POS1510-HPR IDENTIFYING THEORY-DRIVEN THERAPEUTIC CONTENT FOR A SMARTPHONE APP FOR THE SELF-MANAGEMENT OF SJOGREN’S SYNDROME

Background

Technology-supported self-management of long-term conditions (e.g., through the use of smartphone apps) provides easily accessible support. However, currently there are no systematically developed, evidence-based smartphone apps for Sjogren’s Syndrome. We took an agile approach to developing such an app: instead of starting “from scratch” we deemed it more efficient and scientifically sound to digitalise relevant components from existing, evidence-based interventions for the symptoms of SS.

Objectives

The present study was desk research, which aimed to deconstruct interventions and resources down to units of theory-driven therapeutic content, to then select from, for the inclusion in an app for the self-management of SS.

Methods

We used deductive and inductive content analysis, to identify behaviour change techniques (BCTs)[1] and behaviour change methods (BCMs)[2]. The materials consisted of published fatigue, pain and sleep interventions (e.g. [3] and [4]), as well as private-facing clinician notes and public facing resources on self-management from Versus Arthritis and the UK NHS’s CRESTA fatigue clinic.

Results

We found 38 active ingredients from the BCT Taxonomy and the BCM intervention mapping approach frameworks, of which at least 14 were overlapping in function. Importantly we noted that BCTs and BCMs were formulated in various ways pertaining to how the interventions should be delivered (form of delivery-FoD) [5]. Further qualitative analysis revealed 6 themes relating to FoD. The theme Interactivity involved presenting information in ways that would involve the reader in actively responding to it in various ways. The theme Reflection was about engaging the recipient in in-depth consideration of their own experience with symptoms and self-management processes. The theme Validation encompassed all the ways in which the illness and management experience was socialised and normalised to remove stigma and sense of isolation. The theme Treatment Rationale was about providing an a-priory transparent, sound, and compelling justification for the self-management actions required from recipients. The theme Discourse pertained to how information was being communicated, e.g., with language that is warm, simple, assertive, etc. Finally, the theme Approaches was about the therapeutic origins of the active ingredients, e.g. Second and Third Wave CBT. These themes indicate that meaningful therapeutic content is missing from commonly used theoretical frameworks for the development of interventions.

Conclusion

Our findings indicate that meaningful therapeutic content is missing from commonly used theoretical frameworks for the development of interventions.

Interventions should not just include BCTs and methods, but also active ingredients pertaining to how these techniques and methods are delivered, i.e., active ingredients relating to FoD. Reflection deserves particular attention in self-management, as it is unclear empirically in apps what is the most effective way to produce the most useful psychological and behavioural insight, and for whom. FoD is a component of intervention development that requires systematising and the present findings can contribute to such efforts.

References

[1]S. Michie, et al. Annals of Behav Med 2013. 46:1

[2]G. Kok, et al. Health Psych Rev 2016. 10:3

[3]S. Hewlett, et al. Ann. Rheum. Dis 2019. 78: 4.

[4]S. D. Kyle, et al. Sleep Med Rev 2015. 23.

[5]S. U. Dombrowski, et al. Brit. J Health Psych 2016. 21: 4

Acknowledgements

I have no acknowledgments to declare.

Disclosure of Interests

None declared

POS0043-HPR DO COPING STRATEGIES, ILLNESS PERCEPTIONS AND RELATIONSHIP DYNAMICS CONTRIBUTE TO SEXUAL DYSFUNCTION FOR WOMEN WITH SJÖGREN’S SYNDROME?

Background

Women with Sjögren’s syndrome (SS) are more likely to experience vaginal dryness, dyspareunia and reduced sexual function than healthy controls1. There is limited data investigating relationships with psychosocial influences, such as coping mechanisms, illness perceptions, partners behaviours and relationship satisfaction.

Objectives

To investigate associations between sexual function and psychosocial parameters in women with SS.

Methods

Cisgender women aged 18+, diagnosed with SS, were invited to participate in a cross-sectional online survey. Ethical approval and informed consent were obtained. Participants completed the Female Sexual Function Index (FSFI), EULAR Sjӧgren’s Syndrome Patient Reported Index (ESSPRI), NRS scale for vaginal dryness (0-10), Profile of Fatigue and Discomfort (ProFaD), Cognitive Emotion Regulation Questionnaire (CERQ), Brief Illness Perceptions Questionnaire (BIPQ), West-Haven Yale Multidimensional Pain Inventory (WHYMPI – Part II) and Maudsley Marital Questionnaire (MMQ – Marital subscale). Associations between the FSFI and the outcome measures were assessed using Spearman’s correlations. Variables that significantly correlated with FSFI total score were entered into a backward stepwise multiple regression.

Results

The survey was completed by 98 women (M = 48.13, SD = 13.26), 70.4% were diagnosed as having primary SS (disease duration range = 3 – 348 months); 43.8% were premenopausal and 48% were postmenopausal. Vaginal dryness was reported by 92.9% of participants, and sexual dysfunction was identified in 85.2% (n = 69/81) of cases (<26.55). Participants who were not sexually active in the previous three-month period (n = 17) were excluded from analyses as inactivity may cause a low FSFI score which may be incorrectly construed as sexual dysfunction. Reduced sexual function was significantly associated with increases in age, vaginal dryness, mental fatigue (ProFaD), self-blame, rumination and catastrophising (CERQ), consequences and identity (BIPQ), negative partner responses (WHYMPI) and relationship dissatisfaction (MMQ). Reduced sexual function was also significantly associated with decreases in positive reappraisal and perspective (CERQ), personal control (BIPQ), solicitous responses and distracting responses (WHYMPI) (Table 1). No significant associations were found for disease duration, relationship duration or ESSPRI total. Results from regression analyses indicated that vaginal dryness (β = -.278, p = .004), CERQ positive reappraisal (β = .322, p = .003) and CERQ catastrophising (β = -.277, p = .009) were significantly related to sexual function and explained 42.0% of the variance in total FSFI scores (F(3,72) = 17.394, p < .001).

Table 1.

Associations between sexual function and psychosocial parameters

FSFI totalrsp95% CI (LB, UB)Age (years)-.270.015-.467-.049Disease duration (months)-.030.793-.253.196Relationship duration (months)-.180.119-.396.054VAS Vaginal dryness-.350.001-.533-.136ESSPRI total-.165.141-.376.062ProFaD Mental Fatigue-.294.008-.486-.074CERQ Self-Blame-.264.017-.461-.042CERQ Rumination-.296.007-.488-.077CERQ Positive Reappraisal.469.000.273.628CERQ Perspective.341.002.126.525CERQ Catastrophising-.499.000-.651-.310BIPQ Consequences-.237.033-.438-.013BIPQ Personal Control-.288.009-.481-.068BIPQ Identity-.294.008-.487-.075MMQ-.282.013-.483-.054WHYMPI Negative Responses-.252.028-.457-.021WHYMPI Solicitous Responses.267.020.037.470WHYMPI Distracting Responses.311.006.085.506

Note. N = 81. Associations that were not significant are not shown.

Conclusion

Women with SS using positive coping strategies have better sexual function than those with negative coping strategies. Learning positive coping strategies may be an important line of approach for managing sexual dysfunction in SS.

References

[1]Priori R, et al. Quality of sexual life in women with primary Sjögren syndrome. J Rheumatol. 2015;42(8): 1427-31.

Disclosure of Interests

None declared

OP0258-HPR IS THERE A SUBSET OF PATIENTS WITH SJÖGREN’S SYNDROME WHO ARE MORE AT RISK FOR SEXUAL DYSFUNCTION? RESULTS FROM A SCOPING REVIEW

Background:

Individuals with Sjögren’s syndrome (SS) experience significantly higher levels of sexual dysfunction and sexual distress than healthy controls (van Nimwegen et al., 2015). Identifying associated factors may help to identify a subgroup of patients with SS who may benefit from early intervention to maintain sexual wellbeing and avoid unnecessary sexual disruption.

Objectives:

To explore and map the salient symptoms and factors that influence alterations in sexual functioning and intimate relationships for people with SS.

Methods:

The protocol for this review was registered with the Open Science Framework prior to commencement of the searches. The peer-reviewed search strings were used to search the following databases from inception to June 2019: Cochrane Library, CINAHL [EBSCO], MEDLINE [ProQuest], PUBMED [MEDLINE], ScienceDirect, Scopus and Web of Science. Grey literature was searched for on academic databases, topic-specific repositories, and Google Scholar. Databases were searched using key terms corresponding to sexual functioning and intimate relationships. Studies were included if their participant sample was comprised of adults aged ≥18 years, with a diagnosis of primary or secondary SS. Studies were not excluded based on source type, methodology or design. To qualify for inclusion, studies needed to have been peer-reviewed and available in English. Retrieved articles were then screened against the inclusion/exclusion criteria by two reviewers. Hand-searching was conducted on the reference lists of included articles, as well as the three most prevalent publishing journals until saturation had been achieved.

Results:

The search strategy returned 3527 unique citations. After screening processes were completed, only 19 articles met the inclusion criteria. Studies were predominately conducted in European countries (79%), within the last decade (68%; 2010-2019), and were mainly quantitative (n = 17; 89.5%), case-controlled (88.3%), and cross-sectional (100%) in nature. In total there were 1281 patients, 47% (n = 605) were patients with primary SS and the remaining 53% (n = 676) were patients with secondary SS. Both patient groups were predominately comprised of females (n = 600; 99% and n = 673; 99.5%, respectively), with a combined mean age of 50.82 years (M ranges = 35 – 62.82 years). An amalgamation of results from 17 studies, found that women with SS who score higher on the ESSPRI scale (total score and the subdomains of pain, fatigue and dryness) were more likely to experience significantly greater levels of vaginal dryness, sexual dysfunction and sexual distress. Moreover, women with SS who present with clinical levels of anxiety or depression were also more likely to experience disruptions in their sexual functioning and appraise their sexual life more negatively. Furthermore, patients who report greater severity of oral or ocular dryness, or dyspareunia may experience vaginal dryness, which may have ramifications on sexual functioning. Women of all ages are at risk of experiencing sexual dysfunctions, however, younger women (≤50 years) may experience more burdensome disruptions than older women. Finally, women who do not use lubrication products during sexual activity may be impacted further.

Figure 1.

Factors significantly associated with sexual dysfunction and sexual distress for patients with SS.

Conclusion:

Younger women (≤50) with SS who present with more severe symptoms of fatigue, pain, and oral or ocular dryness, or with clinical levels of anxiety or depression, may be at increased risk of experiencing sexual dysfunction and sexual distress. Healthcare professionals should be aware of these potential risk factors and initiate conversations around sexuality as and when a potentially ‘at risk’ individual is identified.

References:

[1]van Nimwegen, J. F., Arends, S., van Zuiden, G. S., Vissink, A., Kroese, F. G. M., & Bootsma, H. (2015). The impact of primary Sjögren’s syndrome on female sexual function. Rheumatology, 54(7), 1286-1293.

Disclosure of Interests:

None declared

SAT0633-HPR AN EXPLORATION INTO THE CONVERSATIONS AROUND SEXUAL FUNCTIONING THAT MALES WITH SJÖGREN’S SYNDROME HAVE ON AN INTERNET FORUM

Background:

Sjögren’s Syndrome (SS) is an autoimmune rheumatic disease that targets secretion glands throughout the body, causing symptoms of oral, ocular and genital dryness (van de Merwe, 2010). A small body of literature has investigated the impact of SS on women’s sexual functioning, however, no research currently exists that has explored this topic in males with SS. Gathering a snapshot of issues may prove difficult given the sensitivity of the topic. Therefore, data must be gathered from sources where individuals may have the confidence to talk openly. Research has shown that many patient groups turn to internet forums to discuss sensitive issues under the cloak of anonymity (White & Dorman, 2001). Analysing this source of data allows us to explore the conversations pertaining to sexual functioning that males with SS may not feel comfortable discussing in a traditional qualitative setting, and may be instrumental in guiding future intervention strategies.

Objectives:

To explore the conversations around sexual functioning that male users with SS have on an internet forum.

Methods:

A large publicly accessible internet forum that individuals with a diagnosis of SS used to discuss issues and share experiences with other users was selected. Thread names and post content were scraped using a web scraping tool, and posts identified as containing relevant keywords were exported into Excel. Braun & Clarke’s (2006) thematic analysis was used to analyse post content.

Results:

A total of 78 posts were identified as being pertinent to the topic of male sexual functioning. Conversations were predominately centred on symptom presence in the reproductive organs. Forum users discussed having fluctuating pain in the testicles, scrotum, groin, anus, and rectum. They also reported experiencing feelings of dryness at the base of the penis, around the testicles, under the foreskin, around the glans of the penis and in the anus. Discussions were also had about changes in the volume and consistency of seminal fluid released either prior to or during ejaculation. Another conversation theme revolved around how the symptoms they experienced affected their ability to engage in sexual intercourse. Forum users discussed how pain and dryness made sexual intercourse painful, resulting in them withdrawing from sexual activity indefinitely. Discussions were also had about the lack of information available to help understand and manage sexual dysfunction. Forum users discussed how feelings of embarrassment about the nature of the symptoms and the stigma of it being “a woman’s disease” kept them from seeking medical assistance. Those who had sought medical assistance shared their belief that health professionals (HPs) were misdiagnosing their symptoms and were prescribing ineffective treatments. They also reported that their HPs were dismissive of symptoms and unwilling to assist further.

Conclusion:

Utilising conversations from an internet forum was an effective method to use to gain insight into some of the issues that males with SS experience with sexual functioning. The absence of accessible information and lack of support from HPs for males with SS is hinted at in this research. Future research should focus on identifying issues surrounding male sexual functioning as this will both guide future intervention strategies and allow HPs to publish material to better support males with SS.

References:

[1]Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology.Qualitative Research in Psychology, 3(2), 77-101.

[2]van de Merwe, J. P. (2010).Sjögren’s Syndrome: Information for patients and professionals.Rotterdam: Erasmus MC.

[3]White, M., & Dorman, S. M. (2001). Receiving social support online: Implications for health education.Health Education Research, 16(6), 693-707.

Disclosure of Interests:

None declared

Altered eating: a definition and framework for assessment and intervention

Background

Eating can be a significant challenge for cancer survivors; however, to date there is no systematic way of assessing and addressing food related quality of life in this group. The purpose of our study was to develop a framework for doing so.

Methods

Over the course of 6 years in participant-led food workshops, we worked alongside 25 head and neck cancer (HNC) survivors and their partners, employing video-reflexive ethnographic (VRE) methods. The current study reports on data from the two summative workshops of this series where we worked with participants to cohere the emergent themes. Video and transcripts were reviewed and coded with participants and stakeholders according to domains of life that were affected by food. Three of the authors, one of whom is both survivor and researcher, arrived at the consensus framework.

Results

Seven areas of life were identified as affecting, or being affected by, altered eating. Three were physiological: anatomical, functional and sensory. Two captured the cognitive and behavioural labour of eating. Social life and identity were altered. The foregoing had an enduring emotional impact.

Conclusions

Altered eating has physical, emotional and social consequences. The altered eating framework provides a systematic way of exploring those consequences with individual survivors. This framework has the potential to improve both the assessment and treatment of altered eating, to benefit food-related quality of life.

Genetic contributions to self-reported tiredness

Self-reported tiredness and low energy, often called fatigue, are associated with poorer physical and mental health. Twin studies have indicated that this has a heritability between 6 and 50%. In the UK Biobank sample (N=108 976), we carried out a genome-wide association study (GWAS) of responses to the question, 'Over the last two weeks, how often have you felt tired or had little energy?' Univariate GCTA-GREML found that the proportion of variance explained by all common single-nucleotide polymorphisms for this tiredness question was 8.4% (s.e.=0.6%). GWAS identified one genome-wide significant hit (Affymetrix id 1:64178756_C_T; P=1.36 × 10-11). Linkage disequilibrium score regression and polygenic profile score analyses were used to test for shared genetic aetiology between tiredness and up to 29 physical and mental health traits from GWAS consortia. Significant genetic correlations were identified between tiredness and body mass index (BMI), C-reactive protein, high-density lipoprotein (HDL) cholesterol, forced expiratory volume, grip strength, HbA1c, longevity, obesity, self-rated health, smoking status, triglycerides, type 2 diabetes, waist-hip ratio, attention deficit hyperactivity disorder, bipolar disorder, major depressive disorder, neuroticism, schizophrenia and verbal-numerical reasoning (absolute rg effect sizes between 0.02 and 0.78). Significant associations were identified between tiredness phenotypic scores and polygenic profile scores for BMI, HDL cholesterol, low-density lipoprotein cholesterol, coronary artery disease, C-reactive protein, HbA1c, height, obesity, smoking status, triglycerides, type 2 diabetes, waist-hip ratio, childhood cognitive ability, neuroticism, bipolar disorder, major depressive disorder and schizophrenia (standardised β's had absolute values<0.03). These results suggest that tiredness is a partly heritable, heterogeneous and complex phenomenon that is phenotypically and genetically associated with affective, cognitive, personality and physiological processes.

Feasibility and acceptability of combining cognitive behavioural therapy techniques with swallowing therapy in head and neck cancer dysphagia

BACKGROUND

Head and neck cancer squamous cell carcinoma (HNSSC) patients report substantial rates of clinically significant depression and/or anxiety, with dysphagia being a predictor of distress and poorer quality of life. Evidence-based dysphagia interventions largely focus on the remediation of physical impairment. This feasibility study evaluates an intervention which simultaneously uses a psychological therapy approach combined with swallowing impairment rehabilitation.

METHODS

This prospective single cohort mixed-methods study, recruited HNSCC patients with dysphagia, from two institutions. The intervention combined Cognitive Behavioural Therapy with swallowing therapy (CB-EST), was individually tailored, for up to 10 sessions and delivered by a speech and language therapist. Primary acceptability and feasibility measures included recruitment and retention rates, data completion, intervention fidelity and the responsiveness of candidate outcome measures. Measures included a swallowing questionnaire (MDADI), EORTC-QLQH&N35, dietary restrictions scale, fatigue and function scales and the Hospital Anxiety and Depression Scale (HADS), administered pre-, post-CB-EST with three month follow-up and analysed using repeated measures ANOVA. Qualitative interviews were conducted to evaluate intervention processes.

RESULTS

A total of 30/43 (70%) eligible patients agreed to participate and 25 completed the intervention. 84% were male, mean age 59 yrs. Patients were between 1 and 60 months (median 4) post-cancer treatment. All patients had advanced stage disease, treated with surgery and radiotherapy (38%) or primary chemoradiotherapy (62%). Pre to post CB-EST data showed improvements in MDADI scores (p = 0.002), EORTC-QLQH&N35 (p = 0.006), dietary scale (p < 0.0001), fatigue (p = 0.002) but no change in function scales or HADS. Barriers to recruitment were the ability to attend regular appointments and patient suitability or openness to a psychological-based intervention.

CONCLUSIONS

CB-EST is a complex and novel intervention, addressing the emotional, behavioural and cognitive components of dysphagia alongside physical impairment. Preliminary results are promising. Further research is required to evaluate efficacy and effectiveness.

General illness and psychological factors in patients with chronic nasal symptoms

OBJECTIVES

Only a minority of patients referred to specialists with sinonasal symptoms have clear evidence of chronic rhinosinusitis (CRS). This study aims to estimate the prevalence of and associations between (i) general illness factors (fatigue, autonomic dysfunction) and (ii) psychological factors (anxiety, depression, somatisation, personality traits) in patients presenting with sinonasal symptoms.

DESIGN

The following validated questionnaires were administered to patients: the Sino-Nasal Outcome Test-22 (SNOT-22) identifying symptom burden, Composite Autonomic Symptom Score-31 (COMPASS-31) measuring autonomic function, Chalder Fatigue Questionnaire, Patient Health Questionnaire-15 (PHQ-15) addressing somatisation symptoms, Hospital Anxiety and Depression Scale (HADS), and the International Personality Item Pool-50 (IPIP-50). Comparisons were made with normative and general population data, and relationships were analysed using nonparametric correlation.

SETTING

Secondary care ENT outpatients.

PARTICIPANTS

Adults referred with chronic sinonasal symptoms.

MAIN OUTCOME MEASURES

SNOT-22, COMPASS-31, Chalder, PHQ-15, HADS, and IPIP-50 questionnaire scores.

RESULTS

Sixty-one patients were included. There was a high prevalence of all general and psychological factors assessed compared with controls. Total SNOT-22 scores showed significant correlation with Chalder fatigue scores, total autonomic dysfunction score, anxiety, depression, somatisation tendencies and the emotionally unstable personality trait. Emotional instability and psychological dysfunction correlated significantly with sleep and psychological subscales of SNOT-22 but not the rhinological or ear/facial subscales.

CONCLUSION

Patients with sinonasal symptoms demonstrate high prevalence and complex associations of general illness factors, psychological distress and certain personality traits. The SNOT-22 is a valuable tool, but its utility is limited by correlations with these confounding factors (eg psychological factors) that may exaggerate the total score. The use of the SNOT-22 component subscales is likely to provide more clinically meaningful and discriminant information.

Family-focused cognitive behaviour therapy versus psycho-education for chronic fatigue syndrome in 11- to 18-year-olds: a randomized controlled treatment trial

BACKGROUND

Only one previous randomized controlled trial (RCT) has examined the efficacy of cognitive behaviour therapy (CBT) for chronic fatigue syndrome (CFS) in children. The aim of this study was to compare family-focused CBT with psycho-education for CFS in adolescents.

METHOD

Sixty-three 11- to 18-year-olds (43 girls, 20 boys) with CFS were randomly assigned to either family-focused CBT or psycho-education delivered over 6 months. School attendance was the main outcome, which was assessed at the end of treatment and at 3, 6 and 12 months follow-up.

RESULTS

At the main outcome point (the 6-month follow-up) both groups had improved similarly. However, although those who received family-focused CBT were attending school for longer than those who received psycho-education, at discharge from treatment and at 3 months follow-up, they improved less quickly across the follow-up period.

CONCLUSIONS

Adolescents with CFS get back to school more quickly after family-focused CBT. This is important as they are at a crucial stage of their development. However, the finding that psycho-education was as effective as family-focused CBT at 6 and 12 months follow-up has important implications for health service delivery.

The cognitive behavioural model of medically unexplained symptoms: A theoretical and empirical review

The article is a narrative review of the theoretical standing and empirical evidence for the cognitive behavioural model of medically unexplained symptoms (MUS) in general and for chronic fatigue syndrome (CFS) and irritable bowel syndrome (IBS) in particular. A literature search of Medline and Psychinfo from 1966 to the present day was conducted using MUS and related terms as search terms. All relevant articles were reviewed. The search was then limited in stages, by cognitive behavioural therapy (CBT), condition, treatment and type of trial. Evidence was found for genetic, neurological, psychophysiological, immunological, personality, attentional, attributional, affective, behavioural, social and inter-personal factors in the onset and maintenance of MUS. The evidence for the contribution of individual factors, and their autopoietic interaction in MUS (as hypothesised by the cognitive behavioural model) is examined. The evidence from the treatment trials of cognitive behavioural therapy for MUS, CFS and IBS is reviewed as an experimental test of the cognitive behavioural models. We conclude that a broadly conceptualized cognitive behavioural model of MUS suggests a novel and plausible mechanism of symptom generation and has heuristic value. We offer suggestions for further research.

Family cognitive behaviour therapy for chronic fatigue syndrome: an uncontrolled study

AIM

To examine the efficacy of family focused cognitive behaviour therapy for 11-18 year olds with chronic fatigue syndrome.

METHODS

Twenty three patients were offered family focused cognitive behaviour therapy. The main outcome was a fatigue score of less than 4 and attendance at school 75% of the time.

RESULTS

Twenty patients completed treatment. Eighteen had completed all measures at six months follow up; 15 of these (83%) improved according to our predetermined criterion. Substantial improvements in social adjustment, depression, and fear were noted.

CONCLUSIONS

Family focused cognitive behaviour therapy was effective in improving functioning and reducing fatigue in 11-18 year olds. Gains were maintained at six months follow up.