Louise Larkin

Correlates of Physical Activity in Adults With Rheumatoid Arthritis: A Systematic Review

BACKGROUND Physical activity (PA) is an important component in the management of Rheumatoid Arthritis (RA). To date the correlates of PA have not been thoroughly investigated in the RA population. The aim of this systematic review was to determine the correlates of PA in the adult RA population. METHODS A search of Medline, EMBASE, AMED, CINAHL plus, Pubmed, Web of Science, and the Cochrane Library was conducted. A manual search of reference lists was conducted to compliment the electronic search. Ten studies fulfilled the inclusion criteria and were assessed for methodological quality. RESULTS Results determined correlates in 4 categories: sociodemographic, physical, psychological and social variables. The variables varied greatly and were inconsistently studied. Changes were noted from a previous review in 2005 in relation to the association between certain variables and PA, including age, gender, disease duration, pain, exercise beliefs and social support. CONCLUSIONS Positive associations with PA were found for motivation, self-efficacy, health perception, and previous PA levels. Negative associations were found for fatigue, a coerced regulation style and certain physiological variables. In addition differences between correlates of PA in the adult RA population and other chronic disease and healthy adult populations have been demonstrated.

Behaviour change interventions to promote physical activity in rheumatoid arthritis: a systematic review

Research has shown that people who have rheumatoid arthritis (RA) do not usually participate in enough physical activity to obtain the benefits of optimal physical activity levels, including quality of life, aerobic fitness and disease-related characteristics. Behaviour change theory underpins the promotion of physical activity. The aim of this systematic review was to explore behaviour change interventions which targeted physical activity behaviour in people who have RA, focusing on the theory underpinning the interventions and the behaviour change techniques utilised using specific behaviour change taxonomy. An electronic database search was conducted via EBSCOhost, PubMed, Cochrane Central Register of Controlled Trials and Web of Science databases in August 2014, using Medical Subject Headings and keywords. A manual search of reference lists was also conducted. Randomised control trials which used behaviour change techniques and targeted physical activity behaviour in adults who have RA were included. Two reviewers independently screened studies for inclusion. Methodological quality was assessed using the Cochrane risk of bias tool. Five studies with 784 participants were included in the review. Methodological quality of the studies was mixed. The studies consisted of behaviour change interventions or combined practical physical activity and behaviour change interventions and utilised a large variety of behaviour change techniques. Four studies reported increased physical activity behaviour. All studies used subjective methods of assessing physical activity with only one study utilising an objective measure. There has been varied success of behaviour change interventions in promoting physical activity behaviour in people who have RA. Further studies are required to develop and implement the optimal behaviour change intervention in this population.

Criterion Validity of the activPAL Activity Monitor for Sedentary and Physical Activity Patterns in People Who Have Rheumatoid Arthritis

Background Accurate measurement of physical activity and sedentary behavior is an important consideration for health care professionals. The activPAL activity monitor has not been validated against a criterion measure for people with rheumatoid arthritis (RA). Objective The objective of this study was to determine the criterion validity of the activPAL activity monitor for measuring step counts, transition counts, and time spent in sedentary, standing, and walking behaviors in people with RA. Design A laboratory-based criterion validation study was conducted. Methods Participants with a confirmed medical diagnosis of RA were recruited from 2 outpatient rheumatology clinics. The testing procedure consisted of standardized testing components and tasks related to activities of daily living. Participants wore an activPAL activity monitor and were video recorded throughout the testing procedure. Direct observation was used as the criterion measure. Data analysis consisted of validation analysis of the activPAL activity monitor data and the criterion measure data. Results Twenty-four people participated in the study. Data from 20 participants were included in the final analysis. The activPAL significantly underestimated step counts by 26% and transition counts by 36%. There was no significant difference between the activPAL activity monitor and the criterion measure for time spent in sedentary, standing or light activity, and walking behaviors. Limitations Validation of activities of daily living in a laboratory environment is a limitation of this study. Conclusions The activPAL activity monitor underestimated step and transition counts and, therefore, is not valid for measuring these outcomes in people with RA. Relative to direct observation, the activPAL activity monitor is valid for measuring time spent in sedentary, standing, and walking behaviors in people with RA.

If a joint is hot it’s not the time: health professionals’ views on developing an intervention to promote physical activity in rheumatoid arthritis

Abstract Purpose: The study aimed to explore the views of health professionals on (i) physical activity in people who have rheumatoid arthritis (RA) and (ii) the design of an intervention to promote physical activity in this population. Method: We used a qualitative methodology and conducted 14 interviews (rheumatologists n = 7, physiotherapist n = 4, clinical nurse specialists n = 3). Interviews were transcribed verbatim and analyzed using thematic analysis. Results: Three key themes were generated: “Personal opinions”, “Supporting physical activity” and “An ideal world”. Although health professionals viewed physical activity as important, recommending it to people who have RA was largely based on persons’ disease status rather than empirical evidence. Resources were highlight as a key challenge to interventions in clinical practice. Supporting physical activity through provision of information, goal setting and monitoring was also discussed. Conclusion: Health professionals believe physical activity is important for people who have RA, although there is uncertainty regarding physical activity recommendations for this population. Thus, there is scope to increase health professionals’ knowledge of recent evidence. Views varied on how an intervention to promote physical activity should be delivered, but consideration of barriers to delivery in clinical practice is important. Implications for Rehabilitation Physical activity is an important aspect of disease management for people who have rheumatoid arthritis. Health professionals need to acknowledge the “mixed messages” received by people who have RA about being physically active thus further education for health professionals is suggested to standardize physical activity advice in clinical practice. Health professionals may benefit from education about behavior change theory and techniques. When designing future physical activity interventions consideration of the practical challenges of implementing research in a clinical setting is necessary.

'It might hurt, but still it's good': People with rheumatoid arthritis beliefs and expectations about physical activity interventions.

Many people who have rheumatoid arthritis report low levels of physical activity. We conducted 17 interviews with people who have rheumatoid arthritis to gain insight into how they view physical activity and to explore how their levels of activity may be increased. Interviews were transcribed verbatim and analysed using thematic analysis. Four main themes were generated: being active, barriers and facilitators, information and advice, and supporting physical activity. A lack of information about being active fostered negative emotions limiting physical activity participation. Improved provision of physical activity advice is warranted to promote physical activity in people who have rheumatoid arthritis.

Is Group-Based or Individual-Based Intervention more Effective for Quality of Life Outcomes in Children with Developmental Coordination Disorder? A Systematic Review

Abstract Aims: To examine whether group-based or individual-based treatment programs are more effective for quality of life (QOL) outcomes in children with developmental coordination disorder (DCD). Methods: A systematic search of the literature was conducted, in accordance with the PRISMA guidelines. Quality of the papers was assessed using the Modified Downs and Black Checklist. Peer-reviewed clinical experimental studies of children diagnosed with DCD with any QOL related outcome measure were included, of all years, languages, and approaches of intervention. Results: Sixteen studies were identified for inclusion, of mixed methodological qualities (predominantly low). Improvement of QOL with both group-based and individual-based interventions were shown, though large degrees of heterogeneity were observed in study designs, participants, modes of interventions, durations, and outcome measures utilized. Conclusions: The effectiveness of group-based versus individual-based interventions on QOL of children with DCD is unclear. There is a pressing need for a high quality, powered trials, utilizing the randomized control trial paradigm, comparing both intervention approaches with standardized treatment approaches and outcome measures to determine and compare the effect on QOL of children with DCD.

THU0738-HPR Promoting physical activity in rheumatoid arthritis: developing a theory-based behaviour change intervention

Background Physical activity has numerous benefits for people who have RA, however interventions targeting physical activity behaviour in people who have RA have had limited efficacy [1]. Objectives To develop a theory-based behaviour change intervention to promote physical activity in people who have RA. Methods Development was guided by the UKs Medical Research Council Complex Interventions framework [2] and consisted of three components; 1. Narrative review which explored the use of behaviour change theory in previous interventions 2. Systematic review which examined the content and structure of previous interventions 3. Qualitative study which explored the preferences of key stakeholders (people who have RA and health professionals) about the design of the intervention. Results Previous interventions lacked consideration of behaviour change theory in design and delivery, and there was a large degree of variance in content, structure and delivery. Lack of knowledge of current physical activity recommendations for people who have RA was highlighted in the qualitative study, and delivery preferences were identified. Intervention development was mapped to the Behaviour Change Wheel [3] and employed the Theory of Planned Behaviour as its theoretical basis. The proposed intervention is outlined in Table 1. Conclusions We have developed a theory-based intervention which considers the preferences of key stakeholders. Future research will determine the feasibility and effectiveness of this intervention. References Larkin et al (2015) Behaviour change interventions to promote physical activity in rheumatoid arthritis: a systematic review. Rheum Intl 35(10):1631–40. Craig et al (2008) Developing and evaluating complex interventions: new guidance, BMJ (Clinical research ed.), 337, a1655. Michie et al (2014) The Behaviour Change Wheel: A Guide to Designing Interventions., Silverback Publishing: Great Britain. Disclosure of Interest None declared

Shouldering the Burden of Evidence-Based Practice: The Experiences of Physiotherapists Partaking in a Community of Practice

The study aim was to elicit the motivators, barriers, and benefits of participation in a Community of Practice (CoP) for primary care physiotherapists. We used a qualitative approach using semistructured interviews. The participants were twelve physiotherapists partaking in a newly formed Shoulder CoP. A desire for peer support was the strongest motivator for joining, with improving clinical practice being less apparent. Barriers to participation included time and work pressures and poor research skills. The structure of the CoP, in terms of access to meetings and the provision of preparation work and deadlines for the journal clubs, was reported to be a facilitator. Multiple benefits ensued from participation. The role of teamwork was emphasised in relation to reducing isolation and achieving goals. The majority of participants reported positive clinical practice changes in terms of improved patient education, increased confidence, and availability of new resources. All participants reported some element of personal growth and development, in particular in their evidence-based practice skills. The results provide support for the use of CoPs as a means of continuing professional development for physiotherapists in the workplace, as significant benefits are gained in terms of evidence-based practice (EBP), patient care, and therapist personal development.

Relationship between, self-efficacy, beliefs, and physical activity in inflammatory arthritis

Background: The benefits of physical activity (PA) in inflammatory arthritis (IA) patients are well-established. However, levels of PA in the IA population are suboptimal and the psychological determinants of PA are poorly understood. Objective: The study aimed to examine the self-reported PA levels and psychological determinants of PA for the IA population. Methods: A cross-sectional study of people with rheumatoid arthritis (RA) and psoriatic arthritis (PsA) was conducted to explore the association between demographic and psychological variables such as self-efficacy and belief about PA, and levels of PA and energy expenditure (EE). PA was recorded using the Yale Physical Activity Survey (YPAS). Results: A total of 102 participants were included in the study. Participants reported low levels of PA [mean ± standard deviation (SD), 24.3 ± 18.2]. Beliefs about PA, but not self-efficacy, correlated with levels of self-report PA over the past week (r = 0.25, p = 0.01), over the past month (r = 0.21, p = 0.04), and EE (r = 0.31, p = 0.01). Conclusion: People with IA have decreased levels of PA. Beliefs about PA are associated with levels of self-report PA and EE in this population. These data provide a useful signpost for guiding and designing interventions to improve PA levels in IA populations by altering beliefs about PA.