Rheumatology Healthcare Professionals Research Articles

Management of refractory disease and persistent symptoms in inflammatory arthritis: qualitative framework analysis of interviews with patients and healthcare professionals.

This study aims to explore patients' and clinicians' experiences in managing and living with refractory disease (RD) and persistent physical and emotional symptoms (PPES) in patients with RA or polyarticular JIA from their perspectives through interviews and/or focus groups. A qualitative exploration with 25 patients and 32 multidisciplinary rheumatology healthcare professionals (HCPs) was conducted to obtain participants respective understanding and experiences of managing RD/PPES and its impact on the patient-professional relationship. A pragmatic epistemology approach with framework analysis was employed. Four key themes were identified from both patients and professionals in the management of RD/PPES: risk/perpetuating factors/triggers; need for a patient-centred holistic approach to care, diagnosis and treatment; discordance and impact on the patient-practitioner relationship and current problems in managing RD/PPES. These themes covered 22 subthemes, with none being patient specific and seven being HCP specific. Suggestions for potential management strategies were highlighted throughout, such as involving other specialties or a multidisciplinary team, assessing/treating patient-reported outcome measures and psychosocial factors, patient (re)education, need for adjustments/aids or adaptations, checking the diagnosis and further investigations/imaging and optimizing medications. Management strategies need to be developed that enable appropriate treatment plans for those with RD/PPES that account for wider biopsychosocial factors beyond inflammation and reduce discordance in the patient-practitioner relationship.

Coalition for Health and Gender Equity (CHANGE)-a protocol for a global cross-sectional survey of health and gender equity in rheumatology.

The primary aim of the CHANGE survey is to determine the current state of gender equity within rheumatology, and secondarily, to review the physician perspective on bullying, harassment and equipoise of opportunities within rheumatology. The CHANGE e-survey is a cross-sectional self-reported questionnaire adapted from EULAR's gender equity in academic rheumatology task force. The survey was launched in January 2023; it is available in six languages and distributed widely via rheumatology organizations and social media. Eligible participants include rheumatologist physicians and rheumatology health-care professionals. Survey responses will undergo descriptive analysis and inter-group comparison aiming to explore gender-based discrimination using logistic regression, with subgroup analyses for country/continent variations. This e-survey represents a comprehensive global initiative led by an international consortium, aimed at exploring and investigating the gender-related disparities and obstacles encountered by rheumatologists and rheumatology health-care professionals across diverse communities and health-care environments. By pursuing this initiative, we aim to take the broader rheumatology community a step closer to understanding the underlying origins of inequities and their determinants. Such insights are pivotal in identifying viable interventions and strategies to foster gender equity within the field. Ultimately, our collective objective is to ensure equitable access to opportunities for every individual, irrespective of gender, thereby promoting inclusivity and fairness across the entire spectrum of professional practice and career development.

Development and testing of a bespoke cultural intervention to support healthcare professionals with patients from a diverse background.

Development and test of a culturally sensitive intervention for rheumatology healthcare professionals (HCPs). Using a before and after study design, 15 HCPs were recruited to undertake the bespoke intervention from four National Health Service sites across England, in areas serving a diverse population. The intervention was evaluated using two validated outcomes: (i) Patient Reported Physician Cultural Competency (PRPCC); and (ii) Patient Enablement Instrument (PEI), measuring patients' perceptions of their overall healthcare delivery. Additionally, HCPs completed the COM-B questionnaire for capability (C), opportunity (O) and motivation (M) to perform behaviour (B), measuring behaviour change. Two hundred patients were recruited before HCPs undertook the intervention (cohort 1), and 200 were recruited after (cohort 2) from 15 HCPs; after exclusions 178 patients remained in cohort 1 and 186 in cohort 2. Sixty percent of patients identified as white in both recruited cohorts, compared with 29% and 33% of patients (cohorts 1 and 2, respectively) who identified as being of South Asian origin. After the intervention, the COM-B scores indicated that HCPs felt more skilled and equipped for consultations. No significant differences were noted in the average overall cultural competency score between the two cohorts in white patients (57.3 vs 56.8, P = 0.8), however in the South Asian cohort there was a statistically significant improvement in mean scores (64.1 vs 56.7, P = 0.014). Overall, the enablement score also showed a statistically significant improvement following intervention (7.3 vs 4.3, P < 0.001) in the white patients and in the South Asian patients (8.0 vs 2.2, P < 0.001). This novel study provides evidence for improving cultural competency and patient enablement in rheumatology settings.

Collaboration in the management of psoriasis and psoriatic arthritis: A survey of joint working in UK clinical practice

AbstractBackgroundTreatment guidelines for psoriasis and psoriatic arthritis consider all skin and joint domains and recommend collaborative multidisciplinary team (MDT) working. The uptake of joint working in clinical practice for psoriatic disease management has not been well studied.ObjectivesThis United Kingdom (UK) study aimed to provide a better understanding of current working patterns and collaborating specialities, as well as benefits and challenges of combined clinics.MethodsAn online survey was emailed to dermatology and rheumatology healthcare professionals (HCPs) using professional networks.ResultsResponses were received between October 2020 and April 2021 (N = 80); 60.0% of respondents worked in dermatology and 40.0% in rheumatology. Use of combined clinics with dermatology was reported by 40.6% of rheumatology HCPs, including joint (25.0%), parallel (3.1%) and virtual clinics (6.3%), and MDT meetings (6.2%). Similarly, 50.1% of dermatology HCPs reported use of joint (25.0%), parallel (4.2%) and virtual clinics (2.1%), single visits (2.1%), and MDT meetings (16.7%) with rheumatology. Around one‐quarter of respondents collaborated via email, which was also the main method of collaboration with other specialists. Overall, one‐quarter of respondents reported no collaboration in psoriatic disease management. Perceived benefits of combined clinics included shared knowledge, improved patient outcomes and increased patient satisfaction. Challenges included difficulties in aligning clinician time and geographical location, as well as limited ‘buy‐in’ from senior management. Most respondents felt that the COVID‐19 pandemic had partially or significantly impacted combined clinics.ConclusionsThis study is one of the first to survey collaborative working in psoriatic disease management and the first in the UK. These findings demonstrate the variety of approaches used and a lack of collaborative working by one‐quarter of respondents. Despite the benefits, numerous challenges in establishing formal arrangements exist. More evidence is needed to demonstrate improved patient outcomes with collaborative working and to standardise best practice.

OP0056 “BECAUSE THAT’S THEIR JOB, ISN’T IT?”: EXPLORING CHILDREN AND YOUNG PEOPLES’ EXPERIENCES OF AND PERSPECTIVES ABOUT PAIN COMMUNICATION IN PAEDIATRIC RHEUMATOLOGY IN THE UK

BackgroundPain communication should be an integral part of every clinical consultation, particularly in paediatric rheumatology where children/young people often present complex long-term conditions in which chronic pain is a feature. Researchers investigating pain communication in paediatric healthcare encounters have been focused on healthcare professionals, yielding inconsistent findings about the occurrence and nature of pain discussions with children/young people. There has been limited research examining children/young peoples’ own experiences and perspectives on this in the literature to date.ObjectivesThe objective of this study was to investigate children/young peoples’ experiences and perceptions of communicating about pain with paediatric rheumatology healthcare professionals in the UK.MethodsTwenty-six children/young people were recruited from three UK paediatric rheumatology centres. Data were collected using semi-structured telephone interviews between April-October, 2021. A framework analysis approach was used to explore similarities and divergences in participants’ narrative accounts.ResultsThe mean age of children/young people was 14.0 years (SD=3.6 years, Range= 6-18 years, 58% female). Diagnoses included; Juvenile Idiopathic Arthritis, Chronic Regional Pain Syndrome, diffuse idiopathic chronic pain, localised idiopathic pain, hypermobility (including Ehlers Danlos Syndrome) and Raynaud’s disease.Findings are organised into four themes.1) Nature and focus of appointments. Children/young people talked about pain with several professionals from the team. Participants reported that pain conversations predominantly occurred during physical examinations.2) Co-ordination of pain communication. Children/young people identified how professionals mostly started pain conversations. They explained how they were often asked to verbally rate pain rather than use a written assessment tool. For some, questions about pain were directed to parents. Participants reported that this was problematic as parents “can’t feel” pain.3) Reflections on pain communication. There were expectations that pain should always be asked about as it was considered a main reason for a consultation. Participants discussed how these conversations gave them an opportunity to “get it off their chest” and made them feel “reassured” that professionals “care”. Being asked about pain reminded them that they were different to peers and they were concerned it could highlight “something else is wrong”. Children/young people talked about how it became easier to talk about pain with familiar professionals.4) Moving forward after pain communication. Children/young people discussed how professionals could give mixed messages about how to manage pain at home following consultations, offering advice which was difficult to put into practice (e.g. “doing too much” vs “not doing enough”). Children/young people expressed their need to discuss the emotional as well as the physical effects of their pain.ConclusionThese study findings highlight a range of effective and ineffective pain communication approaches from the experiences and perspectives of children/young people. These will be used to create recommendations for improving the communication of chronic pain in paediatric rheumatology in the future, in a way that is acceptable and valuable to children/young people.AcknowledgementsThe authors would like to thank the children/young people for kindly taking the time to share their experiences and perceptions about their interactions with healthcare professionals in paediatric rheumatology. The views expressed herein are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the UK Department of Health. This work was supported by a Foundation Fellowship award from Versus Arthritis (Grant 22433). Aspects of this work were also supported by funding from the Centre for Epidemiology Versus Arthritis (Grant 20380) and the NIHR Manchester Biomedical Research Centre.Disclosure of InterestsNone declared.

P264 Bridging the gap: co-producing a virtual self-management programme for individuals living with axial spondyloarthritis

Abstract Background/Aims Despite the considerable impact axial spondyloarthritis (axSpA) has on quality of life, condition-specific group education programmes are not routinely offered. Many people with axSpA report feeling isolated and often have never met anyone else with the condition. In 2020, the National Axial Spondyloarthritis Society (NASS) worked with patients and rheumatology departments to co-produce a pilot self-management programme (SMP) to explore demand from and assess the impact on patients and healthcare professionals (HCPs). Methods NASS identified six NHS centres to host the pilot SMP sessions. These centres represented a range of axSpA services. HCPs invited their axSpA cohort to attend by post or e-mail and NASS invited local NASS members. Attendees booked online via private URL. NASS developed content following consultation with rheumatology HCPs and people living with axSpA. The first session covered pain, flares, fatigue and emotional wellbeing. Following attendee feedback, three centres hosted a second session on medication and exercise. One centre held a third session covering night pain, sleep and stress. Sessions were delivered via online meeting software and included teaching, group discussions, polls and exercise. HCPs of the host rheumatology departments led these sessions in tandem with NASS staff, one of whom has lived experience of axSpA. Content and format were continually reviewed and improved using feedback from attendees and HCPs (Table 1); feedback was gathered by email, informal focus groups and anonymous surveys. Results A total of 266 patients attended. 55% were female and 27% were aged under 45. 10% were diagnosed within the past year; 26% within the last 5 years; &amp;gt;50% more than 10 years ago. No attendees had previously attended a hospital axSpA SMP session. Conclusion There is demand from patients and HCPs for an axSpA virtual patient SMP. Co-producing the programme can be effective for: engaging with a range of patients; educating and empowering patients to self-manage their condition; building relationships between HCPs and patients; reducing patient isolation; enabling appropriate self-referral to rheumatology services. This pilot has informed our next steps to expand the online sessions to new centres and explore co-producing an e-learning programme. Disclosure Z.E. Clark: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. W. Gregory: Honoraria; Speaker, conference registration and advisory board fees from AbbVie, Pfizer, Novartis, UCB. A. Chan: Member of speakers’ bureau; UCB, Novartis, Sanofi, AbbVie, Jannsen. A. Coy: None. Z. Cox: None. S. Dickinson: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. K. Gaffney: Shareholder/stock ownership; SpA Academy. Honoraria; Novartis, AbbVie, UCB, Lilly, Pfizer, Biogen. Member of speakers’ bureau; Celltrion, Novartis, UCB, AbbVie. Grants/research support; NASS, AbbVie, Pfizer, UCB, Novartis, Lilly, Jannsen, Gilead, Biogen. Other; Meeting expenses: AbbVie, Lilly, Roche, Novartis, Pfizer, UCB. B. Harrison: None. H. Herbert: None. C. Lewis: None. C. McCoy: None. K. Noel: None. K. Porthouse: None. K. Rigler: None. K. Weight: None. T. Williams: None. D. Webb: Grants/research support; National Axial Spondyloarthritis Society receives grant funding from AbbVie, Biogen, Eli Lilly, Janssen, Novartis, UCB. L. Dunkley: Honoraria; Honoraria with UCB, AbbVie, Pfizer.

Acceptability of an Adolescent Self-Management Program for Juvenile Idiopathic Arthritis.

ObjectiveThe study objective was to test the acceptability of a self‐management program (SMP) for adolescents with juvenile idiopathic arthritis (JIA) focused on disease information, self‐management, and social support needs.MethodsThis study was conducted using inductive qualitative methods to explore the acceptability of an in‐person/videoconference SMP. Two groups of four adolescents with JIA (mean age = 13.5, SD = 0.8) and two groups of pediatric rheumatology health care professionals (n = 4, n = 5) participated in four feedback sessions each. The SMP was presented to study participants, and feedback was provided on the content, format, and structure of the program. Thematic analysis was used to analyze the data.ResultsAdolescents felt that the content was appropriate and would be effective in supporting self‐management of their arthritis. Participants advised that the trustworthiness of the information would be increased if a rheumatology health care provider facilitated the session. Potential barriers to participation included distance and availability (weekdays and times), but the option for videoconference‐based participation was an appropriate solution to both of these issues. Minor changes were made to content and format, and required changes were made to address participant recommendations for improvement.ConclusionThis study confirmed the acceptability of an in‐person/videoconference SMP for patients with JIA. Modifications were made to the SMP based on the focus group feedback, and future directions include a pilot randomized controlled trial to assess feasibility and preliminary effectiveness of the program.

P201 Therapists' experiences of remotely delivered cognitive-behavioural and graded-exercise interventions to lessen the impact of fatigue in inflammatory rheumatic diseases: a qualitative evaluation

Background/Aims There is evidence for non-pharmacological interventions to support patients to self-manage fatigue, however implementation in clinical practice is a challenge. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomised Trial) is a multi-centre three-arm randomised trial using a remotely delivered cognitive-behavioural approach (CBA) or personalized exercise programme (PEP) interventions, in addition to usual care, compared to normal care alone. Interventions were delivered to patients by rheumatology health professionals using a manual, after training. The aim of this nested qualitative evaluation was to understand their perspectives of delivering the interventions. Methods A subgroup of rheumatology healthcare professionals who had delivered the CBA and PEP interventions took part in semi-structured telephone interviews to explore their experiences of training and delivery, the challenges and benefits of learning new skills, and the barriers and facilitators to supporting patients remotely (mainly by telephone) using the LIFT manual. Results A total of 17 rheumatology healthcare professionals (13 women, 4 men) from the CBA (n = 9) and PEP (n = 8) arms contributed. SB conducted an inductive thematic analysis of the data set. ED, CA, AW and KL reviewed a sub-set of transcripts. Five main themes were identified: The benefits of informative, structured training: Rheumatology healthcare professionals reflected how training, including role-play, helped them to practice their skills, even though this could feel uncomfortable. Those allocated shorter four-hour training sessions would have liked more time to practice. Many felt anxious before meeting patients for the first time but liked the manual to refer to.Getting into the swing of it: Practice gave rheumatology healthcare professionals the confidence to tailor content to individual patients’ requirements. Clinical supervision in the PEP and CBA arm supported rheumatology healthcare professionals to query their own practice, gain valuable feedback, and request assistance where needed. Benefits of telephone delivery: The initial face-to-face session enabled rheumatology healthcare professionals to build rapport with patients. Thereafter, patients seemed engaged and valued the opportunity to address their fatigue and challenge their own beliefs via the telephone.Some patients not ready to change: Rheumatology healthcare professionals struggled to work collaboratively with a minority of patients who were not willing to make changes, lacked motivation to complete tasks or stopped engaging with the intervention.LIFT developing clinical skills: Rheumatology healthcare professionals were confident that they were doing the ‘right thing’ for patients with fatigue and gained professional satisfaction seeing patients’ fatigue improve. Many felt that the skills they acquired and their experiences of remote delivery were helping them to respond to the current COVID-19 related changes in service provision. Conclusion Findings support the value of skills training for rheumatology health professionals to deliver fatigue management interventions remotely. These insights can inform service provision and clinical practice. Disclosure S.E. Bennett: None. E. Dures: None. C. Almeida: None. E. Bachmair: None. K. Lovell: None. L. Paul: None. A. Wearden: None. G.J. Macfarlane: None. N. Basu: None.

Managing patients using telerheumatology: Lessons from a pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges to rheumatology provision. Measures to control the pandemic have limited face-to-face contact with rheumatology healthcare professionals. One innovation has been the widespread adoption of telerheumatology to assist in the care of patients with rheumatic and musculoskeletal diseases, building on an existing evidence base in rheumatology. Widespread adoption has only occurred following the COVID-19 pandemic. We discuss the evidence supporting telerheumatology adoption prior to the pandemic, and outline several innovative approaches used to assist in the care of rheumatology patients that have been introduced. Alongside the advantages of these interventions, we discuss the limitations and regulatory challenges. Advances must be balanced, considering wider issues of equity of access, implementation, adoption, and sustainability of telerheumatology post-pandemic. We propose it is not ‘if’, but ‘how’ rheumatologists embrace newer telerheumatology technology, outlining practice points and future research agenda.

BSR Spondyloarthritis Course, 27 February 2020. Spondyloarthritis: pathogenesis, diagnosis and management.

High-quality continuous medical education is essential to maintain excellence in health-care delivery, upskilling professionals and improving patient outcomes. This is particularly relevant when addressing rare disease groups, such as the spondyloarthritides, a group of heterogeneous inflammatory conditions that affect joints and other organs, such as the skin, bowel and eye. Professional bodies, such as the British Society for Rheumatology (BSR), are well placed to deliver this type of education. In 2020, the BSR ran a dedicated SpA course aimed at rheumatology health-care professionals wishing to update their basic knowledge of SpA with a review of the latest advances in the field. Here, we summarize the proceedings of the meeting and discuss the value of such an initiative.

Patient and clinician views on an app for rheumatoid arthritis disease monitoring: Function, implementation and implications.

Best practice management for rheumatoid arthritis (RA) involves regular clinical assessment of RA disease activity. This is not achievable with current rheumatology systems of care. We aimed to use opinions from people with RA and their specialist rheumatology healthcare professionals to inform development of a mobile app for people with RA for recording their disease activity data for potential integration into clinical service, and assess usability of the app. In phase 1 we interviewed nine people with RA and seven healthcare professionals. In phase 2 we developed an app with professional software developers. In phase 3 we evaluated app usability for people with RA using the System Usability Scale (SUS). Interview data showed four themes regarding functionality and implementation of a patient-held app in RA care: (a) variable app acceptance and readiness; (b) app use to reduce barriers; (c) pros and cons of patient-reported outcomes; and (d) allocation of clinics by need. The app developed has high usability in people with RA using the app on their own device for a month (SUS 79.5, n=16) or using the app on a study device for 10minutes (SUS 83, n=100). People with RA and healthcare professionals have clearly identified features, benefits and risks of an app for self-assessment of RA and incorporation into clinical care. An app developed informed by these opinions has high usability. Next steps are development and validation of a method of patient-performed joint counts, and implementation, with evaluation, in the clinical setting.

Health-care professionals' perceptions of interacting with patients of South Asian origin attending early inflammatory arthritis clinics.

ObjectiveThe aim was to explore the perceptions of rheumatology health-care professionals (HCPs) of interacting with patients of South Asian origin attending early inflammatory arthritis clinics. MethodsWe used face-to-face semi-structured interviews, designed in partnership with a clinician partner, to interview 10 HCPs involved in the running of early inflammatory arthritis clinics across seven centres in the UK. Data were recorded, transcribed by an independent company and analysed using inductive thematic analysis.ResultsThree emerging themes were identified that characterized consulting experiences of HCPs: varied approaches were used in early inflammatory arthritis clinic; the challenges for rheumatology HCPs in managing and delivering information to patients of South Asian origin in early inflammatory arthritis clinics; and moving towards good practice, the views on managing future patients of South Asian origin in early inflammatory arthritis clinics. Overall, HCPs found that they required additional skills to support the engagement and management for patients of South Asian origin living with inflammatory arthritis. The HCPs felt that they were less effective in addressing self-management issues for this patient group, and they found it difficult to determine adherence to medication. In such consultations, HCPs perceived that their own limitation of inadequate training contributed towards poor consultations.ConclusionFor the first time, our data demonstrate that the management of patients of South Asian origin in early inflammatory arthritis clinics is under-served. To address this, HCPs have identified training needs to improve knowledge and skills in engaging with and supporting patients of South Asian origin. These findings provide a good direction for future research.

Training and delivery of a novel fatigue intervention: a qualitative study of rheumatology health-care professionals' experiences.

ObjectivesSuccessful, non-pharmacological research interventions are challenging to implement in clinical practice. The aim of the study was to understand the experiences of rheumatology nurses and occupational therapists (tutors) delivering a novel fatigue intervention in a trial setting, and their views on requirements for clinical implementation. After training, tutors delivered courses of a manualized group cognitive-behavioural intervention to patients with RA in a seven-centre randomized controlled trial [Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT)], which demonstrated reduced fatigue impact at 2 years.MethodsFourteen tutors participated in interviews, and eight tutors also participated in a focus group. Data were audio-recorded, transcribed and analysed using inductive thematic analysis.ResultsThe following five main themes were identified: ‘exciting but daunting’ reflected the mixture of excitement and anxiety in intervention training and delivery; ‘skills practice and demonstrations were essential’ captured the value of learning and practising together, even though the process could be uncomfortable; ‘an individual approach to a standardized intervention’ showed how tutors negotiated adherence to the manual with delivery using their own words; ‘becoming a better practitioner’ described how participation enhanced tutors’ wider clinical practice; and ‘pragmatic and flexible’ highlighted practical adaptations to facilitate training and intervention roll out.ConclusionThese insights inform strategies for clinical implementation of an evidence-based intervention that addresses a patient priority, with implications for other successful research interventions. Tutors believed that the skills acquired during RAFT enhanced their wider clinical practice, which highlights the benefits of upskilling members of clinical teams to provide self-management support to patients.

Developing a group intervention to manage fatigue in rheumatoid arthritis through modifying physical activity

BackgroundFatigue is a major symptom of rheumatoid arthritis (RA). There is some evidence that physical activity (PA) may be effective in reducing RA fatigue. However, few PA interventions have been designed to manage fatigue and there is limited evidence of end-user input into intervention development. The aim of this research was to co-design an intervention to support self-management of RA fatigue through modifying PA.MethodsA series of studies used mixed methodological approaches to co-design a fatigue management intervention focused on modifying PA based on UK Medical Research Council guidance, and informed by the Behaviour Change Wheel theoretical framework. Development was based on existing evidence, preferences of RA patients and rheumatology healthcare professionals, and practical issues regarding intervention format, content and implementation.ResultsThe resulting group-based intervention consists of seven sessions delivered by a physiotherapist over 12 weeks. Each session includes an education and discussion session followed by supervised PA chosen by the participant. The intervention is designed to support modification and maintenance of PA as a means of managing fatigue. This is underpinned by evidence-based behaviour change techniques that might support changes in PA behaviour. Intervention delivery is interactive and aims to enhance capability, opportunity and motivation for PA.ConclusionThis study outlines stages in the systematic development of a theory-based intervention designed through consultation with RA patients and healthcare professionals to reduce the impact of RA fatigue. The feasibility of future evaluation of the intervention should now be determined.

144 The perceptions and perspectives of rheumatology health care professionals on managing South Asian patients in early inflammatory arthritis clinic

144 The perceptions and perspectives of rheumatology health care professionals on managing South Asian patients in early inflammatory arthritis clinic

Protocol for a multicentre randomised controlled parallel-group trial to compare the effectiveness of remotely delivered cognitive-behavioural and graded exercise interventions with usual care alone to lessen the impact of fatigue in inflammatory rheumatic diseases (LIFT)

IntroductionFatigue remains pervasive, disabling and challenging to manage across all inflammatory rheumatic diseases (IRDs). Non-pharmacological interventions, specifically cognitive-behavioural approaches (CBAs) and graded exercise programmes designed to support and increase exercise,...

I179 An evidence based physical activity interactive infographic for rheumatology health care professionals: from design to delivery

i179 An evidence based physical activity interactive infographic for rheumatology health care professionals: from design to delivery

The role of nurse practitioners in delivering rheumatology care and services: Results of a U.S. survey.

Background and purposeRheumatoid arthritis (RA) is a chronic autoimmune disease characterized by inflammation, pain, joint stiffness, and progressive joint destruction. An increased demand for rheumatology healthcare professionals is anticipated in coming years; utilizing more nurse practitioners (NPs) in rheumatology may help meet this demand, and improve early detection and diagnosis of RA.MethodsThe American Association of Nurse Practitioners surveyed, via e‐mail, members who were working in primary care settings to understand their educational and professional needs to help manage their patients with RA. Respondents were surveyed about their NP certifications, patient panel, information received from rheumatologists on shared patients, RA tools or resources that would be helpful, confidence in diagnosing and managing patients with RA, interest in learning about particular topics regarding RA medications, and preferences for exchanging educational information with their professional colleagues.ConclusionsThe results from this survey indicate that the role of NPs in managing RA could be optimized by improved communication with treating rheumatologists, access to educational tools and resources, and further education and training in the management of RA.Implications for practiceNPs in primary care can fill a resource gap and provide access to health care for patients with RA.

038. Pain experts’ and healthcare professionals’ prioritisation and interpretation of multi-dimensional patient-reported pain data from children with Juvenile Idiopathic Arthritis

Background: Patient self-report of pain is regarded as the gold standard of assessment. There is increased recognition of the importance of using electronic, real-time data capture with multi-dimensional methods for children who have chronic pain. Notable advantages of these approaches include reductions in recall bias and improved compliance and engagement. However, the utilisation of the outputs of these tools in paediatric rheumatology settings may be impeded by the uncertainty that exists about which pain facets should be prioritised in guiding pain management decisions. Aims: To determine which features of multidimensional pain information from individuals with Juvenile Idiopathic Arthritis (JIA) were viewed as most salient by pain experts and paediatric rheumatology healthcare professionals. Methods: Participants were recruited via online advertisements posted by their professional organisations. Two separate group workshops were hosted at an international conference on pain and a national conference on paediatric rheumatology. Participants were asked to rank order nine vignette scenarios from highest pain to lowest pain using real patient data collected with an electronic multidimensional pain assessment tool (My Pain Tracker). The pain components collected by the tool were developed by children and included pain intensity, severity, location, pain quality descriptors (including symbols such as fire and sharpness) and emotions. Participants were asked to explain their individual reasoning for their rankings of pain experiences aloud within workshops. Recordings were transcribed and analysed using content analysis. Results: Nineteen participants took part: nine paediatric pain experts and ten paediatric rheumatology healthcare professionals. The high prioritisation of pain intensity was apparent for pain experts whereas pain intensity and severity together were most salient for healthcare professionals. Differences between groups emerged in the prioritisation of specific pain location information. For pain experts, the number of sites affected was important. However, for rheumatology healthcare professionals, localised pain around specific joints and number of joints affected were seen as high priority. Spread of pain around a particular joint, for example (demonstrated by the extent of shading) was not important for pain experts. Descriptors of pain quality were generally high prioritisations. For both groups, pain labels and pain colour (in particular, red) were salient in their interpretations. For rheumatology professionals only, use of the fire symbol was significant. Other than this, symbol chosen was not important. For the majority of both groups, pain emotion was a high priority. Conclusions: From this study it appears that pain experts and rheumatology healthcare professionals extract and use different combinations of pain information to interpret pain reports. The next step of this work is to develop useful visualisation tools that will enhance clinicians’ ability to assess and manage pain effectively.

Rheumatoid Arthritis: Selecting Monotherapy Versus Combination Therapy.

The overall goal of therapy for patients with rheumatoid arthritis (RA) is to achieve low disease activity or remission and to prevent or control joint damage, prevent loss of function, and decrease pain. However, many patients with RA do not have the disease adequately controlled, and only a minority attain consistent remission. To successfully treat to target, rheumatologists need practical guidance to select monotherapy and combination therapy regimens based on available data. Differences in study design, dosing regimens, and data from defined and specific patient populations pose challenges to clinicians who treat patients with diverse characteristics and needs. Because clinical trial results are not always translated into real-life clinical practice, this article synthesizes evidence from all sources, including meta-analyses of clinical trial data, data from patient registries in RA, and results of pragmatic trial designs. Practical guidance with these strategies is demonstrated using application in patient case scenarios, which will enable rheumatology health care professionals to more easily compare the effectiveness and safety of RA treatment strategies as experienced in real-life practice settings. Combination therapy is important for most patients with RA; however, there remain no clear guidelines for selecting the most appropriate combination strategy.