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Dong X, Peng J, Li X, Zhao Q, Zhang X. Home Coping Strategies for Fatigue Used by Patients With Lung Cancer Receiving Chemotherapy in Rural China: A Qualitative Study. J Nurs Res 2021; 29:e178. [PMID: 34483303 DOI: 10.1097/jnr.0000000000000453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cancer-related fatigue, a distressing symptom, is frequently reported by patients with lung cancer as increasing in severity with the number of rounds of chemotherapy. Yet, patients and healthcare providers are challenged to control this fatigue. Thus, healthcare providers must have interventions to effectively enhance coping engagement in patients with lung cancer. PURPOSE The aims of this study were to explore how patients with lung cancer in a rural area of China undergoing chemotherapy cope with the fatigue at home and to summarize their strategies. METHODS A descriptive qualitative research approach was used, and data were collected using semistructured interviews. Sixteen patients with lung cancer with chemotherapy-related fatigue living in rural communities were recruited from a large, tertiary teaching hospital in Huzhou in eastern China. The transcripts of the interviews were analyzed using content analysis. RESULTS Coping strategies for cancer-related fatigue were delineated into the three themes of (a) psychological adjustment, (b) efforts to change lifestyles and act as a Chinese health practitioner, and (c) relying on social support. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The participants in this study provided information on a variety of approaches to reducing/alleviating cancer-related fatigue that were influenced by Chinese culture. Healthcare providers and patients may work together in clinical settings to identify appropriate, effective coping solutions and then to incorporate these into the regular care regimen to help patients transition between hospital and home.
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Affiliation(s)
- Xiaomeng Dong
- MSN, RN, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, China
| | - Jianying Peng
- MSN, RN, Head Nurse, Department of Nursing, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Hubei, China
| | - Xingxing Li
- MSN, RN, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, China
| | - Qiyuan Zhao
- MSN, RN, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, China
| | - Xiuwei Zhang
- PhD, RN, Associate Professor, School of Medicine, Huzhou University, Huzhou Central Hospital, Huzhou, China
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Pope JE. Management of Fatigue in Rheumatoid Arthritis. RMD Open 2021; 6:rmdopen-2019-001084. [PMID: 32385141 PMCID: PMC7299512 DOI: 10.1136/rmdopen-2019-001084] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/04/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022] Open
Abstract
Fatigue in rheumatoid arthritis is highly prevalent. It is correlated only weakly with disease activity but more so with pain, mood, personality features, poor sleep, obesity and comorbidities. Fatigue can be measured by many standardised questionnaires and more easily with a Visual Analogue Scale or numeric rating scale. Most patients with RA have some fatigue, and at least one in six have severe fatigue. Chronic pain and depressed mood are also common in RA patients with significant fatigue. It affects function and quality of life and is worse on average in women. Evidence-based treatment for fatigue includes treatment of underlying disease activity (with on average modest improvement of fatigue), exercise programmes and supervised self-management programmes with cognitive-behavioural therapy, mindfulness and reinforcement (such as reminders). The specific programmes for exercise and behavioural interventions are not standardised. Some medications cause fatigue such as methotrexate. More research is needed to understand fatigue and how to treat this common complex symptom in RA that can be the worst symptom for some patients.
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Affiliation(s)
- Janet E Pope
- Medicine, Division Rheumatology, Western University, Ontario, Canada
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Bergström M, Dahlström Ö, Thyberg I, Björk M. The role of support from significant others in the association between disease-related factors and sickness absence in early rheumatoid arthritis: a longitudinal study. Scand J Rheumatol 2021; 50:427-434. [PMID: 33678129 DOI: 10.1080/03009742.2020.1870712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objective: The aim of this study was to analyse how support from significant others affects the associations between disease-related variables and sickness absence during the first 2 years after rheumatoid arthritis (RA) diagnosis.Method: Data from 274 people with RA (73% women) of working age (18-63 years) were retrieved from the Swedish early RA cohort TIRA-2. These data concerned disease-related variables (disease activity, activity limitations, pain intensity, and grip force), sickness absence, and perceived support from significant others. Associations of disease-related variables with sickness absence and how these associations were moderated by support from significant others were analysed using zero-inflated negative binomial regression.Results: During the 2 years after diagnosis, higher disease activity was significantly associated with increased odds of sickness absence, a connection strengthened by perceived support from family during the first year. More perceived support was also directly and significantly associated with increased odds of sickness absence during the first year.Conclusions: Support from significant others is related to sickness absence in RA, specifically during the first year after diagnosis. Although patients report high levels of support from significant others, this does not necessarily lead to more positive work outcomes. Therefore, it is important to consider other aspects of support that might influence work outcomes, e.g. type and quality of support. Future research should investigate these forms of support, and when significant others should be encouraged to support in the rehabilitation process to increase the chances of people with RA having a well-functioning and sustainable work life.
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Affiliation(s)
- M Bergström
- Unit of Occupational Therapy, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - Ö Dahlström
- Department of Behavioural Sciences and Learning, Faculty of Arts and Sciences, Linköping University, Linköping, Sweden
| | - I Thyberg
- Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - M Björk
- Unit of Occupational Therapy, Department of Health, Medicine and Caring Sciences, Faculty of Health Sciences, Linköping University, Norrköping, Sweden.,Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Multimorbidity and Fatigue in Rheumatoid Arthritis: A Cross-Sectional Study of a Population-Based Cohort. Rheumatol Ther 2020; 7:979-991. [PMID: 33113092 PMCID: PMC7695756 DOI: 10.1007/s40744-020-00247-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/14/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The objective was to evaluate the relationships between multimorbidity and overall fatigue as well as fatigue subdomains in patients with rheumatoid arthritis (RA). Methods A cross-sectional study of a population-based cohort of patients with RA was performed. Fatigue was assessed using the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ). Patients’ medical records were reviewed for 25 chronic comorbidities prior to the BRAF-MDQ. Linear and logistic regression models were used to estimate the differences in BRAF-MDQ total and subdomain (physical, living, cognitive, and emotional) scores associated with multimorbidity, adjusting for age, sex, disease duration, obesity, smoking, C-reactive protein, and RA autoantibodies. Higher BRAF-MDQ scores indicate greater fatigue severity. Results The cohort included 192 patients, median age 62 years, and median RA duration 13 years. Multimorbidity was common with 93 (48%) having ≥ 2 comorbidities, and 27 (14%) having ≥ 4 comorbidities. The median BRAF-MDQ total score was 9 (interquartile range 3–18), with higher scores indicating greater fatigue. Patients with ≥ 4 comorbidities had higher total BRAF-MDQ scores (median 16.5, interquartile range: 6.8–24.8) than patients with < 4 comorbidities (7.5, 2.8–16.0; p = 0.014). Each additional comorbidity was associated with a 2.33 (95% confidence interval [CI] 1.10–3.56) unit increase in total BRAF-MDQ score (p < 0.001), and the presence of ≥ 4 comorbidities was associated with a 9.33 (95% CI 3.92–14.7) unit increase in total BRAF-MDQ score. Multimorbidity was significantly associated with all four fatigue subdomains in adjusted models. Conclusions Multimorbidity is associated with increased fatigue in patients with RA. The findings suggest that interventions targeting multimorbidity could help alleviate treatment-refractory fatigue in patients with RA and other rheumatic diseases. Electronic Supplementary Material The online version of this article (10.1007/s40744-020-00247-y) contains supplementary material, which is available to authorized users.
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Abstract
OBJECTIVES To gain deeper knowledge of factors promoting physical activity in women with fibromyalgia. DESIGN A qualitative study based on semistructured in-depth individual interviews. Analysed using qualitative content analysis. PARTICIPANTS Fourteen women with fibromyalgia, age 38-65, recruited from a previous randomised controlled trial investigating the effects of person-centred progressive resistance exercise compared with relaxation therapy. SETTING Interviews were conducted in a hospital setting. RESULTS The analysis resulted in four categories: a desire to be physically active, finding the proper level and creating proper conditions, managing pain and getting it done. CONCLUSION This study reveals several factors both personal and environmental, which promote the ability to be physically active when living with pain and other symptoms of fibromyalgia. The participants expressed that, although they had a desire to be physically active, they needed support and guidance from a professional with adequate knowledge to help them find the proper level of exercise. They also expressed a need for the professional to understand their preferences, and to use these preferences as a basis for creating the proper conditions, helping them learn to manage pain and supporting them in getting the exercise done.
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Affiliation(s)
- Anette Larsson
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Caroline Feldthusen
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Institute of Neuroscience and Physiology, Section of Health and Rehabilitation, Physiotherapy, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lange E, Gjertsson I, Mannerkorpi K. Long-time follow up of physical activity level among older adults with rheumatoid arthritis. Eur Rev Aging Phys Act 2020; 17:10. [PMID: 32699561 PMCID: PMC7368988 DOI: 10.1186/s11556-020-00242-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Physical activity and exercise are acknowledged as important parts in the management of rheumatoid arthritis (RA). However, long-term maintenance of exercise is known to be difficult. The aim of this study was to evaluate change in physical activity and physical fitness after four years in older adults with RA who had previously participated in exercise with person-centred guidance compared to controls. METHOD A follow-up study was performed where older adults (> 65 years) who had participated in a randomized controlled trial where they were allocated to either exercise with person-centred guidance or home-based, light-intensity exercise (controls) were invited to one visit and assessed with performance-based test, blood-sampling and self-reported questionnaires. Forty-seven out of 70 older adults accepted participation, 24 from the exercise group and 23 from the control group. Comparisons of the result with baseline values were performed and explanatory factors for increase of physical activity were examined with logistic regression. RESULTS The result show that there was no significant difference in weekly hours of physical activity when groups where compared. However, participants in the exercise group rated significantly increased weekly hours of physical activity after four years (p = 0.004) when compared to baseline. Higher levels of fatigue, BMI and physical activity, at baseline were negatively associated with increased physical activity after four years. There was no significant difference in change of physical fitness between the groups. Within group analysis showed that the control group reported increased pain (p = 0.035), fatigue (p = 0.023) increased number of tender joints (p = 0.028) higher disease activity (p = 0.007) and worsening of global health (p = 0.004) when compared to baseline while the exercise group remained at the same level as at baseline. CONCLUSION These results indicate that introducing moderate- to high intensity exercise with person-centred guidance might favor increased physical activity after four years in older adults with RA. Previous partaking in moderate- to high intensity exercise might also be protective against increased disease activity, pain and fatigue over time.
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Affiliation(s)
- Elvira Lange
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30 Göteborg, Sweden
- University of Gothenburg Center for Person-centred Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Gjertsson
- University of Gothenburg Center for Person-centred Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Rheumatology and Inflammation research, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kaisa Mannerkorpi
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30 Göteborg, Sweden
- University of Gothenburg Center for Person-centred Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- The Sahlgrenska University Hospital, Gothenburg, Sweden
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Moderate-to-high intensity exercise with person-centered guidance influences fatigue in older adults with rheumatoid arthritis. Rheumatol Int 2019; 39:1585-1594. [PMID: 31327051 DOI: 10.1007/s00296-019-04384-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
Fatigue is described as a dominant and disturbing symptom of rheumatoid arthritis (RA) regardless of the advances in pharmacological treatment. Fatigue is also found to correlate with depression. The objective was to evaluate the impact of moderate-to-high intensity, aerobic and resistance exercise with person-centered guidance on fatigue, anxiety and depression, in older adults with RA. Comparisons were made between older adults (> 65 years) with RA taking part in a 20-week moderate-to-high intensity exercise at a gym (n = 36) or in home-based exercise of light intensity (n = 38). Assessments were performed at baseline, at 20 weeks, and at 52 weeks. Outcomes were differences in Multidimensional Fatigue Inventory (MFI-20), Visual Analog Scale Fatigue (VAS fatigue), and Hospital Anxiety and Depression Scale (HADS). Analysis of metabolomics was also performed. The subscales "physical fatigue" and "mental fatigue" in MFI-20 and symptoms of depression using HADS depression scale improved significantly at week 20 in the exercise group compared with the control group. Exercise did not influence global fatigue rated by VAS or subscales "reduced motivation", "reduced activity" and "general fatigue" in MFI-20. No significant change was found on the anxiety index of HADS. The improvements in physical fatigue were associated with changes in the metabolism of lipids, bile acids, the urea cycle and several sugars. Moderate-to-high intensity exercise with person-centered guidance decreased fatigue and improved symptoms of depression and were accompanied by metabolic changes in older adults with RA.
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