scholarly journals 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

2021 ◽  
pp. annrheumdis-2021-220249
Author(s):  
Elena Nikiphorou ◽  
Eduardo José Ferreira Santos ◽  
Andrea Marques ◽  
Peter Böhm ◽  
Johannes WJ Bijlsma ◽  
...  
Keyword(s):  
Inflammatory Arthritis ◽  
Management Strategies ◽  
Behavioural Therapy ◽  
Self Management ◽  
Eular Recommendations ◽  
Experience Of Care ◽  
Patient Organisations ◽  
Management Interventions ◽  
Management Advice ◽  
Available Resources

BackgroundAn important but often insufficient aspect of care in people with inflammatory arthritis (IA) is empowering patients to acquire a good understanding of their disease and building their ability to deal effectively with the practical, physical and psychological impacts of it. Self-management skills can be helpful in this regard.ObjectivesTo develop recommendations for the implementation of self-management strategies in IA.MethodsA multidisciplinary taskforce of 18 members from 11 European countries was convened. A systematic review and other supportive information (survey of healthcare professionals (HCPs) and patient organisations) were used to formulate the recommendations.ResultsThree overarching principles and nine recommendations were formulated. These focused on empowering patients to become active partners of the team and to take a more proactive role. The importance of patient education and key self-management interventions such as problem solving, goal setting and cognitive behavioural therapy were highlighted. Role of patient organisations and HCPs in promoting and signposting patients to available resources has been highlighted through the promotion of physical activity, lifestyle advice, support with mental health aspects and ability to remain at work. Digital healthcare is essential in supporting and optimising self-management and the HCPs need to be aware of available resources to signpost patients.ConclusionThese recommendations support the inclusion of self-management advice and resources in the routine management of people with IA and aim to empower and support patients and encourage a more holistic, patient-centred approach to care which could result in improved patient experience of care and outcomes.

scholarly journals Effectiveness of self-management interventions in inflammatory arthritis: a systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001647
Author(s):  
Andréa Marques ◽  
Eduardo Santos ◽  
Elena Nikiphorou ◽  
Ailsa Bosworth ◽  
Loreto Carmona
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Inflammatory Arthritis ◽  
Data Extraction ◽  
Management Strategies ◽  
Psychosocial Interventions ◽  
Behavioural Therapy ◽  
Self Management ◽  
Cochrane Library ◽  
Management Interventions

ObjectiveTo perform a systematic review (SR) on the effectiveness of self-management interventions, in order to inform the European League Against Rheumatism Recommendations for its implementation in patients with inflammatory arthritis (IA).MethodsThe SR was conducted according to the Cochrane Handbook and included adults (≥18 years) with IA. The search strategy was run in Medline through PubMed, Embase, Cochrane Library, CINAHL Plus with Full Text, and PEDro. The assessment of risk of bias, data extraction and synthesis were performed by two reviewers independently. A narrative Summary of Findings was provided according to the Grading of Recommendations, Assessment, Development and Evaluation.ResultsFrom a total 1577 references, 57 were selected for a full-text review, and 32 studies fulfilled the inclusion criteria (19 randomised controlled trials (RCTs) and 13 SRs). The most studied self-management components were specific interactive disease education in ten RCTs, problem solving in nine RCTs, cognitive–behavioural therapy in eight RCTs, goal setting in six RCTs, patient education in five RCTs and response training in two RCTs. The most studied interventions were multicomponent or single exercise/physical activity in six SRs, psychosocial interventions in five SRs and education in two SRs. Overall, all these specific components and interventions of self-management have beneficial effects on IAs-related outcomes.ConclusionsThe findings confirm the beneficial effect of the self-management interventions in IA and the importance of their implementation. Further research should focus on the understanding that self-management is a complex intervention to allow the isolation of the effectiveness of its different components.

Theoretical and contextual considerations for self-management strategies of children and adolescents with chronic diseases: An integrative review

2021 ◽  
pp. 136749352110136
Author(s):  
Logan J Camp-Spivey ◽  
Ayaba Logan ◽  
Michelle Nichols
Keyword(s):  
Children And Adolescents ◽  
Chronic Diseases ◽  
Management Strategies ◽  
Healthcare Providers ◽  
Integrative Review ◽  
Self Management ◽  
Intervention Delivery ◽  
Management Interventions ◽  
Technological Platforms ◽  
Management Behaviors

The primary aim of this integrative review was to critically evaluate and synthesize published, peer-reviewed research to better understand self-management strategies of children and adolescents with chronic diseases. This review was guided by Whittemore and Knafl’s methodological framework. The Pediatric Self-management Model provided the theoretical framework for understanding how self-management behaviors operate within the domains of individual, family, community, and healthcare systems. In June 2019, the electronic databases of EBSCOhost, PubMed, and Scopus, along with reference lists of applicable studies, were searched for appropriate publications. The initial searches yielded 920 citations. Of these, 11 studies met inclusion criteria. A key finding was that involving children and adolescents in the design and delivery phases of interventions was most effective in improving self-management when the interventions did not outweigh cognitive ability or maturity level. In addition, incorporating self-efficacy promotion into self-management interventions may lead to greater sense of responsibility and improved health outcomes. In terms of intervention delivery of self-management strategies, the use of technological platforms and devices was revealed as a promising avenue for youth. A final implication was the importance of family members, peers, and healthcare providers in supporting children and adolescents in adopting self-management behaviors.

scholarly journals Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review

Arthritis ◽  
2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Shabana Amanda Ali ◽  
Kristina M. Kokorelias ◽  
Joy C. MacDermid ◽  
Marita Kloseck
Keyword(s):  
Social Support ◽  
Health Care ◽  
Scoping Review ◽  
Health Care Professionals ◽  
Management Strategies ◽  
Self Management ◽  
Cochrane Library ◽  
Group Settings ◽  
Management Interventions ◽  
Positive Social Interaction

Systematic reviews of self-management programs for osteoarthritis suggest minimal evidence of benefit and indicate substantial heterogeneity in interventions. The purpose of this scoping review was to describe the nature of self-management interventions provided to patients with osteoarthritis focusing on the inclusion and type of education and social support components. We searched PsycINFO, EMBASE, MEDLINE, and Cochrane Library databases from 1990 to 2016 to identify studies addressing community-based management strategies for osteoarthritis that included aspects of disease-specific education and ongoing social support. Results are presented as a narrative synthesis to facilitate integration of diverse evidence. Data were extracted from 23 studies that met our inclusion and exclusion criteria, describing complex, multicomponent interventions for osteoarthritis. All studies included education components, and 18 of these were osteoarthritis-specific. Social support was most often offered through peers and health care professionals, but also through exercise trainers/instructors and researchers, and lasted between 5 and 52 weeks. We charted positive social interaction offered by peers in group settings and emotional/informational support offered by health care professionals. Overall, descriptions of self-management provided limited documentation of the rationale or content of the programs. This suggests that more precise definitions of the theoretical underpinnings, components, and mechanisms would be useful for greater insight into best practices for osteoarthritis self-management programs.

scholarly journals Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis

2021 ◽  
pp. 174239532110397
Author(s):  
Sungha Kim ◽  
Ying Xu ◽  
Kelly Dore ◽  
Rebecca Gewurtz ◽  
Nadine Larivière ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Chronic Conditions ◽  
Meta Analysis ◽  
Experimental Studies ◽  
Occupational Therapists ◽  
Behavioural Therapy ◽  
Mean Difference ◽  
Self Management ◽  
Management Interventions ◽  
Quasi Experimental

Objective The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. Methods Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. Results Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:−0.62 to − 0.21); standardised mean difference of the seven exercise studies was −0.55 (95% confidence interval: −0.78 to −0.31). Discussion Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.

Exploring and Prioritization of Mobile-Based Self-Management Strategies for HIV Care

2019 ◽  
Vol 19 (3) ◽  
pp. 288-296
Author(s):  
Esmaeil Mehraeen ◽  
Reza Safdari ◽  
SeyedAhmad SeyedAlinaghi ◽  
Niloofar Mohammadzadeh
Keyword(s):  
Quality Of Life ◽  
Management Strategies ◽  
Healthcare Services ◽  
Point Of View ◽  
Hiv Care ◽  
Self Management ◽  
Second Phase ◽  
People Living With Hiv ◽  
Management Interventions

Background: Appropriate mobile-based self-management strategies can be as new approaches to decelerate the HIV infection progression and improve the quality of life. This study aims at (i) identifying in the literature mobile-based self-management strategies for HIV care and (ii) prioritizing those from the point of view of infectious diseases specialists. This study provides some clues to design useful mobile-based self-management tools for HIV patients, from the point of view of practitioners. Methods: This mixed methods study was done in two main phases. In the first phase, a review was conducted in: PubMed, Web of Science, Science Direct, Scopus, and Ovid. In this manner, related studies published between 2010 and 2017 and in the English language were reviewed. In the second phase, identified mobile-based self-management strategies were scored and prioritized by 23 participants. Frequency distribution and mean reports were calculated using SPSS statistical software. Results: By detailed reviewing of 24 related articles, the HIV mobile-based self-management strategies were identified in 47 categories and subcategories. According to the findings, "enhance the quality of life" was the main self-management strategy addressed by reviewed studies. However, "antiretroviral therapy and medication adherence" was reported at a higher rate to be a more helpful strategy than "enhance the quality of life". Conclusion: In this study, helpful HIV mobile-based self-management strategies were identified that can be used to guide self-management interventions which have the potential to improve the healthcare services for people living with HIV.

Patients’, carers’ and providers’ experiences and requirements for support in self-management of multiple sclerosis: a qualitative study

2013 ◽  
Vol 1 (2) ◽  
pp. 457 ◽  
Author(s):  
Francesca Deibel ◽  
Michelle Edwards ◽  
Adrian Edwards
Keyword(s):  
Multiple Sclerosis ◽  
Qualitative Study ◽  
Focus Groups ◽  
Management Strategies ◽  
Strong Relationship ◽  
Information Provision ◽  
Self Management ◽  
Management Skills ◽  
Long Term Conditions ◽  
Management Interventions

Background: Self-management is a process increasingly promoted for the management of long term conditions, both for ethical reasons of enhancing autonomy and for likely cost-effectiveness, but the nature and scope of self-management strategies are currently highly variable.Objective: To identify patients’, carers’ and clinicians’ current experiences of self-management in multiple sclerosis (MS) and their recommendations for the development of a future MS-specific self-management interventionMethods: Qualitative study using focus groups and semi-structured one-to-one interviews with a purposive sample. Three focus groups were held with 25 patients with moderate to advanced multiple sclerosis and 4 carers. Ten clinicians were interviewed. Data underwent thematic analysis.Results: Participants perceived multiple aspects of MS to be amenable to self-management, but identified a current lack of service provision to support their abilities to self-manage. Participants felt that to address both the physical and psychosocial challenges posed by MS required better information provision, a strong relationship with healthcare professionals and a toolkit of self-management skills. Participants expressed concern at the lack of consideration currently given to carers, which should be addressed in future provision.Conclusion: The diverse experiences of patients living with MS warrant a multidisciplinary, flexible and proactive approach to improve their self-management capabilities, acknowledging both patients’ and carers’ unmet needs. The findings can be used to guide the development of future self-management interventions specific to individuals with multiple sclerosis.

scholarly journals Results from 10 Years of a CBT Pain Self-Management Outpatient Program for Complex Chronic Conditions

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Kathryn A. Boschen ◽  
Edward Robinson ◽  
Kent A. Campbell ◽  
Sarah Muir ◽  
Elvina Oey ◽  
...  
Keyword(s):  
Management Strategies ◽  
Behavioural Therapy ◽  
Self Management ◽  
Future Research ◽  
Passive Coping ◽  
Empirically Supported ◽  
Pain Disability ◽  
Outpatient Program ◽  
Cognitive Behavioural ◽  
Before And After

Background.Traditional unimodal interventions may be insufficient for treating complex pain, as they do not address cognitive and behavioural contributors to pain. Cognitive Behavioural Therapy (CBT) and physical exercise (PE) are empirically supported treatments that can reduce pain and improve quality of life.Objectives.To examine the outcomes of a pain self-management outpatient program based on CBT and PE at a rehabilitation hospital in Toronto, Ontario.Methods.The pain management group (PMG) consisted of 20 sessions over 10 weeks. The intervention consisted of four components: education, cognitive behavioural skills, exercise, and self-management strategies. Outcome measures included the sensory, affective, and intensity of pain experience, depression, anxiety, pain disability, active and passive coping style, and general health functioning.Results.From 2002 to 2011, 36 PMGs were run. In total, 311 patients entered the program and 214 completed it. Pairedt-tests showed significant pre- to posttreatment improvements in all outcomes measured. Patient outcomes did not differ according to the number or type of diagnoses. Both before and after treatment, women reported more active coping than men.Discussion.The PMGs improved pain self-management for patients with complex pain. Future research should use a randomized controlled design to better understand the outcomes of PMGs.

scholarly journals Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: a systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis

RMD Open ◽  
2021 ◽  
Vol 7 (1) ◽  
pp. e001512
Author(s):  
Nadia M T Roodenrijs ◽  
Attila Hamar ◽  
Melinda Kedves ◽  
György Nagy ◽  
Jacob M van Laar ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Literature Review ◽  
Goal Setting ◽  
Systematic Literature Review ◽  
Functional Disability ◽  
Therapeutic Strategies ◽  
Self Management ◽  
Eular Recommendations ◽  
Management Interventions ◽  
Pregnancy And Lactation

ObjectivesTo summarise, by a systematic literature review (SLR), the evidence regarding pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis (D2T RA), informing the EULAR recommendations for the management of D2T RA.MethodsPubMed, Embase and Cochrane databases were searched up to December 2019. Relevant papers were selected and appraised.ResultsTwo hundred seven (207) papers studied therapeutic strategies. Limited evidence was found on effective and safe disease-modifying antirheumatic drugs (DMARDs) in patients with comorbidities and other contraindications that limit DMARD options (patients with obesity, hepatitis B and C, risk of venous thromboembolisms, pregnancy and lactation). In patients who previously failed biological (b-)DMARDs, all currently used b/targeted synthetic (ts-)DMARDs were found to be more effective than placebo. In patients who previously failed a tumour necrosis factor inhibitor (TNFi), there was a tendency of non-TNFi bDMARDs to be more effective than TNFis. Generally, effectiveness decreased in patients who previously failed a higher number of bDMARDs. Additionally, exercise, psychological, educational and self-management interventions were found to improve non-inflammatory complaints (mainly functional disability, pain, fatigue), education to improve goal setting, and self-management programmes, educational and psychological interventions to improve self-management.The identified evidence had several limitations: (1) no studies were found in patients with D2T RA specifically, (2) heterogeneous outcome criteria were used and (3) most studies had a moderate or high risk of bias.ConclusionsThis SLR underscores the scarcity of high-quality evidence on the pharmacological and non-pharmacological treatment of patients with D2T RA. Effectiveness of b/tsDMARDs decreased in RA patients who had failed a higher number of bDMARDs and a subsequent b/tsDMARD of a previously not targeted mechanism of action was somewhat more effective. Additionally, a beneficial effect of non-pharmacological interventions was found for improvement of non-inflammatory complaints, goal setting and self-management.

scholarly journals Self-Management Interventions to Prevent the Secondary Condition of Pain in People with Disability Due to Mobility Limitations

2016 ◽  
Vol 5 ◽  
pp. RPO.S12339 ◽  
Author(s):  
Katherine Froehlich-Grobe ◽  
Simon J. Driver ◽  
Katherine D. Sanches
Keyword(s):  
Health Care Providers ◽  
Scoping Review ◽  
Management Strategies ◽  
Self Management ◽  
Secondary Outcome ◽  
Care Providers ◽  
Mobility Limitations ◽  
Review Of The Literature ◽  
Mobility Impairment ◽  
Management Interventions

Introduction This focused review examines the use and effectiveness of self-management strategies in preventing or managing pain, which is among the most common secondary conditions faced by individuals with a mobility disability. Methods This focused review was part of a two-phase comprehensive scoping review. Phase I was a comprehensive scoping review of the literature targeting multiple outcomes of self-management interventions for those with mobility impairment, and Phase II was a focused review of the literature on self-management interventions that target pain as a primary or secondary outcome. Two authors searched CINAHL, PubMed, and PsyclNFO for papers published from January 1988 through August 2014 using specified search terms. Following the scoping review, the authors independently screened and selected the studies and reviewed the eligible studies, and the first author extracted data from the included studies. Results The scoping review yielded 40 studies that addressed pain self-management interventions for those living with mobility impairment. These 40 accumulated papers revealed a heterogeneous evidence base in terms of setting (clinic, community, and online), target populations, intervention duration (3 weeks to 24 months), and mode (health-care providers and lay leaders). Most of the reviewed studies reported that the self-management intervention led to significant reduction of pain over time, suggesting that self-management may be a promising approach for addressing pain experienced by people who live with mobility limitations. Discussion This review also reveals moderate-to-high bias across studies, and findings indicate that future research should enhance the methodological quality to provide stronger evidence about the effectiveness of self-management strategies for reducing pain among those with mobility impairments.

scholarly journals Perspectives of healthcare providers on the nutritional management of patients on haemodialysis in Australia: an interview study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020023 ◽  
Author(s):  
Jessica Stevenson ◽  
Allison Tong ◽  
Katrina L Campbell ◽  
Jonathan C Craig ◽  
Vincent W Lee
Keyword(s):  
Clinical Status ◽  
Management Strategies ◽  
Healthcare Providers ◽  
Dietary Behaviour ◽  
Self Management ◽  
Multidisciplinary Teams ◽  
Nutritional Management ◽  
Nutritional Care ◽  
Management Interventions ◽  
Collaborative Structures

ObjectiveTo describe the perspectives of healthcare providers on the nutritional management of patients on haemodialysis, which may inform strategies for improving patient-centred nutritional care.DesignFace-to-face semistructured interviews were conducted until data saturation, and thematic analysis based on principles of grounded theory.Setting21 haemodialysis centres across Australia.Participants42 haemodialysis clinicians (nephrologists and nephrology trainees (15), nurses (12) and dietitians (15)) were purposively sampled to obtain a range of demographic characteristics and clinical experiences.ResultsSix themes were identified: responding to changing clinical status (individualising strategies to patient needs, prioritising acute events, adapting guidelines), integrating patient circumstances (assimilating life priorities, access and affordability), delineating specialty roles in collaborative structures (shared and cohesive care, pivotal role of dietary expertise, facilitating access to nutritional care, perpetuating conflicting advice and patient confusion, devaluing nutritional specialty), empowerment for behaviour change (enabling comprehension of complexities, building autonomy and ownership, developing self-efficacy through engagement, tailoring self-management strategies), initiating and sustaining motivation (encountering motivational hurdles, empathy for confronting life changes, fostering non-judgemental relationships, emphasising symptomatic and tangible benefits, harnessing support networks), and organisational and staffing barriers (staffing shortfalls, readdressing system inefficiencies).ConclusionsOrganisational support with collaborative multidisciplinary teams and individualised patient care were seen as necessary for developing positive patient–clinician relationships, delivering consistent nutrition advice, and building and sustaining patient motivation to enable change in dietary behaviour. Improving service delivery and developing and delivering targeted, multifaceted self-management interventions may enhance current nutritional management of patients on haemodialysis.

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