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Abstract Number: 0462

Remotely Delivered Cognitive Behavioural and Personalised Exercise Interventions Reduce Fatigue Severity and Impact in Inflammatory Rheumatic Diseases: Results from a Multi-centre Randomised Controlled Parallel Group Trial

Eva-Maria Bachmair1, Kathryn Martin Remmes1, Lorna Aucott1, Emma Dures2, Richard Emsley3, Stuart Gray4, Elizabeth Kidd5, Vinod Kumar6, Karina Lovell7, Graeme MacLennan1, Paul McNamee1, John Norrie8, Lorna Paul9, Jon Packham10, Stuart Ralston11, Stefan Siebert4, Alison Wearden7, Gary Macfarlane12 and Neil Basu4, 1University of Aberdeen, Aberdeen, United Kingdom, 2University of West of England, Bristol, United Kingdom, 3King's College London, London, United Kingdom, 4University of Glasgow, Glasgow, United Kingdom, 5Newcastle Hospitals NHS Foundation Trust, Newcastle, United Kingdom, 6NHS Tayside, Dundee, United Kingdom, 7University of Manchester, Manchester, United Kingdom, 8Usher Institute – University of Edinburgh, Edinburgh, United Kingdom, 9Glasgow Caledonian University, Glasgow, Scotland, United Kingdom, 10Midlands Partnership NHS Foundation Trust, Stoke-on-Trent, United Kingdom, 11University of Edinburgh, Edinburgh, Scotland, United Kingdom, 12Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen, Scotland, United Kingdom

Meeting: ACR Convergence 2021

Keywords: exercise, Fatigue, Intervention, remote, rheumatoid arthritis

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Session Information

Date: Saturday, November 6, 2021

Title: Abstracts: Health Services Research (0462–0465)

Session Type: Abstract Session

Session Time: 10:30AM-10:45AM

Background/Purpose: Inflammatory rheumatic disease (IRD) related fatigue is pervasive and disabling, even in otherwise stable disease. Although cognitive-behavioural approaches (CBAs) and personalised exercise programmes (PEP) are considered effective treatments, rheumatology services encounter significant implementation barriers: 1) existing interventions have not been standardised and tested across the range of IRDs managed by rheumatology 2) the requisite specialist expertise does not commonly exist within rheumatology multi-disciplinary teams (MDT) 3) regular face to face sessions are often undesirable for patients, especially during a pandemic.

This is the first study to test remotely delivered CBA and PEP, by the rheumatology MDT, across IRDs.

Methods: A multicentre, three-arm randomised controlled trial of usual care (UC) alongside telephone delivered CBA or PEP were tested against UC alone. UC typically comprised a fatigue self-management education booklet. Patients with any stable (unaltered immunomodulatory therapy for ≥3 months), physician diagnosed IRD were considered eligible if they reported significant (≥6 on numeric rating 0-10 scale, NRS) and persisting (≥3 months) fatigue. CBA and PEP was delivered by members of the rheumatology MDT, who received specialist training and supervision. Patients received up to 7 sessions across 14 weeks with a booster session at 6 months. Primary outcomes were fatigue severity (Chalder Fatigue Scale, CFS) and impact (Fatigue Severity Scale, FSS) at 12 months. Secondary outcomes included depression (Hospital Anxiety and Depression Scale), pain (NRS), sleep disturbance (Jenkins) and Work Productivity and Activity Impairment (WPA-I), also at 12 months. Generalized linear mixed models were used to compare the effectiveness of active therapies versus UC following an Intention-To-Treat approach. Results are expressed as mean difference (md) with 95% confidence intervals (95% CI).

Results: 368 IRD patients (55% rheumatoid arthritis, 21% connective tissue disease, 19% spondyloarthritis, 5% other IRD) were randomised. Baseline characteristics were similarly distributed across the trial arms (table 1). 73% and 85% completed PEP and CBA respectively and primary outcome data was available for 77% of all patients. PEP and CBA significantly improved fatigue severity (CFS md -2.9, 95% CI [-4.6, -1.2], p=0.001 and md -2.5, 95% CI [-4.01, -0.8], p=0.003, respectively) and fatigue impact (FSS md -0.6, 95% CI [-0.9, -0.3], p< 0.001 and md -0.6, 95% CI [-0.8, -0.3], p< 0.001, respectively) compared to UC alone at 12 months (figure 1). Both PEP and CBA also improved sleep (Jenkins md -1.3, 95% CI [-2.56, -0.1] and -1.8, 95% CI [-3.0, -0.6], respectively), while PEP further improved depression (HADS md -1.0, 95% CI [-1.7, -0.2]) and overall work impairment (WPAI md -14.1, 95% CI [-26.7, -1.4]) (table 2).

Conclusion: Telephone delivered CBA and PEP provided statistically and clinically significant reductions in fatigue severity and impact for a wide range of stable IRD patients. The benefit was maintained for 6 months following treatment completion and was successfully delivered by members of the rheumatology MDT after specialist training.

#Continuous data: mean (sd)
†Ordinal data: N n(%)

Figure 1 Fatigue severity (CFS) and fatigue impact (FSS) over time by treatment group
Data are shown as adjusted means (sd). All models adjusted for their baseline outcome measure, HADS depression subscale >10 at baseline as fixed effects fixed effect with Centre clustering and individuals nested within Centre’s as random effects. PEP, personalised exercise programme; CBA, cognitive-behavioural approach; UC, usual care; HADS, Hospital Anxiety and Depression Scale;

Data are shown as adjusted means (sd); n. Results are expressed as mean difference (md) with 95% confidence intervals (95% CI) and p-value. All models adjusted for their baseline outcome measure, HADS depression subscale >10 at baseline as fixed effects fixed effect with Centre clustering and individuals nested within Centre’s as random effects. PEP, personalised exercise programme; CBA, cognitive-behavioural approach; UC, usual care; HADS, Hospital Anxiety and Depression Scale; WPAI, Work Productivity and Activity Impairment (overall work impairment domain);


Disclosures: E. Bachmair, None; K. Martin Remmes, QIAGEN, 12, Spouse is an employee; L. Aucott, None; E. Dures, None; R. Emsley, BigHealth Ltd, 2; S. Gray, None; E. Kidd, None; V. Kumar, Novartis, 6, Eli Lilly, 12, Eli Lilly EULAR 2021 virtual conference expenses; K. Lovell, None; G. MacLennan, None; P. McNamee, None; J. Norrie, None; L. Paul, None; J. Packham, None; S. Ralston, Abbvie, 12, Grant to institution to support scientific meeting, Pfizer, 12, Grant to institution to support scientific meeting, Jannsen, 12, Grant to institution to support scientific meeting, Alexion, 12, Grant to institution to support scientific meeting, Bristol Myers Squibb, 12, Grant to institution to support scientific meeting, Celgene, 12, Grant to institution to support scientific meeting, Consilient Health, 12, Grant to institution to support scientific meeting, Eli Lilly, 5, 12, Grant to institution to support scientific meeting, Novartis, 12, Grant to institution to support scientific meeting, Roche, 12, Grant to institution to support scientific meeting, Sandoz, 12, Grant to institution to support scientific meeting, Sanofi-Genzyme, 12, Grant to institution to support scientific meeting, Thornton & Ross, 12, Grant to institution to support scientific meeting, UCB, 12, Grant to institution to support scientific meeting, Astra-Zeneca, 5, Kyowa Kirin, 5; S. Siebert, AbbVie, 5, 6, Biogen, 6, Amgen (previously Celgene), 5, 6, Bristol Myers Squibb, 5, Boehringer-Ingelheim, 5, Novartis, 5, 6, UCB, 5, 6, Janssen, 1, 5, 6, GlaxoSmithKline, 5; A. Wearden, None; G. Macfarlane, GSK, 5, AMGEN, 5; N. Basu, Vifor, 2, 6, Lilly, 1, 5, 6, GSK, 1, Gilead, 1, Vorso, 5.

To cite this abstract in AMA style:

Bachmair E, Martin Remmes K, Aucott L, Dures E, Emsley R, Gray S, Kidd E, Kumar V, Lovell K, MacLennan G, McNamee P, Norrie J, Paul L, Packham J, Ralston S, Siebert S, Wearden A, Macfarlane G, Basu N. Remotely Delivered Cognitive Behavioural and Personalised Exercise Interventions Reduce Fatigue Severity and Impact in Inflammatory Rheumatic Diseases: Results from a Multi-centre Randomised Controlled Parallel Group Trial [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/remotely-delivered-cognitive-behavioural-and-personalised-exercise-interventions-reduce-fatigue-severity-and-impact-in-inflammatory-rheumatic-diseases-results-from-a-multi-centre-randomised-controlle/. Accessed .
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