Rheumatology Rehabilitation Research Articles

Feasibility test of WORK-ON: a vocational rehabilitation intervention for people with chronic inflammatory arthritis

BackgroundPeople with chronic inflammatory arthritis (IA) often have a reduced work ability. Consequently, they are at high risk of losing their jobs and being permanently excluded from the labor market. Therefore, we developed a new context-specific vocational rehabilitation intervention for people with IA based on the Medical Research Council’s framework for complex interventions. This intervention is called “WORK-ON” and consists of: (1) Initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation; (2) coordinated support from the same occupational therapist, including assistance in navigating the primary and secondary healthcare and social care systems; (3) group sessions for peer support; and (4) individually tailored consultations with physiotherapists, nurses, and/or social workers. This study investigates the feasibility of WORK-ON.MethodsA 6-month single-arm feasibility study with a pre-test post-test design was conducted to evaluate recruitment, intervention fidelity and delivery, data collection, and possible outcome measures. Work ability was the primary outcome, and sick leave, quality of life, fatigue, pain, physical activity, sleep, and well-being were the secondary outcomes evaluated.ResultsIn total, 19 participants (17 women and 2 men) with a median age of 55 years (range, 34–64) participated and completed WORK-ON. Of these, 17 participants completed patient-reported outcomes at baseline and follow-up, and the results indicated a tendency to improvement in work ability, quality of life, level of physical activity, decrease in pain, and increase in days of sick leave during the 6-month intervention period. The rehabilitation clinicians spent an average of 15.3 h per participant, and the participants spent an average of 13.5 h in the intervention.ConclusionsWORK-ON is considered feasible and has the potential to increase work ability among people with IA who are concerned about their future ability to keep working. Though, an adjustment of the intervention is needed before testing in a randomized controlled trial.

A joint venture: patients’ experiences with goal setting in rheumatology rehabilitation – a qualitative study

Purpose To explore how patients with rheumatic musculoskeletal diseases (RMDs) perceive participation in the goal setting process prior to interdisciplinary rehabilitation. Methods We conducted semi-structured interviews with 22 participants admitted to an interdisciplinary rehabilitation stay for patients with RMDs at two Danish rehabilitation centres. Qualitative content analysis was applied. Results The participants perceived goal setting as a joint venture between two parties: the health professionals and the participant. Three categories were formed, which described both facilitators and barriers in the process. Responsibility for goal setting described the importance of shared responsibility, or health professionals as experts, taking full responsibility for goal setting. Equipped for goal setting included perceptions of being well prepared for the process, or considerations that goal setting was difficult because of a lack of information. An equal member of the team entailed both the feeling of being recognised as one in the team, or feeling like an outsider. Conclusion Goal setting is perceived as a challenge by some patients. Participation in goal setting depends on both the capacity and the opportunity to participate which are factors linked to patients’ level of health literacy.

Examining the Building Blocks of Health Behavior Change in Rheumatology Rehabilitation: A Theory-Driven Qualitative Study.

To identify and describe behavior change techniques (BCTs) used in rehabilitation for patients with rheumatic and musculoskeletal diseases (RMDs), according to their own perceptions. Further, to examine patients' descriptions of their capability, opportunity, motivation, and readiness for health behavior change. Patients were adults in need of specialized, multidisciplinary rehabilitation services due to inflammatory rheumatic disease, systemic connective tissue disease, or fibromyalgia / chronic widespread pain. Semi-structured interviews of 21 patients were analyzed with deductive qualitative content analysis applying three theoretical frameworks: the Behavior Change Technique Taxonomy, the transtheoretical model and stages of change, and the capability, opportunity, and motivation model of behavior. Forty-six BCTs aggregated within 14 BCT groups were identified used by either patients, healthcare professionals (HPs), or both. Goals and planning, feedback and monitoring, social support, shaping knowledge, repetition and substitution were most frequently used to facilitate behavior change. Twenty patients had reached the action stage and made specific lifestyle changes concerning more than half of their goals. Concerning other goals, 6 of these patients reported to be contemplating behavior change and 15 to be preparing for it. The rehabilitation process appeared to strengthen capability, opportunity, motivation, and the desired behaviors. Patient-reported barriers to behavior change were connected with restrictions in physical capability resulting from an unpredictable and fluctuating disease course, weakened motivation, and contextual factors, such as lack of access to healthcare support and training facilities, and high domestic care burden. The rehabilitation process seemed to strengthen individual and contextual prerequisites for behavior change and facilitate the use of required techniques and engagement in the desired behaviors. However, patients with RMDs may need prolonged support from HPs to integrate healthy lifestyle changes into everyday life. The findings can be used to optimize rehabilitation interventions and patients' persistent engagement in healthy behaviors.

A Lifestyle Management for Arthritis Group education intervention for people with inflammatory and degenerative arthritis: An observational study.

Occupational therapy self-management groups aim to assist individuals to incorporate health-promoting behaviours and management strategies into their daily routines to promote wellbeing. The Lifestyle Management for Arthritis Group (LMAG) is a 2-h-long, occupational therapy educational-behavioural group intervention adapted from the evidence-based Lifestyle Management for Arthritis Programme (Hammond & Rayner,2013) and was delivered to inpatients with inflammatory and degenerative arthritis separately. The aim of this study was to evaluate the effectiveness of this intervention in an inpatient Rheumatology Rehabilitation setting. This was an observational study with a pretest-posttest design using multiple methods. A knowledge of joint protection survey was gathered at three intervals. In-depth semi-structured phone interviews were undertaken 6weeks post intervention. The quantitative data was analysed using IBM SPSS version 25, whilst thematic analysis was used to analyse the interviews. The results confirmed that the 36 participants who completed the study had increased joint protection knowledge immediately after LMAG and continued to retain that knowledge 6weeks post intervention. The majority of participants evaluated the intervention as excellent whilst empowerment emerged as the core concept from the qualitative analysis. These study findings suggest that the LMAG intervention can have a beneficial effect inimproving the self-management skills and confidence levels of patients with inflammatory and degenerative arthritis.

The effect of an integrated multidisciplinary rehabilitation programme for patients with chronic low back pain: Long-term follow up of a randomised controlled trial

Objective: To compare the long-term effectiveness of an integrated rehabilitation programme with an existing rehabilitation programme, in terms of back-specific disability, in patients with chronic low back pain. Design: A single-centre, pragmatic, two-arm parallel, randomised controlled trial. Setting: A rheumatology rehabilitation centre in Denmark. Subjects: A total of 165 adults (aged ⩾ 18 years) with chronic low back pain. Interventions: An integrated programme (a pre-admission day, two weeks at home, two weeks inpatient followed by home-based activities, plus two 2-day inpatient booster sessions, and six-month follow-up visit) was compared with an existing programme (four-week inpatient, and six-month follow-up visit). Main measure: The primary outcome was disability measured using the Oswestry Disability Index after one year. Secondary outcomes included pain intensity (Numerical Rating Scale), pain self-efficacy (Pain Self-Efficacy Questionnaire), health-related quality of life (EuroQol-5 Domain 5-level (EQ-5D)), and depression (Major Depression Inventory). Analysis was by intention-to-treat, using linear mixed models. Results: 303 patients were assessed for eligibility of whom 165 patients (mean age 50 years (SD 13) with a mean Oswestry Disability Index score of 42 (SD 11)) were randomly allocated (1:1 ratio) to the integrated programme (n = 82) or the existing programme (n = 83). The mean difference (integrated programme minus existing programme) in disability was –0.53 (95% CI –4.08 to 3.02); p = 0.770). No statistically significant differences were found in the secondary outcomes. Conclusion: The integrated programme was not more effective in reducing long-term disability in patients with chronic low back pain than the existing programme.

Patients' experiences with goal pursuit after discharge from rheumatology rehabilitation: A qualitative study.

To explore rehabilitation goals and experiences with goal striving in patients with rheumatic diseases after rehabilitation discharge. Thirty-three patients with rheumatic diseases participated in goal-setting conversations with healthcare professionals during a 1-week rehabilitation programme. After discharge, they received four follow-up phone calls over a period of 5 months to support individual goal striving and self-management. A qualitative thematic analysis was conducted of the patients' rehabilitation goals, action plans and their statements about their experiences pursuing their goals at home after discharge. Analysis revealed that the experiences were related to five overarching themes: (1) things take time, (2) the importance of changing ways of thinking, (3) the pieces fall into place, (4) own health = own responsibility and (5) events outside of the plan. At discharge, the participants had set between one and five long-term goals, focussing mainly on having a healthier lifestyle and a better quality of life. The study showed that, to a large extent, the participants employed different self-management strategies after discharge from rehabilitation. In addition, the findings demonstrated that they experienced certain challenges when pursuing their goals. These challenges were related to health problems and changes in routine, such as holidays. Health professionals should explain to participants who pursue their own rehabilitation goals after discharge that changes in habit require conscious decision-making, priority setting and time, as well as the importance of having alternative plans for holidays and periods of disease exacerbations.

Interprofessional collaboration in rheumatology rehabilitation – the clash between ideology and practice

Interprofessional collaboration in rheumatology rehabilitation – the clash between ideology and practice

Rehabilitation in rheumatology: for young and old

Rehabilitation in rheumatology: for young and old

Long term type 1 diabetes is associated with hand pain but not with structural hand osteoarthritis features – The Dialong hand study

s / Osteoarthritis and Cartilage 24 (2016) S63eS534 S209 started with an initial cohort of people with a diagnosis of OA (ICD 9 code 715) who were treated within the VHA system between January 1, 2000 and December 31, 2014. We further classified the cohort, focusing on OA of the knee and hip. For knee OA, we included people with a diagnosis of OA (ICD 9 code 715), who were at least 50 years old, and who had been treated at least once for knee pain (ICD 9 code 719.46). For hip OA, we included people with a diagnosis of OA (ICD 9 code 715), who never had an erythrocyte sedimentation rate of 20 or above, and who had been treated at least once for hip pain (ICD 9 code 719.45). We validated the cohort through a manual review of 40 charts, with half of the charts randomly selected from the identified OA cohort, and half of the charts randomly selected from among those excluded from the cohort. Results: A total of 12,064,025 clinical records were available for this research. The OA identified cohort included 1,147,535 patients, of which 1,073,169 (94%) were male. The median age was 56 (interquartile range 51e68). There were 755,010 (66%) Caucasian, 177,745 (16%) African American, 51,826 (4%) Hispanic, 4,822 (<1%) Asian, and 158,132 (14%) of unknown race/ethnicity. Within the cohort, 11,976 had a history of a lower joint replacement (1%). Our manual review of the cohort included 20 true positives, 13 true negatives, 7 false negatives, and no false positives, resulting in a sensitivity of 74% and specificity of 100%. Between the years 2000 and 2014, the cohort accounted for 5,980,233 primary care visits, 884,882 rheumatology clinic visits, and 4,649,522 emergency medical visits within the VHA system. The top five ICD 9 codes for all clinic and emergency medical visits were hypertension (719,558 visits), hyperlipidemia (372,900 visits), diabetes (348,787 visits), lower back pain (222,397 visits), and joint pain (211,739 visits). Most patients in the cohort received prescriptions for NSAIDs (919,469, 79%), acetaminophen (874,721, 76%), and opiates (829,063, 72%). Less than half of the cohort received prescriptions for neuropathic pain medication (478,462, 42%), tramadol (431,338, 38%), and muscle relaxants (355,325, 31%). Over-the-counter use of acetaminophen and NSAIDs was not ascertainable. Conclusions: This demonstration project illustrates the feasibility of using a big data approach to select a large cohort of OA patients. This approach could improve our understanding of OA and holds promise for understanding OA subphenotypes, development of personalized treatment strategies for OA and facilitation of OA clinical trials. The next steps include combining clinical analytics with available genomic data as well as further validating this work with other datasets that include more females and other demographic diversity. 354 LONG TERM TYPE 1 DIABETES IS ASSOCIATED WITH HAND PAIN BUT NOT WITH STRUCTURAL HAND OSTEOARTHRITIS FEATURES e THE DIALONG HAND STUDY K. Magnusson y, N.G. Juel z, J.I. Brox zx, K. Holte k, K.B. Hagen yx, I.K. Haugen ¶, T. Julsrud Berg xk. yDept. of Rheumatology, Diakonhjemmet Hosp., Natl. Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway; zDept. of Physical Med. and Rehabilitation, Oslo Univ. Hosp., Oslo, Norway; xUniv. of Oslo, Oslo, Norway; kDept. of Endocrinology, Oslo Univ. Hosp., Oslo, Norway; Dept. of Rheumatology, Diakonhjemmet Hosp., Oslo, Norway Purpose: Previous studies have shown an association between diabetes and hand osteoarthritis (OA). However, these studies have not Associations between type 1 diabetes and radiographic hand OA, hand pain, function

Hypnosis and physiotherapy

Summary Hypnotherapy is now a validated evidence-based science, demonstrated on brain imaging, especially thanks to modern techniques of medical imaging. Imaging studies further enabled the hypnotic state to be described as a specific state of consciousness, differentiating it from other states of consciousness. This state of consciousness is primarily characterized by a state of mental permeability or suggestibility, showing an increased ability to produce desirable changes in motivation, habits, lifestyle, health, perception and behavior as well as modifying physical sensation. Its usefulness is interesting for physiotherapists since hypnosis has higher levels of evidence than many other conventional tools used in physiotherapy. The basic techniques of hypnosis are: the interview which seeks to put the patient at ease, eliminating all preconceived misconceptions about hypnosis and creating treatment expectations that are as positive as possible; suggestion which is the most powerful technique in hypnosis: direct suggestion, indirect suggestion, post-hypnotic suggestion, and self-suggestion; induction which is the process of transition from the usual waking state to the hypnotic state; visualization which consists in a virtual experience of a specific event proposed by the therapist. It is often used by physiotherapists in traumatologic, rheumatologic and neurologic rehabilitation, where efficacy is improved by hypnosis. Hypnosis affects the subconscious, which is the center of emotions, habits and automatisms. The subconscious transmits commands to the unconscious mind, which in return translates these emotions into somatic feelings and reactions. In parallel, the neurophysiology of hypnotic suggestion is currently well-defined, as is the brain permeability associated with increased regional cerebral blood flow in the attentional system of the brain. Furthermore, positive expectation and labeling of “hypnosis” seem to have remarkable effects on the efficacy of the procedure. Clinical randomized controlled studies have shown efficacy on pain in general, tension headache and migraine, temporomandibular pain, chronic low back pain, osteoarthritis and bone and joint pain, fibromyalgia, regional pain syndrome, phantom limb pain, sports rehabilitation, irritable bowl syndrome, stress and anxiety, and many other pathologies. Hypnosis is a powerful and very useful tool in everyday physiotherapy. Level of evidence NA.

Empowerment by patient education in rheumatology

Due to the chronic course, rheumatic diseases may be associated with both long-lasting pain and movement limitations. Those afflicted by these disorders thus face continuous challenges regarding both adapting to their illness as well as changing their lifestyle habits, for example increasing the physical activity levels. However, patient education may provide patients with the competencies they need to cope with their illness and modify their behavior. Therefore, patient education programs are core elements of rehabilitation in rheumatology. The German Society for Rheumatology has performed pioneering work concerning conceptualization and evaluation of standardized educational programs. In this article some more recent developments and up to date standards for contents and didactics of self-management programs are presented. Empowerment may be considered the overriding aim of these programs, i.e. enabling patients to make informed decisions in situations where their health is involved. Patient-centered didactic methods as used in state of the art concepts mirror the empowerment approach. To foster sustainability of lifestyle changes, detailed planning of behavioral modifications is recommended, thus increasing the chance of transferring changes adopted during rehabilitation into everyday living. Such methods have been proven to be effective and are employed in the updated education concept for patients with fibromyalgia syndrome, which is described here as an example. The Centre for Patient Education offers support in updating and evaluating patient education concepts.

Rheumatologic rehabilitation: towards recommendations.

Rheumatic patients are highly complex and often affected by chronic diseases. Rehabilitation is generally needed for proper management of the underlying disease. This article describes the characteristics of an effective rheumatologic rehabilitation, takes into account data published in international literature, suggests recommendations based on scientific evidence to develop a correct rehabilitation plan for rheumatic patients and proposes the basis to draw up guidelines in the field of rheumatologic rehabilitation.

SP0138 Setting invividual treatment goals in complex cases

Goal planning is considered an essential part of rehabilitation practice and is a collaborative process between the patient and the rehabilitation team directed at setting goals at various levels of...

SP0040 Collaboration across health service levels - examples of norwegian projects involving primary and specialist health care

In Norway, as in many other countries, there is a need to develop integrated care and smooth collaboration between health care levels. A new health sector reform is recently initiated...

AB0535 Effects of disease activity and physical functions on sexual life in patients with ankylosing spondylitis

BackgroundObjectivesThe aim of this study is to evaluate the sexual functions in patients with Ankylosing Spondylitis (AS) and to determine the relationships between sexual problems and disease activity as well...

Illness perceptions in patients receiving rheumatology rehabilitation: association with health and outcomes at 12 months

BackgroundIllness perceptions have been found to change over time and following health care. Hence, addressing illness perceptions alongside existing health care interventions may be important for the sustainment of health gains following rehabilitation. The aim of this study was to measure the illness perceptions of patients receiving inpatient rheumatology rehabilitation and assess the association with aspects of health and outcomes at baseline, discharge and 12 months.MethodsPatients with a rehabilitation stay of one week or more at three institutions in Norway in 2009 were invited to participate in the study. At baseline, discharge and 12 months, patients completed The Rheumatic Disease Illness Perception Questionnaire (RD-IPQ) which includes aspects of illness perceptions important to patients with rheumatic diseases. Stepwise regression analysis was used to assess associations between RD-IPQ scores and different aspects of health at baseline and follow-up after controlling for other aspects of health and sociodemographic variables.ResultsFor the 134 patients included in the study, baseline RD-IPQ scores had a mean of 58.2 (SD 14.9) on a 0–100 scale, where 100 is the worst possible. Scores showed improvement after the rehabilitation stay which were maintained at 12 months. RD-IPQ scores were positively associated with health and outcomes. At baseline RD-IPQ scores were statistically significant in explaining variation in pain, physical function and SF-36 mental health scores. Baseline RD-IPQ scores were significant in explaining fatigue, pain, SF-36 role limitations and social function scores following rehabilitation and at 12 months.ConclusionIllness perceptions as measured by the RD-IPQ were associated with health and outcomes as measured by rheumatology-specific and generic instruments. The consideration of illness perceptions as a component of rehabilitation may be important in achieving desired outcomes.

Quality of life of osteoporotic patients attending rheumatology rehabilitation in-patient units

There has been no report on demographic, social and quality of life data of osteoporotic patients attending rheumatology rehabilitation in-patient units in Hungary. The authors analyzed the data of osteoporotic patients treated in rheumatology rehabilitation departments as in-patients in four hospitals in Hungary. Demographic and social data were obtained by using a questionnaire developed by the authors, and quality of life was assessed with the use of the SF-36 questionnaire. The quality of life data of osteoporotic patients were compared to that obtained from patients with rheumatoid arthritis, osteoarthrosis and chronic low back pain who were treated in the same department at the same time. Of the 253 patients who were asked to participate in the study, 211 patients filled out the questionnaires. 25.6% of the patients were male. 58% of the patients were younger than 60 years of age, and 40% of them were heavy physical workers earlier. More than 50% of the patients did not complete secondary school education, and only 6.7% of the patients had a per capita monthly income higher than 100 000 HUF. The quality of life of the osteoporotic patients assessed by SF-36 scored 34.7, which was significantly lower than that of the mean of the Hungarian population scoring 70-90. The SF-36 scores of osteoporotic patients were lower in all domains compared to the scores of patients with rheumatoid arthritis, osteoarthritis and low back pain, although the difference was significant only in the domain of physical activity. The affective role of patients with osteoporosis was significantly lower than those with rheumatoid arthritis and osteoarthritis. Osteoporotic patients attending in-patient rheumatology in-patient rehabilitation units in Hungary have poor quality of life comparable, even worse than that found in patients with rheumatoid arthritis, osteoarthritis and chronic low back pain.

“It is about taking grips and not let myself be ravaged by my body”: A qualitative study of outcomes from in-patient multidisciplinary rehabilitation for patients with chronic rheumatic diseases

Purpose: To explore how patients experience the process and personal impact of deriving outcomes from a rheumatological rehabilitation program. Methods: Semi-structured interviews were conducted with 23 patients with inflammatory rheumatic diseases approximately 2 months after a 4-week hospital based multidisciplinary rehabilitation program. A thematic analysis was applied. Results: Overarching themes were increased dignity and self-respect. Initial uncertainty regarding illness management was exchanged with confident coping and of becoming an active agent in ones own life. Strategies and coping tools tried out during the rehabilitation stay, do by their experienced effect become primary sources of gained insight into illness and symptom manifestation. Both elements give a sense of control and influence self-confidence and motivation to engage in self-management. The process from gained insight and experienced effect of coping tools, to active self management, is however, not automatic. Psychological factors play a key role, and there is a need to take individual psychological themes into account and tailor interventions accordingly. Conclusions: Specialized multidisciplinary rehabilitation is an ongoing active process, in which psychological factors play a key role and must be accounted for. Well targeted rehabilitation has the potential to create outcomes of major personal impact.Implications for RehabilitationWell targeted multidisciplinary rehabilitation has the potential to create outcomes of major personal impactRehabilitation interventions should be tailored according to the patient’s subjective perception of challenges.A secure and supportive environment where patients are met with respect and interest represents a crucial element in rehabilitation.

Concepts of functioning and health important to people with systemic sclerosis: a qualitative study in four European countries

ObjectiveTo describe the experiences of people with systemic sclerosis (SSc) in different European countries of functioning and health and to link these experiences to the WHO International Classification of Functioning,...

Sindrome di Churg-Strauss: trattamento riabilitativo

The authors present the clinical case of a patient suffering from recurrent upper respiratory tract pathologies with the subsequent development of a worsening polyneuropathy with impaired motility and sensitivity to the upper and lower limbs and severe reduction in the autonomy of the B-ADL and the ability to walk. The patient was diagnosed with Churg-Strauss disease and medical treatment (steroids and cyclophosphamide) was set up. Rehabilitative treatment was promptly begun, with exercises targeted to motor recovery and prevention of secondary damage (prevention of complications with passive mobilization and exercises, prevention of pressure ulcers, reduction of the formation of edema stasis, maintenance of functional ROM at upper and lower limbs). After initial recovery of voluntary muscle reclutation, we introduced active-assisted movements facilitation of motor neurons (Kabat type). When the patient recovered an adequate strength we introduced walking exercises with the Perfetti method, with a sequential and progressive process of attention, motion perception and memory aimed at recovering motor patterns. This phase was addressed with the help of a walking aid with forearm support and peroneal brace. In the later stages of treatment we introduced re-education and kinesthetic sensory-tactile exercises, still with the Perfetti method, occupational therapy exercises to acquire and support processes aimed at recovering maximum independence, Bobath method exercises in order to optimize postural strategies, as well as Feldenkrais exercises. The combination of rheumatological clinical treatment and rehabilitation treatment has allowed an almost complete recovery of the patient’s autonomy.