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THU0563 “I Definitely would Recommend It…I Think It’s been Quite Amazing Really”: Experiences of an Upper Limb Education, Self-Management, and Exercise Training Programme (The Extra Programme) Among People with Early Rheumatoid Arthritis
  1. V. L. Manning1,2,
  2. M. V. Hurley3,
  3. D. L. Scott4,
  4. E. Choy5,
  5. L. M. Bearne1
  1. 1Deaprtment of Health and Social Care Research, King’s College London
  2. 2Department of Surgery, Imperial College London
  3. 3Faculty of Health and Social Care, St. George’s University of London and Kingston University
  4. 4School of Medicine, King’s College London, London
  5. 5Cardiff Institute of Infection and Immunity, Cardiff University, Cardiff, United Kingdom


Background Exercise is a complex, burdensome health behaviour, and non-adherence is common. To be effective, interventions need to be socially, educationally, and culturally appropriate, and accommodate the strengths and skills of the target population [1]. A global upper limb Education, self-management, and eXercise Training programme for people with early Rheumatoid Arthritis (RA) (the EXTRA programme) which incorporates an upper limb home exercise regimen supplemented with 4 supervised group education, self-management and exercise sessions improves upper limb disability, function, and strength.

Objectives This qualitative study evaluates participants’ experiences of the EXTRA programme.

Methods 12 participants who completed the EXTRA programme were purposively selected for age (range 32 to 87 years), upper limb disability (range 8 to 70 ‘Disabilities of the Arm, Shoulder, and Hand Questionnaire’), and arthritis self-efficacy (range 96 to 272 ‘Arthritis Self-Efficacy Scale’). Participants completed semi-structured interviews conducted by a single moderator according to a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were read, coded, analysed and themes generated, using interpretive phenomenological analysis.

Results Five superordinate themes reflecting participants’ experiences of the EXTRA programme were identified: 1) The EXTRA programme improves disease status and provides a self-management strategy, 2) Individual needs and lifestyle factors influence acceptability, 3) Others facilitate learning, confidence, and enjoyment, 4) Seminars and written materials increase knowledge and autonomy, and 5) Socio-environmental, self-regulatory, and self-belief factors influence uptake and maintenance. Participants perceived that the programme improved their function, health, and disease status, and provided them with an effective self-management strategy. Individual needs and lifestyle factors, such as disability and employment status, influenced the acceptability of the programme. Support and guidance received from the physiotherapist, group members, and significant others were integral to participants’ learning, confidence, and overall satisfaction with the programme. Seminars supported by written materials increased participants’ knowledge of exercise and self-management, and facilitated autonomy. Socio-environmental factors (e.g. loyalty toward the physiotherapist, competing responsibilities), self-regulatory factors (e.g. the adaptability of the regimen, exercise diary), and self-perceptions (e.g. disease status, need, ability) altered participants’ uptake and maintenance of the EXTRA programme.

Conclusions The EXTRA programme was an acceptable, positive experience for people with early RA.


  1. Abraham C., Kelly M. P., West R., et al. The U.K National Institute for Health and Clinical Excellence Public Health Guidance on Behaviour Change: A Brief Introduction. Psychology, Health & Medicine 2008; 14: 1-8.

Disclosure of Interest None Declared

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