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Codd Y, Coe Á, Kane D, Mullan RH, Stapleton T. A multidisciplinary-led early arthritis service to manage client-identified participation restrictions in early inflammatory arthritis: A qualitative study of service user and staff perspectives. Musculoskeletal Care 2023; 21:130-142. [PMID: 35933715 DOI: 10.1002/msc.1677] [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: 06/04/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND The impact of inflammatory arthritis (IA) on occupational performance and on participation in meaningful life roles is recognised. However, limited research has explored how clinical services support broader life impact and participation restrictions associated with early disease as part of routine healthcare. This exploratory study was undertaken to describe how a novel multidisciplinary-led early arthritis service approach addresses client-identified participation restrictions in early IA. METHODS Qualitative Description (QD) approaches were used to explore perspectives of staff and clients of these multidisciplinary-led early arthritis services in Ireland. Data were gathered using focus groups with staff, and individual semi-structured interviews with clients. Transcripts were analysed using thematic analysis. RESULTS Fifteen staff working in these services participated in the focus groups and 43 clients with IA participated in interviews (female n = 31); diagnosis duration ranged from 5 to 24 months. Participants described how the multidisciplinary-led service had a clear remit to address participation alongside traditional symptom management and provided automatic, immediate access to interventions focussed on identification and management of participation restrictions experienced in early disease. The service model utilised a delivery approach that allowed for ease of early access to a full multidisciplinary team and prolonged support. The most significant feature of the service approach was 'the centrality of the client' which influenced a person-centred approach to identification of needs and priorities for interventions. CONCLUSION Findings indicate the role and value of this innovative multidisciplinary approach in addressing client-identified participation restrictions in routine clinical practice that is positively regarded by clients and staff.
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Affiliation(s)
- Yvonne Codd
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland.,Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - Áine Coe
- Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - David Kane
- Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - Ronan H Mullan
- Rheumatology Departments Naas General and Tallaght University Hospital, Dublin, Ireland
| | - Tadhg Stapleton
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Søvik ML, Eide REM, Rene B, Strand MM, Devik I, Liland DE, Kjeken I, Taule T. Rheumatic disease and fatigue: Participants' experiences of an activity-pacing group. Scand J Occup Ther 2021:1-12. [PMID: 34749574 DOI: 10.1080/11038128.2021.1998609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fatigue is a common symptom of inflammatory rheumatic disease and has a great impact on everyday life. Activity-pacing is proposed as an intervention to increase participation in meaningful activities. AIMS To explore participants' experiences with an activity-pacing group, how participants perceived self-managing everyday life after group attendance, and their reflections on unmet needs that could enhance self-management of everyday life with fatigue. MATERIALS AND METHODS Semi-structured interviews were conducted with 10 participants who had attended an activity-pacing group. Thematic analyses were conducted. FINDINGS Prior to group attendance, the participants expressed an awareness of their lack of knowledge of fatigue. Through group attendance, they increased their understanding of fatigue and their ability to apply strategies to better manage everyday life. Participants found it difficult to balance their energy use and realised that implementing activity-pacing strategies takes time. Therefore, they requested follow-up sessions with the activity-pacing group. They also desire that rheumatologists pay more attention to and acknowledge fatigue. CONCLUSIONS AND SIGNIFICANCE Enhancing the understanding of fatigue and how to manage everyday life with fatigue, appears to be important. Group interventions led by occupational therapists and with a focus on activity-pacing may be a suitable approach. Follow-up sessions are recommended.
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Affiliation(s)
- Margaret L Søvik
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway.,Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Ruth Else M Eide
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Bjørg Rene
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | | | - Ingvill Devik
- Department of Rheumatology, Nordland Hospital, Bodø, Norway
| | - Dag Einar Liland
- Patient Participation Group, Haukeland University Hospital, Bergen, Norway
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Tina Taule
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
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Hollick RJ, Stelfox K, Dean LE, Shim J, Walker-Bone K, Macfarlane GJ. Outcomes and treatment responses, including work productivity, among people with axial spondyloarthritis living in urban and rural areas: a mixed-methods study within a national register. Ann Rheum Dis 2020; 79:1055-1062. [PMID: 32522742 PMCID: PMC7392479 DOI: 10.1136/annrheumdis-2020-216988] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
Objective To examine differences in clinical and patient-reported outcomes, including work, in individuals with axial spondyloarthritis (axSpA) living in rural and urban settings. Methods Using a sequential, explanatory mixed-method design, data from the British Society for Rheumatology Biologics Register for Ankylosing Spondylitis were used to (1) characterise participants with axSpA living in rural and urban areas and (b) assess any differences in outcome after commencement of biologic therapy (phase 1). Semistructured interviews (phase 2) further explored the results from phase 1. Results Patients with axSpA living in rural areas were older and more likely to work in a physical job. Among patients prescribed biologics, there were no differences in response to biologics, but after adjustment for age, sex and local area deprivation rural dwellers reported more presenteeism and overall work impairment. Work effects could be explained by accounting for individual differences in disease activity, fatigue, physical function and job type. Interviews highlighted the complex relationship between clinical factors, contextual factors (work environment, job demands) and work disability. The ability to work and flexibility in terms of what, when and how tasks are undertaken were important. Support from employers was variable and healthcare professionals were often perceived as unsupportive. Conclusions Patients with axSpA living in rural areas report a greater impact of their disease on work productivity. New measures are needed to capture important contextual factors and comprehensively determine the impact of long-term conditions on work. Future European League Against Rheumatism axSpA recommendations should include support to work as a target to optimise quality of life in patients with axSpA.
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Affiliation(s)
- Rosemary J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Kevin Stelfox
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Linda E Dean
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Joanna Shim
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Aberdeen, Aberdeen, UK
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Graham K, Birt L, MacGregor A, Watts L, Poland F. "It's my own fault": Accounts and consequences of falling when living with rheumatoid arthritis. Musculoskeletal Care 2019; 17:346-353. [PMID: 31419006 PMCID: PMC6973095 DOI: 10.1002/msc.1426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/23/2019] [Accepted: 07/27/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) leads to biomechanical joint changes, which increases the risk of falling. The consequence of falling may be physical injury. However, the psychological consequences, including the fear of falling, can be equally important. METHODS Participants were recruited from a larger prospective study which explored the incidence of falls in people with RA. Purposive sampling considered age, sex, time since diagnosis and fall history. The recruitment site was a regional hospital. Data were collected from semi-structured qualitative interviews and, after each fall, brief telephone interviews. Thematic analysis methods were used to investigate the psychological and social impact of falling in people with RA. RESULTS Twelve participants were interviewed (aged 64-85, mean 74 years; six had fallen between one and 23 times, and six had no reported falls in last 12 months). Data were supplemented with telephone notes from 287 post-fall telephone calls. Three themes were developed: (i) the falls imaginary illustrates that the fear of falling is not dependent on experience; (ii) agentic risk management reports on the ways people self-manage and display resilience when at risk of falling; (iii) the absence of the health professional explores the ways in which people reported being unsupported by healthcare services. CONCLUSION Fear of falling when living with RA is tangible in those who have and have not fallen. This fear may limit opportunities for full participation in life. However, some people display personal resourcefulness, continuing to live purposeful lives. Understanding personal responses to falling will support the development of community interventions specific to this high-risk group.
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Affiliation(s)
- Karly Graham
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Linda Birt
- School of Health SciencesUniversity of East AngliaNorwichUK
| | | | - Laura Watts
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Fiona Poland
- School of Health SciencesUniversity of East AngliaNorwichUK
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Bergström M, Sverker A, Larsson Ranada Å, Valtersson E, Thyberg I, Östlund G, Björk M. Significant others' influence on participation in everyday life - the perspectives of persons with early diagnosed rheumatoid arthritis. Disabil Rehabil 2019; 42:385-393. [PMID: 30634863 DOI: 10.1080/09638288.2018.1499825] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To describe the meaning of significant others in relation to participation in everyday life of persons with early diagnosed rheumatoid arthritis (RA).Materials and methods: Fifty-nine persons participated in this interview study. Inclusion criteria were three years' experience of diagnosis and being of working age. Semi-structured interviews were conducted using critical incident technique (CIT), and the material was analysed using content analysis.Results: Four categories were revealed: (1) My early RA causes activity adaptations for us all, referring to the person and significant others modifying activities. (2) Making the significant others balance between shortfalls and participation, where the participants distinguished between needing help and feeling involved in activities. (3) Physical interactions with significant others, referring to both the problematic and manageable impact RA could have on body contact. (4) Emotions in relation to activities with others, where participants described feelings of failing others, and anxiety about future activities.Conclusions: For persons with early diagnosed RA, significant others can be both hindering and facilitating for participation in everyday life. As a clinical implication, it is valuable to identify how significant others can be involved in the rehabilitation process, to enhance participation in everyday life early in the disease process.Implications for rehabilitationSignificant others of persons with rheumatoid arthritis can facilitate as well as hinder participation in everyday life, even early in the disease process.It is important to include the significant others in the rehabilitation process of persons with early diagnosed rheumatoid arthritis.It is of great importance to identify when and how significant others can be facilitators of participation in everyday life for persons with early rheumatoid arthritis.To make it easier for significant others to facilitate participation, there is a need for the healthcare system to explore ways to support significant others with easily accessible information about early rheumatoid arthritis.
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Affiliation(s)
- Maria Bergström
- Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Annette Sverker
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Åsa Larsson Ranada
- Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Eva Valtersson
- Department of Activity and Health, Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Department of Clinical and Experimental Medicine, Linköping University, Department of Rheumatology, Heart and Medicine Center, Region Östergötland, Linköping, Sweden
| | - Gunnel Östlund
- School of Health Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Mathilda Björk
- Division of Occupational Therapy, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Department of Rheumatology, Heart and Medicine Center, Region Östergötland, Linköping, Sweden
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Abstract
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA. Newer biologic agents, such as those targeting the interleukin 17-interleukin 23 axis, have promising efficacy and may improve HRQoL for patients with AxSpA. The AxSpA has many negative effects on HRQoL. By targeting disease pathways responsible for the development of AxSpA, approved and emerging therapies potentially reduce disease activity and improve the functional status of patients with AxSpA. This narrative review reflects on the findings of studies evaluating HRQoL of individuals with AxSpA and the role of newer therapies.
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