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

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Abstract

Objective

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

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.

Section snippets

Design

A single-blind randomized controlled trial included an intervention group, assigned to a 12-week person-centered physical therapy intervention, and a reference group. Both groups continued to receive usual care, including usual visits with rheumatologists and rehabilitation as prescribed. The 2 groups differed only with respect to the intervention group receiving person-centered physical therapy. The reference group was advised to continue with usual physical and social activities. Three

Results

Of the 70 participants in the study, 36 were randomized to the intervention group and 34 to the reference group. One person in the intervention group and 2 in the reference group dropped out before posttest, and 1 person in the reference group dropped out by follow-up (fig 1). The mean age ± SD for participants was 53.5±9.7 years; 89% were women, and 71% were working or studying. Four persons in the intervention group and 5 persons in the reference group received standard physical therapy

Discussion

Our findings support our hypothesis that a person-centered physical therapy intervention program focusing on health-enhancing physical activity and balancing life activities reduces fatigue in persons with RA. This reduction in fatigue was documented in general fatigue, and tendencies toward improvement were observed for multidimensional aspects of fatigue and persisted up to 6-month follow-up for the physical aspects of fatigue. In the between-group analysis, the median reduction in general

Conclusions

Person-centered care focuses on partnership building and includes sharing of information, deliberation, and decision-making between patient and practitioner. Person-centered physical therapy that focuses on health-enhancing physical activity and balancing activities in daily life in persons with RA was shown to reduce general fatigue. Therefore, we conclude that person-centered physical therapy shows promise as a strategy to augment the self-management of fatigue related to this condition.

Supplier

  • a.

    SPSS version 15.0; SPSS.

Acknowledgments

We thank the nurses at the Rheumatology Clinic at Sahlgrenska University Hospital for performing the clinical examinations.

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    Supported by the University of Gothenburg Centre for Person-Centred Care, the Swedish Research Council, and the Medical Faculty of University of Gothenburg Sahlgrenska University Hospital, Gothenburg, Sweden.

    Clinical Trial Registration No.: NCT02120963.

    Disclosures: none.

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