Session: Abstracts: Health Services Research I (0805–0810)
0806: Effectiveness of a Technology-enabled Self-monitoring and Physical Therapist Counselling Program for Improving Self-management Ability in People with Rheumatoid Arthritis: A Randomized Controlled Trial
University of British Columbia Vancouver, BC, Canada
Disclosure(s): No financial relationships with ineligible companies to disclose
Linda Li1, Hui Xie2, Lynne feehan1, Na Lu3, Alison Hoens4, Kelly English5, Eileen Davidson5, Catherine L. Backman6, Smruthi Ramachandran1, Ellen Wang1, Stephanie Therrien3, Julia Mucha1, Teresa Liu-Ambrose1, Kimberly Miller7, Christopher Shaw8 and Diane Lacaille9, 1University of British Columbia, Vancouver, BC, Canada, 2Simon Fraser University, Vancouver, BC, Canada, 3Arthritis Research Canada, Vancouver, BC, Canada, 4University of British Columbia, Richmond, BC, Canada, 5Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, BC, Canada, 6The University of British Columbia, Vancouver, BC, Canada, 7BC Children’s and Women’s Hospital & Health Centre, Vancouver, BC, Canada, 8Simon Fraser University, Burnaby, BC, Canada, 9Arthritis Research Canada, University of British Columbia, Vancouver, BC, Canada
Background/Purpose: To achieve optimal health outcomes, people with rheumatoid arthritis (RA) need to know their symptom patterns and be able to practice self-care activities. With patient partners, we co-developed a Fitbit®-compatible app (OPERAS) for monitoring symptoms, disease activity, physical activity, and self-care goals. This study assessed a remote physical therapist (PT) counselling intervention using self-monitoring tools for enhancing self-management ability, physical activity participation, and health outcomes.
Methods: Eligible participants had a physician-confirmed diagnosis of RA. After baseline assessment (T0) and randomization, the ImmediateGroup (IG) received group education (2 hours), a Fitbit®, the app, and phone calls from a PT at weeks 2, 4, 6, 8, 13 and 26 to review their symptoms, treatment use, physical activity, and self-care goals. The Delay Group (DG) received a monthly e-newsletter unrelated to RA management until week 26, and then the intervention. Participants were assessed again at 27 weeks (T1) and 53 weeks (T2). Primary Outcome: Self-management ability assessed with the Patient Activation Measure (PAM-13). Secondary Outcomes: 1) RA Disease Activity Index (RADAI), 2) McGill Pain Questionnaire, 3) Fatigue Severity Scale, 4) Patient Health Questionnaire-9 (PHQ-9), 5) Self-Reported Habit Index for sitting/walking,6) daily time in moderate/vigorous physical activity and sedentary activity, and step count(SenseWear®).
We conducted intention-to-treat analysis using Generalized Linear Mixed-effect Models, adjusting forage and sex. The dependent variable was the change in outcome variable between two assessment time points. Three contrasts were assessed: 1) between-group difference (DG vs. IG) in the outcome change at T1 from T0 (T1-T0); 2) within-group difference (DG only): T2-T1 vs. T1-T0; and 3) average of contrasts 1 and 2. Contrast 3 was the primary contrast as it combined the between-group intervention effect and the within-group intervention effect.
Results: We recruited 132 participants (IG: n=66, 92.4% women; DG: n=66, 90.9% women). Both groups were similar in age [IG: 55.1 years (SD 13.3); DG: 56.9 years (SD 13.2)]. 80.3% completed the study during the COVID-19 pandemic. The adjusted mean difference in PAM-13 was 5.4 (95% CI: 0.9, 9.9). Contrast 3 was statistically significant for PAM-13 (Contrast coefficient: 5.3, 95% CI: 2.0, 8.7; p = 0.002).Examination of Contrasts 1 and 2 revealed that the effect on PAM-13 was underpinned by both the between group difference at T0-T1 and the within group change in the DG from T0-T1 (no-intervention period) to T1-T2 (intervention period) (Tables 1 & 2). Intervention effects were also found in RADAI (Contrast 3: -0.6, 95% CI: -1.1, -0.2), Fatigue Severity Scale (Contrast 3: -0.3, 95% CI: -0.5, -0.1), PHQ-9 (Contrast 3: -1.3, 95% CI: -2.3, -0.3), and Self-Reported Habit Index - walking subscale (Contrast 3: 0.4, 95% CI: 0.0, 0.7).
Conclusion: Remote PT counselling paired with use of self-monitoring tools improved self-management ability in people with RA. We also found significant effects in disease activity, fatigue, depression, and perceived walking habit at 26 weeks, suggesting the intervention had a positive effect on symptom management.
Table 1: Participant outcomes
Table 2: Intervention effect estimates using general linear mixed-effects models
L. Li: None; H. Xie: None; L. feehan: None; N. Lu: None; A. Hoens: None; K. English: None; E. Davidson: None; C. Backman: None; S. Ramachandran: None; E. Wang: None; S. Therrien: None; J. Mucha: None; T. Liu-Ambrose: None; K. Miller: None; C. Shaw: None; D. Lacaille: None.