Physical therapy app, provider phone calls improve rheumatoid arthritis fatigue, self-care
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SAN DIEGO — A remote, technology-based physical therapy intervention that included phone calls with a health care provider improved self-management and physical activity in patients with rheumatoid arthritis, according to a speaker.
“When it comes to self-management, patients with RA have to think about balancing physical activity with rest and sleep, managing medications, and knowing when to seek help when it is necessary,” Linda Li, PT, PhD, of the University of British Columbia, told attendees at ACR Convergence 2023.
Li and colleagues, alongside patient partners, co-developed a Fitbit-compatible app called OPERAS for monitoring symptoms, disease activity, physical activity and self-care goals for patients with RA. In the current analysis, the researchers examined the utility of the app using remote counseling by a physical therapist.
The overall cohort included 132 participants, 66 of whom were randomly assigned to immediate intervention, where they received a 2-hour group education course, a Fitbit, the OPERAS app and phone calls from a physical therapist at weeks 2, 4, 6, 8, 13 and 26 to review their symptoms, treatment use, physical activity and self-care goals.
Another group of 66 patients, called the delay group, received a monthly electronic newsletter unrelated to RA management for the first 26 weeks of the study. Between weeks 27 and 52, they then received the same intervention as the immediate intervention group. Assessments were performed at weeks 27 and 53.
Self-management of RA using the Patient Activation Measure (PAM-13) served as the primary endpoint. Secondary endpoints included RA Disease Activity Index (RADAI), McGill Pain Questionnaire, Fatigue Severity Scale, Patient Health Questionnaire-9 (PHQ-9), Self-Reported Habit Index for sitting/walking, daily time in moderate/vigorous physical activity and sedentary activity, and step count, according to the findings.
According to Li, previous studies of tech-based interventions on RA showed “no impact” on PAM-13.
“But if you integrate counseling with a health care professional with tailored educational content, they were found to have some effect on PAM-13,” she said.
What separates the current study from previous studies is the duration of follow up, Li said. “Previous studies were short, around 6 weeks,” she said. “If you look at longer follow-up, changes in PAM-13 no longer exist.”
It was for this reason that the group used a 53-week follow-up duration.
Results showed an adjusted mean difference in PAM-13 between the immediate and delay groups of 5.4 (95% CI, 0.9-9.9). Importantly, week 27 assessment demonstrated a slight increase in PAM-13 in the immediate treatment group, with 18 of 27 patients in this group achieving a four-point improvement in this metric, according to the researchers. At this time point, there was a slight decrease in PAM-13 among patients in the delay group.
In addition, the researchers observed intervention effects, as assessed by RADAI (Contrast 3, –0.6; 95% CI, –1.1 to –0.2), Fatigue Severity Scale (Contrast 3, –0.3; 95% CI, –0.5 to –0.1), PHQ-9 (Contrast 3, –1.3; 95% CI; –2.3 to –0.3), and the walking subscale of Self-Reported Habit Index (Contrast 3, 0.4; 95% CI, 0-0.7).
“The program improved RA disease activity, fatigue, depression and self-reported walking habits, although the effect size was small,” Li said.
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Li L. Abstract 806 Presented at: ACR Convergence 2023; Nov. 10-15, 2023; San Diego (hybrid meeting).
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