scholarly journals A Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Intervention as an Addition to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation alongside an RCT (Preprint)

2018 ◽  
Author(s):  
Maaike Ferwerda ◽  
Sylvia van Beugen ◽  
Henriët van Middendorp ◽  
Henk Visser ◽  
Harald Vonkeman ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Usual Care ◽  
Cognitive Behavioural Therapy ◽  
Behavioural Therapy ◽  
Healthcare Use ◽  
Cognitive Behavioural ◽  
Related Quality ◽  
Health Related

BACKGROUND A chronic somatic condition, such as rheumatoid arthritis (RA), can significantly reduce health related quality of life due to psychological, social and physical consequences. Cognitive behavioural therapy can aid in improving outcomes for patients, for example in terms of disease trajectory, health care utilization, and workplace disability of patients. In recent years internet-based cognitive behavioural therapy has been proposed as an effective and efficient way to offer cognitive behavioural therapy and further implementation. However, little research has been conducted to support this proposition. OBJECTIVE To stimulate the implementation of effective treatment strategies for improving health-related quality of life (HRQoL) of patients with rheumatoid arthritis (RA), cost-benefit ratios are required to inform stake-holders. A cost-effectiveness study from a societal perspective was conducted alongside a randomized controlled trial on a tailored and therapist-guided internet-based cognitive behavioural intervention (ICBT) for patients with elevated levels of distress, as an addition to usual care alone. METHODS Data were collected at baseline/pre-intervention, 6 months/post-intervention, and three-monthly thereafter during one year follow-up. Effects were measured in quality-adjusted life years (QALYs) and costs from a societal perspective including healthcare sector costs (including healthcare use, medication, and intervention costs), patient travel costs for healthcare use, and costs associated with loss of labor. RESULTS The intervention improved quality of life compared to usual care alone (Δ QALYs= 0.059), but also led to higher costs (Δ= € 4.211,44), which reduced substantially when medication costs were left out of the equation (Δ= € 1.862,72). Most (93%) of the simulated ICERS were in the north-east quadrant, suggesting a high probability that the intervention is effective in improving HRQoL, but at a greater monetary cost for society compared to usual care alone. CONCLUSIONS A tailored and guided ICBT intervention as an addition to usual care for patients with RA with heightened distress was effective in gaining quality of life. Consequently, implementation of the ICBT into standard healthcare for patients with RA is recommended, yet further study into cost reductions in this population is warranted. CLINICALTRIAL National trial registry number:NTR2100

scholarly journals Cognitive–behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

2021 ◽  
Vol 25 (9) ◽  
pp. 1-378
Author(s):  
Beth Fordham ◽  
Thavapriya Sugavanam ◽  
Katherine Edwards ◽  
Karla Hemming ◽  
Jeremy Howick ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Behavioural Therapy ◽  
Systematic Reviews ◽  
Prediction Interval ◽  
Behavioural Therapy ◽  
Health Related Quality ◽  
Cognitive Behavioural ◽  
Related Quality ◽  
Health Related

Background Cognitive–behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive–behavioural therapy systematic reviews suggested that cognitive–behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials. Objectives This project was undertaken to map the quality and gaps in the cognitive–behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive–behavioural therapy. Data sources The overview was designed with cognitive–behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019. Review methods Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive–behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive–behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I 2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality. Results A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive–behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive–behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.05 to 0.50, I 2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval –0.28 to 0.88, I 2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval –0.28 to 0.74, I 2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions. Limitations Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them. Conclusion Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive–behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes. Future work Future research should focus on how the modest effect sizes seen with cognitive–behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality. Study registration This study is registered as PROSPERO CRD42017078690. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

Effects of brief mindfulness-based cognitive behavioural therapy on health-related quality of life and sense of coherence in atrial fibrillation patients

2018 ◽  
Vol 17 (7) ◽  
pp. 589-597 ◽  
Author(s):  
Dan Malm ◽  
Bengt Fridlund ◽  
Helena Ekblad ◽  
Patric Karlström ◽  
Emma Hag ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Sense Of Coherence ◽  
Behavioural Therapy ◽  
Health Related Quality ◽  
Cognitive Behavioural ◽  
Related Quality ◽  
Health Related

Background: The aim of this study was to evaluate the effects of a brief dyadic cognitive behavioural therapy (CBT) programme on the health-related quality of life (HRQoL), as well as the sense of coherence in atrial fibrillation patients, up to 12 months post atrial fibrillation. Methods: A longitudinal randomised controlled trial with a pre and 12-month post-test recruitment of 163 persons and their spouses, at a county hospital in southern Sweden. In all, 104 persons were randomly assigned to either a CBT ( n=56) or a treatment as usual (TAU) group ( n=55). The primary outcome was changes in the HRQoL (Euroqol questionnaire; EQ-5D), and the secondary outcomes were changes in psychological distress (hospital anxiety and depression scale; HADS) and sense of coherence (sense of coherence scale; SOC-13). Results: At the 12-month follow-up, the CBT group experienced a higher HRQoL than the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.015; P=0.02). The sense of coherence improved in the CBT group after the 12-month follow-up, compared to the TAU group (mean changes in the CBT group 0.062 vs. mean changes in the TAU group −0.16; P=0.04). The association between the intervention effect and the HRQoL was totally mediated by the sense of coherence ( z=2.07, P=0.04). Conclusions: A dyadic mindfulness-based CBT programme improved HRQoL and reduced psychological distress up to 12 months post atrial fibrillation. The sense of coherence strongly mediated the HRQoL; consequently, the sense of coherence is an important determinant to consider when designing programmes for atrial fibrillation patients.

scholarly journals Are we sleeping on the job? Insomnia among men with prostate cancer

2016 ◽  
Vol 2 (2) ◽  
pp. 74 ◽  
Author(s):  
Frances Josephine Drummond
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Psychological Health ◽  
Large Population ◽  
Behavioural Therapy ◽  
Health Related Quality ◽  
Cognitive Behavioural ◽  
Related Quality ◽  
Health Related

<p>Prostate cancer is one of the most commonly diagnosed cancers in men and almost half of male cancer survivors in the US have had a prostate cancer diagnosis. Insomnia is common among cancer patients and survivors. There is evidence that cognitive behavioural therapy can be used to effectively manage insomnia among women with breast cancer. The aim of this review was to investigate the prevalence, risk factors and management of insomnia among men with prostate cancer. The effect of insomnia on the psychological health and health-related quality of life of these patients and/or survivors is also discussed. Increased awareness and knowledge of this symptom among men with prostate cancer may facilitate improved diagnosis, and management of insomnia in this large population. This in turn may improve the health-related quality of life of these men. Therefore, research into the effective management of insomnia among men with prostate cancer is essential.</p>

scholarly journals Randomized controlled study of the impact of a participatory patient care plan among primary care patients with common chronic diseases: a one-year follow-up study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Tusa ◽  
Hannu Kautiainen ◽  
Pia Elfving ◽  
Sanna Sinikallio ◽  
Pekka Mäntyselkä
Keyword(s):  
Quality Of Life ◽  
Patient Care ◽  
Usual Care ◽  
Care Plan ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Disease Specific

Abstract Backround Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases. Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension. Methods The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017–2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit. Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up. Results A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes. Conclusions During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline. Trial registration ClinicalTrials.gov Identifier: NCT02992431. Registered 14/12/2016

Differential impact of systemic lupus erythematosus and rheumatoid arthritis on health-related quality of life

2017 ◽  
Vol 26 (7) ◽  
pp. 1767-1775 ◽  
Author(s):  
Benjamin Chaigne ◽  
◽  
Axel Finckh ◽  
Deshire Alpizar-Rodriguez ◽  
Delphine Courvoisier ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rheumatoid Arthritis ◽  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Health Related Quality ◽  
Systemic Lupus ◽  
Differential Impact ◽  
Related Quality ◽  
Health Related
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