Effects of Person-Centered Physical Therapy on Fatigue-Related Variables in Persons With Rheumatoid Arthritis: A Randomized Controlled Trial

  • Caroline Feldthusen
    Correspondence
    Corresponding author Caroline Feldthusen, PhD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 480, S-405 30 Gothenburg, Sweden.
    Affiliations
    Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    The University of Gothenburg Centre for Person-centred Care, Gothenburg, Sweden
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  • Elizabeth Dean
    Affiliations
    Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
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  • Helena Forsblad-d’Elia
    Affiliations
    Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
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  • Kaisa Mannerkorpi
    Affiliations
    The University of Gothenburg Centre for Person-centred Care, Gothenburg, Sweden

    Section of Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Published:October 16, 2015DOI:https://doi.org/10.1016/j.apmr.2015.09.022

      Abstract

      Objective

      To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA).

      Design

      Randomized controlled trial.

      Setting

      Hospital outpatient rheumatology clinic.

      Participants

      Persons with RA aged 20 to 65 years (N=70): intervention group (n=36) and reference group (n=34).

      Interventions

      The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist and tailored health-enhancing physical activity and balancing life activities. The reference group continued with regular activities; both groups received usual health care.

      Main Outcome Measures

      Primary outcome was general fatigue (visual analog scale). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire) and fatigue-related variables (ie, disease, health, function).

      Results

      At posttest, general fatigue improved more in the intervention group than the reference group ( P=.042). Improvement in median general fatigue reached minimal clinically important differences between and within groups at posttest and follow-up. Improvement was also observed for anxiety ( P=.0099), and trends toward improvements were observed for most multidimensional aspects of fatigue ( P=.023–.048), leg strength/endurance ( P=.024), and physical activity ( P=.023). Compared with the reference group at follow-up, the intervention group improvement was observed for leg strength/endurance ( P=.001), and the trends toward improvements persisted for physical ( P=.041) and living-related ( P=.031) aspects of fatigue, physical activity ( P=.019), anxiety ( P=.015), self-rated health ( P=.010), and self-efficacy ( P=.046).

      Conclusions

      Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities showed significant benefits on fatigue in persons with RA.

      Keywords

      List of abbreviations:

      BRAF-MDQ ( Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire), DAS-28 ( disease activity score), HADS ( Hospital Anxiety and Depression Scale), RA ( rheumatoid arthritis), VAS ( visual analog scale)
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