Background There is a lack of evidence based interventions available to help people with rheumatoid arthritis (RA) manage symptoms of fatigue. For such interventions to be successful they should meet the aspirations of patients and appropriate health professionals, and be based on sound learning principles. We designed a physical activity (PA) self-management intervention for managing fatigue based on preferences expressed by RA patients and professionals, informed by a theoretical framework for health behaviour change1.
Objectives To explore acceptability of the intervention format, content and support materials to the study population
Methods The intervention consisted of seven group sessions delivered by a physiotherapist and an assistant over 12 weeks. Each session consisted of a one hour education and discussion session followed by a 30 to 40 minute practical PA session. One group of RA patients who experienced fatigue were recruited from a specialist rheumatology department in the United Kingdom and undertook the intervention. Their experience of and opinions about the intervention was evaluated using a questionnaire designed for the study that included open and closed questions. Likert scales (0-10, higher scores represent greater acceptability) were used to rate intervention components (overall satisfaction, usefulness of education and practical sessions, helpfulness of handouts, recommendation to other patients). Data were analysed using descriptive statistics and qualitative content analysis.
Results Nine RA patients (8 female) were recruited (age range: 38 to 75 years (mean: 58.3); disease duration: 4 months to 12 years (mean: 4.9 years); Bristol Rheumatoid Arthritis Fatigue Numeric Rating Scale for severity (possible range 0-10): 6 to 9 (mean: 7.2)). Eight patients completed the intervention (mean attendance: 6.5 sessions). Overall feedback was positive. Mean Likert scores ranged from 8.9 to 10.
Qualitative feedback suggested that the group format and peer support were central to improving motivation and self-management skills. All discussion topics, including pacing, goal setting and managing setbacks were helpful; practical sessions boosted confidence in selecting and undertaking PA, and provided ideas for home exercise. Support materials such as activity diaries and pedometers were considered useful for self-monitoring and motivation, and handouts were valuable for future reference.
Suggested improvements to the programme included a longer course, a 6 month follow-up session to review progress and ongoing support. (It was not specified if this meant peer or professional support or both.)
Conclusions The format and content of this carefully designed PA self-management intervention and its associated support materials were acceptable to group participants in the UK. This intervention should now be considered for further evaluation in a pilot study prior to full scale testing in a randomised controlled trial.
Michie, S., van Stralen, M.M. and West, R. (2011). The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implementation Science 6:42
Acknowledgements This work was supported by University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Disclosure of Interest None declared