Education (Pain EASE) program. Feasibility (ie, website use, treatment credibility, satisfaction) was measured using descriptive methods. Mixed models were used to assess mean within-subject changes from baseline to 10 weeks post-baseline in pain interference (primary outcome, West Haven-Yale Multidimensional Pain Inventory, scale of 0 to 6), pain intensity, mood, fatigue, sleep, and depression. RESULTS Phase I participants (n = 15) suggested modifications including style changes, content reduction, additional "Test Your Knowledge" quizzes, and cognitive behavioral therapy skill practice monitoring form revisions for enhanced usability. In Phase II, participants (n = 58) were mostly male (93%) and White (60%), and had an average age of 55 years (standard deviation [SD] = 12) and moderate pain (mean score 5.9/10); 41 (71%) completed the post-baseline assessment. Participants (N = 58) logged on 6.1 (SD = 8.6) times over 10 weeks, and 85% reported being very or moderately satisfied with Pain EASE. Pain interference improved from a mean of 3.8 at baseline to 3.3 at 10 weeks (difference 0.5 [95% confidence interval 0.1 to 0.9], P = 0.008). Within-subject improvement also occurred for some secondary outcomes, including mood and depression symptoms. DISCUSSION Veterans with cLBP may benefit from technology-delivered interventions, which may also reduce pain interference. Overall, veterans found that Pain EASE, an internet-based self-management program, is feasible and satisfactory for cLBP.
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Affiliation(s)
- Diana M Higgins
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts.,Boston University School of Medicine, Boston, Massachusetts
| | - Eugenia Buta
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | | | - Allison Halat
- Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, Boston, Massachusetts
| | - Matthew J Bair
- VA Health Services Research and Development, Center for Health Information and Communication (CHIC), Indianapolis, IN.,Indiana University School of Medicine and Regenstrief Institute, Indianapolis, IN
| | - Alicia A Heapy
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
| | - Sarah L Krein
- University of Michigan Medical School, Ann Arbor, MI.,VA Ann Arbor Center for Clinical Management Research Health Services Research and Development Center of Innovation, Ann Arbor, MI
| | | | - Marc I Rosen
- Pain Research Informatics Multimorbidities and Education (PRIME) Center of Innovation, VA Connecticut Healthcare System, West Haven, Connecticut.,Yale School of Medicine, New Haven, Connecticut
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van der Vaart R, van Driel D, Pronk K, Paulussen S, Te Boekhorst S, Rosmalen JGM, Evers AWM. The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study. JMIR Form Res 2019; 3:e12883. [PMID: 31750839 PMCID: PMC6914283 DOI: 10.2196/12883] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 05/15/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022] Open
Abstract
Background Internet-based cognitive behavior therapy (iCBT) can be effective in mental and somatic health care. Research on the feasibility of internet interventions in clinical practice is, however, still scarce. Studies with a focus on the patient regarding usability of interventions and digital health literacy skills are especially lacking. Objective The goal of this study was to assess the usability of an iCBT for chronic pain, Master Your Pain, and the relationship between its usability outcomes and the factors age, educational level, and digital health literacy skills. The aims were to determine what changes were needed in the program for sufficient usability and which individual characteristics were related to the usability of the program. Methods Patients were recruited from two mental health care practices. A mixed methods approach was used in this study. A qualitative observational study comprising performance tasks in the iCBT program was used to test usability. A quantitative questionnaire was used to measure possible related constructs. Usability was operationalized as the number of tasks that could be completed and the type and number of problems that occurred while doing so. Performance tasks were set up to measure 6 digital skills: (1) operating the computer and internet browser, (2) navigation and orientation, (3) using search strategies, (4) evaluating relevance of content, (5) adding personal content, and (6) protecting and respecting privacy. Participants were asked to think aloud while performing the tasks, and screen activities and webcam recordings were captured. The qualitative observational data was coded using inductive analysis by two independent researchers. Correlational analyses were performed to test how usability relates to sociodemographics and digital health literacy. Results A total of 32 patients participated, with a mean age of 49.9 years and 84% (27/32) being female. All performance tasks except one (fill in a diary registration) could be completed independently by more than 50% of the participants. On operational, navigation, and search levels, participants struggled most with logging in, logging out, and finding specific parts of the intervention. Half of the sample experienced problems evaluating the relevance and adding content to the program to some extent. Usability correlated moderately negatively with age and moderately positively with digital health literacy skills but not with educational level. Conclusions The results provide insight into what is essential for proper usability regarding the design of an iCBT program considering variations in age, educational level, and digital health literacy. Furthermore, the results provide insight into what type of support is needed by patients to properly use the intervention. Tailoring support among the needs of certain age groups or skill levels could be beneficial and could range from no extra support (only online feedback, as intended) to practical support (an additional usability introduction session) to blended care (combined face-to-face sessions throughout the therapy).
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Affiliation(s)
- Rosalie van der Vaart
- Leiden University, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, Leiden, Netherlands
| | | | - Kristel Pronk
- Leiden University, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, Leiden, Netherlands
| | - Suzan Paulussen
- Leiden University, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, Leiden, Netherlands
| | | | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Internal Medicine, Groningen, Netherlands
| | - Andrea W M Evers
- Leiden University, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, Leiden, Netherlands
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van der Vaart R, Worm-Smeitink M, Bos Y, Wensing M, Evers A, Knoop H. Implementing guided ICBT for chronic pain and fatigue: A qualitative evaluation among therapists and managers. Internet Interv 2019; 18:100290. [PMID: 31737491 PMCID: PMC6849065 DOI: 10.1016/j.invent.2019.100290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/22/2019] [Accepted: 10/27/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Internet-based cognitive behavioural therapy (ICBT) for chronic pain and chronic fatigue syndrome (CFS) has a high potential to increase the number of patients who can receive an evidence based treatment aimed to reduce symptoms and/or disability and to lower burden on (mental) health care. However, implementing a new behaviour-change intervention, and especially an online intervention, has shown to be a challenge. This study aimed to identify factors influencing the implementation process of ICBT for chronic pain and CFS in mental health care. METHODS A qualitative study using semi-structured interviews with therapists and managers from twelve mental health care clinics was conducted. Questions and analysis were guided by the Consolidated Framework for Implementation Research (CFIR), covering five domains: (1) the implemented intervention, (2) individual characteristics of the users, (3) the inner setting of implementation, (4) the outer setting, and (5) the implementation process. RESULTS In all five domains important facilitators and barriers were found. Key themes were: (1) the quality of the content, its perceived effectiveness and usability, (2) the attitude, self-efficacy and ability to learn new skills among therapists, and motivation to start online treatment among patients, (3) internal communication within a team, existing workload, and top-down support from the management, (4) availability of reimbursement options and marketing strategies, and (5) involvement of all key stakeholders, steering towards independence of the implementation sites during the process and adequate training of therapists. CONCLUSIONS This study provides insight in the challenge of implementing ICBT for chronic pain and CFS in daily clinical practice. Several lessons can be learned from the interviews with therapists and managers which can also be more broadly applied to (ICBT) implementation projects in general. Development of practical tools to support the implementation process would be a valuable next step to overcome certain challenges at forehand and to properly prepare for those expected to come along.
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Affiliation(s)
- Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands,Corresponding author.
| | - Margreet Worm-Smeitink
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Yvonne Bos
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute of Health Sciences, Nijmegen, the Netherlands,Heidelberg University Hospital, Department of General Practice and Health Services Research, Heidelberg, Germany
| | - Andrea Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam University Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands
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Mariano TY, Wan L, Edwards RR, Jamison RN. Online teletherapy for chronic pain: A systematic review. J Telemed Telecare 2019; 27:195-208. [PMID: 31488004 DOI: 10.1177/1357633x19871746] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE A systematic review designed to evaluate the benefits of remote group pain management for persons with chronic pain was performed. METHODS PubMed, EMBASE and PsychINFO databases were searched in April 2019. Eligible studies evaluated teletherapy for chronic pain based on set inclusion and exclusion criteria. Two reviewers independently screened eligible studies, assessed risk of bias and extracted data. Each study design was rated and study quality was assessed using an 11-point scale of methodological quality. RESULTS Comprehensive searches identified 12 studies that met all inclusion/exclusion criteria and each study was assessed for type of technology, study design, outcome measures, study findings and limitations. No published studies investigated synchronous teletherapy for groups of chronic pain patients. Methods of assessment varied considerably across studies. Strength of evidence was moderate and many of the selected studies had issues with treatment compliance/adherence and selection bias. Teletherapy strategies for persons with chronic pain were shown to improve pain, mood, disability and catastrophising, however half of the studies selected did not meet the criteria for acceptable standards for internal validity. Those trials with limited therapist involvement appeared to be less beneficial and tended to report lower adherence than those which had higher levels of therapist guidance or peer support. CONCLUSIONS Preliminary findings suggest that teletherapy and remote online cognitive behavioural therapy strategies can be effective in improving quality of life among persons with chronic pain, although the overall quality of evidence is moderate. Controlled trials are needed to assess live remote teletherapy for chronic pain.
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Affiliation(s)
- Timothy Y Mariano
- Department of Psychiatry, Brigham and Women's Hospital, USA.,Harvard Medical School, USA.,Butler Hospital, USA.,Providence Veterans Affairs Medical Center, USA
| | - Limeng Wan
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA
| | - Robert R Edwards
- Department of Psychiatry, Brigham and Women's Hospital, USA.,Harvard Medical School, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA
| | - Robert N Jamison
- Department of Psychiatry, Brigham and Women's Hospital, USA.,Harvard Medical School, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, USA
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DiRenzo D, Finan P. Self-Efficacy and the Role of Non-Pharmacologic Treatment Strategies to Improve Pain and Affect in Arthritis. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019; 5:168-178. [PMID: 31832330 PMCID: PMC6907160 DOI: 10.1007/s40674-019-00123-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW There is increasing evidence that adjunctive, non-pharmacologic treatment programs are beneficial in the management of arthritis when added to traditional disease-modifying medications. This review focuses on non-pharmacologic management strategies that impact pain and affect, with a focus on self-efficacy, for those with osteoarthritis (OA) and rheumatoid arthritis (RA). RECENT FINDINGS We reviewed both office-based and internet-based self-management strategies, mindfulness based interventions (MBIs), and cognitive behavioral therapies (CBTs) for patients with arthritis. These behavioral strategies have shown to improve pain, mood disturbance, and physical function in those with both osteoarthritis and rheumatoid arthritis. Improvements in self-efficacy and coping capacity are associated with improvements in patient-reported outcomes (PROs) related to pain and functioning. SUMMARY Self-management programs, MBIs, and CBTs are more effective at improving pain and mood disturbance compared to usual care for patients with arthritis although high quality randomized controlled trials are lacking. Non-pharmacologic management programs are increasingly available via the internet and mobile applications.
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Affiliation(s)
- Dana DiRenzo
- The Johns Hopkins University, Baltimore, MD, USA
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Ciere Y, van der Vaart R, van der Meulen-De Jong A, Maljaars P, van Buul A, Koopmans J, Snoeck-Stroband J, Chavannes N, Sont J, Evers A. Implementation of an eHealth self-management care path for chronic somatic conditions. CLINICAL EHEALTH 2019. [DOI: 10.1016/j.ceh.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med 2018; 42:169-187. [DOI: 10.1007/s10865-018-9984-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
AbstractThis systematic review and meta-analysis aims to evaluate the effectiveness of internet-delivered cognitive behavioural therapy (ICBT) on anxiety and depression among persons with chronic health conditions. A systematic database search was conducted of MEDLINE, CINAHL, PsycInfo, EMBASE, and Cochrane for relevant studies published from 1990 to September 2018. A study was included if the following criteria were met: (1) randomized controlled trial involving an ICBT intervention; (2) participants experienced a chronic health condition; (3) participants ≥ 18 years of age; and (4) effects of ICBT on anxiety and/or depression were reported. The Cochrane Risk of Bias tool was used to assess the risk of bias on the included studies. Pooled analysis was conducted on the primary and condition specific secondary outcomes. Twenty-five studies met inclusion criteria and investigated the following chronic health conditions: tinnitus (n = 6), fibromyalgia (n = 3), pain (n = 7), rheumatoid arthritis (n = 3), cardiovascular disease (n = 2), diabetes (n = 1), cancer (n = 1), heterogeneous chronic disease population (n = 1), and spinal cord injury (n = 1). Pooled analysis demonstrated small effects of ICBT in improving anxiety and depression. Moderate effects of therapist-guided approach were seen for depression and anxiety outcomes; while, self-guided approaches resulted in small effects for depression and moderate effects in anxiety outcomes. ICBT shows promise as an alternative to traditional face-to-face interventions among persons with chronic health conditions. Future research on long-term effects of ICBT for individuals with chronic health conditions is needed.Trial Registration PROSPERO registration number: CRD42018087292.
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Ferwerda M, van Beugen S, van Middendorp H, Visser H, Vonkeman H, Creemers M, van Riel P, Kievit W, Evers A. Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial. J Med Internet Res 2018; 20:e260. [PMID: 30309835 PMCID: PMC6231867 DOI: 10.2196/jmir.9997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/31/2022] Open
Abstract
Background Internet-based cognitive behavioral therapy can aid patients with rheumatoid arthritis with elevated levels of distress to enhance their quality of life. However, implementation is currently lacking and there is little evidence available on the (cost-) effectiveness of different treatment strategies. Objective Cost-benefit ratios are necessary for informing stakeholders and motivating them to implement effective treatment strategies for improving health-related quality of life (HRQoL) of patients with rheumatoid arthritis. A cost-effectiveness study from a societal perspective was conducted alongside a randomized controlled trial on a tailored, therapist-guided internet-based cognitive behavioral therapy (ICBT) intervention for patients with rheumatoid arthritis with elevated levels of distress as an addition to care as usual (CAU). Methods Data were collected at baseline or preintervention, 6 months or postintervention, and every 3 months thereafter during the 1-year follow-up. Effects were measured in terms of quality-adjusted life years (QALYs) and costs from a societal perspective, including health care sector costs (health care use, medication, and intervention costs), patient travel costs for health care use, and costs associated with loss of labor. Results The intervention improved the quality of life compared with only CAU (Δ QALYs=0.059), but at a higher cost (Δ=€4211). However, this increased cost substantially reduced when medication costs were left out of the equation (Δ=€1863). Of all, 93% (930/1000) of the simulated incremental cost-effectiveness ratios were in the north-east quadrant, indicating a high probability that the intervention was effective in improving HRQoL, but at a greater monetary cost for society compared with only CAU. Conclusions A tailored and guided ICBT intervention as an addition to CAU for patients with rheumatoid arthritis with elevated levels of distress was effective in improving quality of life. Consequently, implementation of ICBT into standard health care for patients with rheumatoid arthritis is recommended. However, further studies on cost reductions in this population are warranted. Trial Registration Nederlands Trial Register NTR2100; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2100 (Archived by WebCite at http://www.webcitation.org/724t9pvr2)
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Affiliation(s)
- Maaike Ferwerda
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sylvia van Beugen
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henk Visser
- Department of Rheumatology, Rijnstate Hospital, Arnhem, Netherlands
| | - Harald Vonkeman
- University of Twente, Enschede, Netherlands.,Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marjonne Creemers
- Department of Rheumatology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Piet van Riel
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Andrea Evers
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
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41
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Nia NG, Afrasiabifar A, Behnammoghadam M. Comparing the effect of eye movement desensitization and reprocessing (EMDR) with guided imagery on pain severity in patients with rheumatoid arthritis. J Pain Res 2018; 11:2107-2113. [PMID: 30319285 PMCID: PMC6169765 DOI: 10.2147/jpr.s158981] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective Previous studies reported the reduction of pain following eye movement desensitization and reprocessing (EMDR) and guided imagery; however, the effectiveness of these modalities was not compared. The current study aimed to compare the effects of EMDR and guided imagery on pain severity in patients with rheumatoid arthritis. Material and methods In this randomized controlled trial, 75 patients were selected using non-random method, and then allocated into two intervention groups and one control group. Interventions were conducted individually in six consecutive sessions for the intervention groups. The Rheumatoid Arthritis Pain Scale was used for data collection before and after the interventions. Collected data were analyzed with descriptive and inferential statistics in SPSS. Significance level was considered at P<0.05. Results The post-intervention mean scores of physiological, affective, sensory-discriminative, and cognitive pain sub-scales for patients in guided imagery group were 16.3±2.2, 13.9±2.2, 30.6±3.4, and 23.2±3, respectively. The post-intervention mean scores of these sub-scales in the EMDR group were 22±1.5, 18.1±1.8, 39.6±2.8, and 29±1.8, respectively. A significant difference was observed in the mean pain score between EMDR and guided imagery groups, and also between each intervention group and the control group (P=0.001). Conclusion Guided imagery and EMDR could reduce pain in rheumatoid arthritis, but pain reduction was more following the EMDR than guided imagery.
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Affiliation(s)
- Nasrin Ghanbari Nia
- Student Committee Research, Yasuj University of Medical Sciences, Yasuj, Iran
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Abstract
PURPOSE OF REVIEW We reviewed research on computer-assisted cognitive-behavior therapy (CCBT) performed in medical settings with the goals of assessing the effectiveness of this newer method of treatment delivery, evaluating the need for clinician support of therapeutic computer programs, and making suggestions for future research and clinical implementation. RECENT FINDINGS The overall results of randomized, controlled trials suggest that CCBT can be an effective treatment for depression in primary care patients and health care anxiety. Also, it can be a useful component of treatment for somatic conditions including irritable bowel syndrome, diabetes, fibromyalgia, and chronic pain. The amount and type of clinician support needed for maximizing effectiveness remains unclear. CCBT offers promise for overcoming barriers to delivering effective psychotherapy in medical settings. We recommend that next steps for researchers include more definitive studies of the influence of clinician support, investigations focused on implementation in clinical practices, cost-benefit analyses, and use of technological advances.
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Terpstra JA, van der Vaart R, Spillekom-van Koulil S, van Dam A, Rosmalen JGM, Knoop H, van Middendorp H, Evers AWM. Becoming an eCoach: Training therapists in online cognitive-behavioral therapy for chronic pain. PATIENT EDUCATION AND COUNSELING 2018; 101:1702-1707. [PMID: 29661704 DOI: 10.1016/j.pec.2018.03.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 02/24/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Online cognitive-behavioral therapy (iCBT) is effective in supporting patients' self-management. Since iCBT differs from face-to-face CBT on several levels, proper training of therapists is essential. This paper describes the development and evaluation of a therapist training based on theoretical domains that are known to influence implementation behavior, for an iCBT for chronic pain. METHODS The training consists of 1.5 days and covers the implementation domains "knowledge", "skills", "motivation", and "organization", by focusing on the therapy's rationale, iCBT skills, and implementation strategies. Using an evaluation questionnaire, implementation determinants (therapist characteristics, e-health attitude, and implementation domains) and iCBT acceptance were assessed among participants after training. RESULTS Twenty-two therapists participated, who generally showed positive e-health attitudes, positive implementation expectations, and high iCBT acceptance. Organizational aspects (e.g., policy regarding iCBT implementation) were rated neutrally. CONCLUSIONS An iCBT therapist training was developed and initial evaluations among participants showed favorable implementation intentions. PRACTICE IMPLICATIONS Therapists' positive training evaluations are promising regarding the dissemination of iCBT in daily practice. Organizational support is vital and needs to be attended to when selecting organizations for iCBT implementation.
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Affiliation(s)
- Jessy A Terpstra
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, PO Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Rosalie van der Vaart
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, PO Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Saskia Spillekom-van Koulil
- Radboud University Medical Center Nijmegen, Department of Medical Psychology Nijmegen, PO Box 9101, 6500 HB, The Netherlands.
| | - Arno van Dam
- Tilburg University, Tilburg School of Social and Behavioral Sciences, PO Box 90153, 5000 LE, Tranzo, Tilburg, The Netherlands.
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Departments of Psychiatry and Internal Medicine, PO Box 30001, 9700 RB, Groningen, The Netherlands.
| | - Hans Knoop
- Academic Medical Center, Department of Medical Psychology, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, PO Box 9555, 2300 RB, Leiden, The Netherlands.
| | - Andrea W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, PO Box 9555, 2300 RB, Leiden, The Netherlands; Leiden University Medical Center, Department of Psychiatry, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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Wirken L, van Middendorp H, Hooghof CW, Bremer TE, Hopman SPF, van der Pant KAMI, Hoitsma AJ, Hilbrands LB, Evers AWM. Development and feasibility of a guided and tailored internet-based cognitive-behavioural intervention for kidney donors and kidney donor candidates. BMJ Open 2018; 8:e020906. [PMID: 29961018 PMCID: PMC6042571 DOI: 10.1136/bmjopen-2017-020906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. A subgroup of the kidney donor population experiences adjustment problems during or after the donation procedure (eg, anxiety or fatigue). There is a need for evidence-based interventions that decrease donation-related difficulties before or after donation. In the current study, a guided and tailored internet-based cognitive-behavioural therapy (ICBT) intervention for donors and donor candidates was developed and the feasibility and perceived effectiveness were evaluated. DESIGN Pilot study including qualitative and quantitative research methods for intervention development and evaluation. SETTING Living kidney donor population of two Dutch transplantation centres. PARTICIPANTS Donors and healthcare professionals participated in focus group interviews conducted to identify intervention themes and to map attitudes towards internet-based interventions. In a pilot feasibility study, 99 donors and donor candidates participated, of whom 38 completed the screening. Eight donors or donor candidates with a risk profile (ie, impaired mental health-related quality of life (HRQoL)) received and evaluated the intervention. INTERVENTIONS A guided and tailored ICBT intervention for donors and donor candidates was developed. Donation-related treatment modules, assignments and psychoeducation were integrated within an existing disease-generic ICBT intervention. OUTCOME MEASURES HRQoL, anxiety and depression were assessed before and after the ICBT intervention. Additional questionnaires were included to identify specific problem areas of donor functioning to tailor the ICBT intervention to the donor's needs. RESULTS Different intervention themes were derived from the focus group interviews (eg, physical limitations, and donation-specific emotional and social-relational problems). Participants were satisfied about the intervention content (7.7±0.8 on a 0-10 scale) and the therapeutic relationship (4.4±0.6 on a 1-5 scale), and indicated an improvement on domains of their treatment goals (3.2±0.7 on a 1-4 scale). CONCLUSION This study showed positive evaluations concerning both feasibility and perceived effectiveness of the tailored ICBT intervention in kidney donors and donor candidates, in line with previous studies using comparable ICBT treatment protocols in other populations. Future research should examine the possibilities of integrating the intervention into psychosocial care for kidney donors.
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Affiliation(s)
- Lieke Wirken
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Christina W Hooghof
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Tamara E Bremer
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - Sabine P F Hopman
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Karlijn A M I van der Pant
- Department of Internal Medicine/Nephrology, Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
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Srikesavan C, Bryer C, Ali U, Williamson E. Web-based rehabilitation interventions for people with rheumatoid arthritis: A systematic review. J Telemed Telecare 2018; 25:263-275. [PMID: 29669470 DOI: 10.1177/1357633x18768400] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Rehabilitation approaches for people with rheumatoid arthritis include joint protection, exercises and self-management strategies. Health interventions delivered via the web have the potential to improve access to health services overcoming time constraints, physical limitations, and socioeconomic and geographic barriers. The objective of this review is to determine the effects of web-based rehabilitation interventions in adults with rheumatoid arthritis. METHODS Randomised controlled trials that compared web-based rehabilitation interventions with usual care, waiting list, no treatment or another web-based intervention in adults with rheumatoid arthritis were included. The outcomes were pain, function, quality of life, self-efficacy, rheumatoid arthritis knowledge, physical activity and adverse effects. Methodological quality was assessed using the Cochrane Risk of Bias tool and quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Six source documents from four trials ( n = 567) focusing on self-management, health information or physical activity were identified. The effects of web-based rehabilitation interventions on pain, function, quality of life, self-efficacy, rheumatoid arthritis knowledge and physical activity are uncertain because of the very low quality of evidence mostly from small single trials. Adverse effects were not reported. CONCLUSION Large, well-designed trials are needed to evaluate the clinical and cost-effectiveness of web-based rehabilitation interventions in rheumatoid arthritis.
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Affiliation(s)
- Cynthia Srikesavan
- 1 Centre for Rehabilitation Research in Oxford, University of Oxford, UK
| | | | - Usama Ali
- 3 Centre for Statistics in Medicine, Oxford Clinical Trials Research Unit & Centre for Rehabilitation Research in Oxford, University of Oxford, UK
| | - Esther Williamson
- 1 Centre for Rehabilitation Research in Oxford, University of Oxford, UK
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Ferreira RJO, Duarte C, Ndosi M, de Wit M, Gossec L, da Silva JAP. Suppressing Inflammation in Rheumatoid Arthritis: Does Patient Global Assessment Blur the Target? A Practice-Based Call for a Paradigm Change. Arthritis Care Res (Hoboken) 2018; 70:369-378. [PMID: 28544615 DOI: 10.1002/acr.23284] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/16/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In current management paradigms of rheumatoid arthritis (RA), patient global assessment (PGA) is crucial to decide whether a patient has attained remission (target) or needs reinforced therapy. We investigated whether the clinical and psychological determinants of PGA are appropriate to support this important role. METHODS This was a cross-sectional, single-center study including consecutive ambulatory RA patients. Data collection comprised swollen 28-joint count (SJC28), tender 28-joint count (TJC28), C-reactive protein (CRP) level, PGA, pain, fatigue, function, anxiety, depression, happiness, personality traits, and comorbidities. Remission was categorized using American College of Rheumatology/European League Against Rheumatism Boolean-based criteria: remission, near-remission (only PGA >1), and nonremission. A binary definition without PGA (3v-remission) was also studied. Univariable and multivariable analyses were used to identify explanatory variables of PGA in each remission state. RESULTS A total of 309 patients were included (remission 9.4%, near-remission 37.2%, and nonremission 53.4%). Patients in near-remission were indistinguishable from remission regarding disease activity, but described a disease impact similar to those in nonremission. In multivariable analyses, PGA in near-remission was explained (R2adjusted = 0.50) by fatigue, pain, anxiety, and function. Fatigue and pain had no relationship with disease activity measures. CONCLUSION In RA, a consensually acceptable level of disease activity (SJC28, TJC28, and CRP level ≤1) does not equate to low disease impact: a large proportion of these patients are considered in nonremission solely due to PGA. PGA mainly reflects fatigue, pain, function, and psychological domains, which are inadequate to define the target for immunosuppressive therapy. This consideration suggests that clinical practice should be guided by 2 separate remission targets: inflammation (3v-remission) and disease impact.
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Affiliation(s)
- Ricardo J O Ferreira
- Centro Hospitalar e Universitário de Coimbra and Health Sciences Research Unit: Nursing, Coimbra, Portugal
| | - Cátia Duarte
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
| | | | - Maarten de Wit
- Patient research partner, EULAR Standing Committee of People with Arthritis/Rheumatism in Europe, Zurich, Switzerland, and VU University Medical Centre, Amsterdam, The Netherlands
| | - Laure Gossec
- Sorbonne Universités, UPMC University Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS), and AP-HP, Pitié-Salpetrière Hospital, Paris, France
| | - J A P da Silva
- Centro Hospitalar e Universitário de Coimbra and University of Coimbra, Coimbra, Portugal
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Kloek C, Bossen D, de Bakker DH, Veenhof C, Dekker J. Blended Interventions to Change Behavior in Patients With Chronic Somatic Disorders: Systematic Review. J Med Internet Res 2017; 19:e418. [PMID: 29269338 PMCID: PMC5754569 DOI: 10.2196/jmir.8108] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/18/2017] [Accepted: 09/23/2017] [Indexed: 01/07/2023] Open
Abstract
Background Blended behavior change interventions combine therapeutic guidance with online care. This new way of delivering health care is supposed to stimulate patients with chronic somatic disorders in taking an active role in their disease management. However, knowledge about the effectiveness of blended behavior change interventions and how they should be composed is scattered. Objective This comprehensive systematic review aimed to provide an overview of characteristics and effectiveness of blended behavior change interventions for patients with chronic somatic disorders. Methods We searched for randomized controlled trials published from 2000 to April 2017 in PubMed, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the Cochrane Collaboration tool. Study characteristics, intervention characteristics, and outcome data were extracted. Studies were sorted based on their comparison group. A best-evidence synthesis was conducted to summarize the effectiveness. Results A total of 25 out of the 29 included studies were of high quality. Most studies (n=21; 72%) compared a blended intervention with no intervention. The majority of interventions focused on changing pain behavior (n=17; 59%), and the other interventions focused on lifestyle change (n=12; 41%). In addition, 26 studies (90%) focused on one type of behavior, whereas 3 studies (10%) focused on multiple behaviors. A total of 23 studies (79%) mentioned a theory as basis for the intervention. The therapeutic guidance in most studies (n=18; 62%) was non face-to-face by using email, phone, or videoconferencing, and in the other studies (partly), it was face-to-face (n=11; 38%). In 26 studies (90%), the online care was provided via a website, and in 3 studies (10%) via an app. In 22 studies (76%), the therapeutic guidance and online care were integrated instead of two separate aspects. A total of 26 outcome measures were included in the evidence synthesis comparing blended interventions with no intervention: for the coping strategy catastrophizing, we found strong evidence for a significant effect. In addition, 1 outcome measure was included in the evidence synthesis comparing blended interventions with face-to-face interventions, but no evidence for a significant effect was found. A total of 6 outcome measures were included in the evidence synthesis comparing blended interventions with online interventions, but no evidence for a significant effect was found. Conclusions Blended behavior change interventions for patients with chronic somatic disorders show variety in the type of therapeutic guidance, the type of online care, and how these two delivery modes are integrated. The evidence of the effectiveness of blended interventions is inconsistent and nonsignificant for most outcome measures. Future research should focus on which type of blended intervention works for whom.
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Affiliation(s)
- Corelien Kloek
- Tranzo, Tilburg University, Tilburg, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, Netherlands.,Brain Center Rudolf Magnus, Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Daniël Bossen
- ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Dinny H de Bakker
- Tranzo, Tilburg University, Tilburg, Netherlands.,Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Human Movement Care, HU University of Applied Sciences, Utrecht, Netherlands.,Brain Center Rudolf Magnus, Department of Rehabilitation, Physical Therapy Science & Sports, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joost Dekker
- EMGO Institute, VU University Medical Center Amsterdam, Amsterdam, Netherlands.,Department of Rehabilitation Medicine, VU University Medical Center Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, VU University Medical Center Amsterdam, Amsterdam, Netherlands
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