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Title: Development of a physical activity intervention for managing fatigue in rheumatoid arthritis
Author: Salmon, Victoria Emmeline
ISNI:       0000 0004 5370 6250
Awarding Body: University of the West of England
Current Institution: University of the West of England, Bristol
Date of Award: 2016
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Rheumatoid arthritis (RA) is a chronic, inflammatory auto-immune disease. Fatigue is a major symptom of RA and has a considerable impact on patients' daily lives. RA patients report that they struggle to manage their fatigue and receive little professional support. Currently there are no physical activity (PA) interventions that have been specifically designed to manage RA fatigue. However, secondary outcomes for fatigue in PA trials in RA suggest that it may be beneficial. This is supported by evidence in other long-term conditions. A pragmatic mixed methods approach was undertaken to explore the potential use of PA to manage RA fatigue and to develop a PA intervention specifically for fatigue management. A series of iterative studies was conducted using a range of methodologies, including systematic literature reviews, semi-structured interviews, focus groups, systematic intervention development and a proof-of-concept study. A review of existing evidence demonstrated a small beneficial short-term effect of PA for managing RA fatigue but this was based on secondary outcomes in low quality studies. A lack of evidence was also identified for theory-based interventions to promote engagement in and long-term maintenance of PA in RA. Semi-structured interviews with healthcare professionals (HCPs) delivering existing PA interventions in other long-term conditions confirmed a lack of an explicit theoretical basis for these programmes. However, participants acknowledged the importance of addressing motivational and psychosocial issues in order to change PA behaviour in patients with fatigue. Programmes varied in terms of format and delivery, but consistent findings included graded approaches to exercise and a flexible approach to implementation and delivery. Findings were subsequently discussed in focus groups with RA patients and rheumatology HCPs. Preferences for similar interventions in RA were identified, for example, a face-to-face group programme incorporating a practical PA session to develop self-management skills and address barriers to PA. Practicalities regarding implementation were noted, including staffing and resource issues. Existing evidence and primary data generated by the qualitative studies were used to develop a PA self-management programme using the Behaviour Change Wheel, a theoretical framework for behaviour change interventions. The novel intervention was delivered to a group of RA patients to model implementation and delivery processes and to explore acceptability. Findings suggested that the intervention was deliverable, and content and support materials were acceptable to this group of participants. These findings have implications for clinical practice as RA patients and rheumatology HCPs acknowledged that current fatigue management could be improved. The use of PA for managing fatigue was supported by patients and professionals. This theoretically-informed intervention should now be considered for further evaluation in a feasibility and pilot study prior to full scale testing in a randomised controlled trial.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available