Session Title: Rehabilitation Sciences
Session Type: Abstract Submissions (ARHP)
Background/Purpose: An RCT showed a 6 week group cognitive-behavioural (CB) intervention for RA fatigue self-management was effective, when delivered by a clinical psychologist.1 Few rheumatology teams have clinical psychologists; therefore the intervention was re-formatted for delivery by the rheumatology team, in preparation for a multi-centre RCT. We piloted the feasibility of the materials, training, and support for clinicians, plus the acceptability of the intervention for patients.
Methods: The clinical psychologist from the original intervention worked with researchers, patient partners and clinicians to re-format a clinician-led version. A clinician’s programme manual was developed with timetables, session aims, example scripts and patient handouts. A 2-day training for the rheumatology nurse and occupational therapist was developed, focusing on CB approaches (eg Socratic questioning, goal setting), managing groups, and using the session tools (eg activity diaries). They then co-delivered the intervention to 2 patient cohorts, first supervised by the clinical psychologist, then independently with supervised debriefing. On-going refinements were made, based on a cycle of feedback, review and de-briefing during all stages of the piloting.
Results: Materials for non-CB specialists: Some material has been re-written to be more suitable for non-CB specialists to deliver (eg ‘sabotage’ re-written as ‘self-defeating behaviours’); links between sessions, explaining how they build on each other and relate to CB theory, have been made more explicit.
Training: Clinicians expressed anxiety about using new CB skills, and the need to respond rapidly to differences in session discussions that inevitably occur between different patient groups. Thus training will be increased to 4 days, with more focus on CB theory (eg formulating helpful questions) and more practice delivering sessions (eg explaining metaphors).
Support: An increased emphasis on the use of supervised debrief/reflection emerged; thus a guide to debriefing has been added to the manual, and extra time allocated. Proposed clinical supervision/quality control has been increased by adding supervision of any sessions that clinicians find challenging in their second pilot.
Acceptability: Feedback from the 10 patients was positive. Mean scores on rating scales (0-10, higher scores representing greater acceptability) were: satisfaction 8.8, encouragement from clinicians 9.0, sessions well-run 9.0, helpfulness of handouts 8.4, and recommendation of the intervention to other patients 8.8.
Conclusion: Piloting interventions prior to RCT is recommended but there is little evidence about how it influences development. Iterative feedback during piloting led to essential refinements, particularly in training and support, when re-formatting the CBT intervention for delivery by non-CB specialists. It is now ready for formal testing in an RCT.
1 Hewlett et al, Ann Rheum Dis 2011;70:1060-7
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