Roos Arends

The role of goal management for successful adaptation to arthritis

OBJECTIVE Persons with polyarthritis often experience difficulties in attaining personal goals due to disease symptoms such as pain, fatigue and reduced mobility. This study examines the relationship of goal management strategies - goal maintenance, goal adjustment, goal disengagement, goal reengagement - with indicators of adaptation to polyarthritis, namely, depression, anxiety, purpose in life, positive affect, participation, and work participation. METHODS 305 patients diagnosed with polyarthritis participated in a questionnaire study (62% female, 29% employed, mean age: 62 years). Hierarchical multiple-regression-analyses were conducted to examine the relative importance of the goal management strategies for adaptation. Self-efficacy in relation to goal management was also studied. RESULTS For all adaptation indicators, the goal management strategies added substantial explained variance to the models (R(2): .07-.27). Goal maintenance and goal adjustment were significant predictors of adaptation to polyarthritis. Self-efficacy partly mediated the influence of goal management strategies. CONCLUSION Goal management strategies were found to be important predictors of successful adaptation to polyarthritis. Overall, adjusting goals to personal ability and circumstances and striving for goals proved to be the most beneficial strategies. PRACTICE IMPLICATIONS Designing interventions that focus on the effective management of goals may help people to adapt to polyarthritis.

A goal management intervention for polyarthritis patients: rationale and design of a randomized controlled trial

BackgroundA health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention’s effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders’ analysis are planned.Methods/designThe protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition.DiscussionThe purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life.Trial registrationNederlands Trial Register = NTR3606, registration date 11-09-2012.

A mixed-methods process evaluation of a goal management intervention for patients with polyarthritis

Process evaluations of newly developed interventions are necessary to identify effective and less effective intervention components. First aim of this study was to identify key components of a psychosocial goal management intervention from the perspective of participants, and second aim was to evaluate the intervention’s fidelity. A mixed-methods approach was applied to 24 interviews with participants post-intervention and 16 audio recordings of random training sessions. Participants experienced three key components: (1) the content, in which specific exercises helped to raise awareness and (intention to) change goal management behaviour, (2) person-focused approach, specifically, the nurse as trainer and personal fit of the approach, and (3) social mechanisms, including facilitating group processes and interpersonal processes. Adherence to the protocol by the trainers was high, while differences were found in the degree to which they were able to apply the intended collaborative approach and psychological communication skills. The applied design provided valuable insights into the processes that took place. Both the effects experienced by participants in relationship to the content, approach and social mechanisms as well as the strengths and weaknesses found with regard to fidelity provide insights that can inform the development and implementation of person-focused interventions.

SAT0645-HPR Results of A Goal Management Intervention for Patients with Polyarthritis with Mild Depressive Symptoms

Background Persisting disease symptoms can threaten attainment of personal important goals for patients with polyarthritis, resulting in elevated levels of depression and anxiety1. Interventions that provide patients with the skills and techniques to live with and manage their disease in daily life are essential, as people have to manage a chronic disease most of the time outside of the health-care system. For this purpose participants practice four goal management competencies (goal maintenance, goal adjustment, goal disengagement and goal re-engagement) and the flexible use of these strategies during the self-management intervention “Right on Target”. Objectives The purpose of this study was to establish whether an intervention aimed at increasing goal management capacities is effective in decreasing symptoms of depression and increasing adaptation in patients with polyarthritis with elevated levels of depressive symptoms. Methods In total, 85 persons with a diagnosis of polyarthritis and elevated levels of depression received the group-based goal management intervention Right on Target with measurements at baseline, post-intervention (after 2 months) and follow-up (6 months). A quasi-experimental design was applied in which the reference group consisted of 151 participants of a previously conducted observational study selected according to the inclusion criteria for the intervention group. Primary outcome was depression, secondary outcomes anxiety, purpose in life, positive affect and satisfaction with participation. Mediating variables were goal management strategies and arthritis self-efficacy. Linear mixed model procedure was applied to evaluate changes in outcomes. Proportions showing clinically relevant changes and possible mediators were analyzed. Results No improvement was found for depressive symptoms. Positive affect significantly improved in the intervention group mediated by an increase in goal adjustment. No changes were found for the other secondary outcomes, while goal maintenance decreased and self-efficacy for other symptoms than pain increased in the intervention group. Conclusions This study indicates the value of improving the management of personal threatened goals of people with polyarthritis and showed that especially facilitating goal adjustment and downgrading goal tenacity are potentially helpful. While more research is needed, the present study provides a small but promising direction towards greater wellbeing for patients with polyarthritis. References Arends RY, Bode C, Taal, E & van de Laar MAFJ. The longitudinal relation between patterns of goal management and psychological health in people with arthritis: The need for adaptive flexibility. BJHP, 2016, DOI:10.1111/bjhp.12182 Disclosure of Interest None declared

OP0226-HPR An In-Depth Process-Evaluation of a Goal Management Intervention Given by Rheumatology Nurses

Background This study evaluated from a patient-perspective a holistic goal management intervention intended to support patients with polyarthritis in coping with their disease and its consequences. “Right on target” is a psychosocial group intervention, given by trained rheumatology nurses, that focuses on the threatened goals of patients. The new intervention is tailored to the needs and capacities of the individual participant. Objectives The first aim of this study was to identify key components of the intervention from the perspective of patients who participated. The second aim was to evaluate whether the intervention was executed as intended (fidelity). Methods A mixed-methods approach was applied to combine different perspectives. Both qualitative and quantitative analyses were applied to (i) written weekly evaluations from 85 participants and 4 trainers, (ii) 24 in-depth structured interviews with a random selection of participants post intervention, and (iii) audio recordings of 16 random sessions. Results Participants experienced the aim of the intervention as improving adaptation to arthritis through stimulating flexible goal management behaviour. Participants highly valued that the intervention was provided in a group setting, and they perceived the group processes as increasing the effectiveness of the intervention. From patient perspective, the intervention achieved a higher awareness among participants of their personal goals, behavioural patterns, and possibilities and limitations caused by arthritis. Furthermore, change of behaviour (e.g. new behaviour) was noted by many participants. To a large extent, the applied behavioural change methods were perceived to contribute to the effectiveness of the intervention. With regard to the fidelity of the intervention, adherence to the protocol by the trainers was high. Differences were found with regard to the psychological communication skills of the trainers and the degree to which they were able to apply the intended coaching approach. The trainers had a vital role in facilitating the open and safe atmosphere that helped participants to share experiences and try out new behaviours. Conclusions Participants identified group interaction, exercises, personal trajectory and the atmosphere as key components for achieving raised awareness and behavioural change. The possibility to shape the intervention to the needs, capacities and the social environment of individual participants was also highly valued. However, analysis of the interventions fidelity indicated that both patients and nurses need support to benefit fully from the interventions patient-expert approach. The training for nurses should include advanced psychological communication skills and nurses should be regularly supervised to reduce differences between trainers. References Arends RY, Bode C, Taal E, van de Laar MAFJ (2013). A goal management intervention for polyarthritis patients: Rationale and design of a randomized controlled trial. BMC Musculoskeletal Disorders,14:239 Disclosure of Interest None declared

THU0590-HPR Self-Efficacy and Positive Adaptation in Patients with Polyarthritis

Background. A lack of self-efficacy, the confidence in one’s competencies to cope with arthritis, has been found to be related to negative aspects of psychological functioning such as depression and anxiety. There is an increasing attention for positive adaptation to chronic diseases, inspired by positive psychology. The longitudinal relationships between changes in self-efficacy and positive adaptation in patients with polyarthritis have not been investigated. Objective of this study is to analyse the relationships of changes over one in year in pain, functional limitations and self-efficacy with indicators of positive adaptation to polyarthritis Methods. 331 patients participated in a longitudinal questionnaire study. Positive adaptation was measured with PIL (purpose in life), PANAS (positive affect) and IPA (social participation). Self-efficacy to cope with arthritis was measured with ASES. Pain was assessed with a NRS and functional limitations with HAQ-DI. Data were analysed with hierarchical multiple regression analyses. Results. Changes in pain, functional limitations and self-efficacy significantly explained changes in positive adaptation (R2 =0.05-0.25). In all analyses change in self-efficacy was the strongest predictor of changes in positive adaptation. Individual beta coefficients of changes in pain and functional limitations were not significant for changes in purpose in life and positive affect. Self-efficacy significantly mediated the relationships of changes in pain and functional limitations with changes in social participation. Conclusion: This study showed that change over one year in self-efficacy is a relevant predictor of change in positive adaptation.Background A lack of self-efficacy, the confidence in ones own competencies to cope with the symptoms of arthritis, has been found to be related to negative aspects of psychological functioning such as feelings of depression and anxiety. There is an increasing attention for positive adaptation to chronic diseases, inspired by the upcoming field of positive psychology. The relationships between self-efficacy and positive adaptation in patients with polyarthritis has not been investigated. Objectives To study the relationships of pain, fatigue, functional limitations and self-efficacy with indicators of positive adaptation to polyarthritis, namely purpose in life, positive affect and social and work participation. Methods 331 patients (61% women, mean age=61 years, mean disease duration=14 years) participated in a questionnaire study. Positive adaptation was measured with PIL (purpose in life), PANAS (positive affect) and IPA (social and work adaptation). Self-efficacy to cope with pain and self-efficacy to cope with other symptoms of arthritis were measured with ASES. Pain was assessed with a VAS, fatigue with SF36 Vitality scale and functional limitations with HAQ-DI. Hierarchical multiple regression analyses were applied to analyse the relationships of physical health (pain, fatigue, functional limitations) and self-efficacy with positive adaptations. Results In regression analyses physical health (pain, fatigue, functional limitations) significantly explained positive adaptation (R2: 0.15-0.50). Explained variance in positive adaptation significantly increased when Pain self-efficacy (ΔR2:0.03-0.06) or other symptoms self-efficacy (ΔR2: 0.07-0.18). In most analyses pain and other symptoms self-efficacy pain and other symptoms self-efficacy were stronger predictors of positive adaptation than pain, fatigue or functional limitations. Except for one model (purpose in life, other symptoms self-efficacy) self-efficacy was found to be partly mediating the relationship between physical health (pain, fatigue, functional limitations) and positive adaptation. Conclusions This study showed that self-efficacy is significantly related to positive adaptation in polyarthritis. A longitudinal study should be done to get more insight in the causality of the relations. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.6008

AB1155-HPR The Relationship of Goal Management with Fatigue over One Year in Patients with Polyarthritis

Background Many patients with polyarthritis experience severe fatigue. How to cope with severe fatigue in polyarthritis is unclear. For related symptoms as pain, depressive feelings and feelings of anxiety some studies have pointed to the beneficial effects of goal management. Objectives Aim of this study was to describe the relationship of four goal management strategies (goal maintenance, goal adjustment, goal disengagement, goal re-engagement) and fatigue (severity, impact and coping) in a longitudinal perspective. Methods 331 patients (61% women, mean age=61 years, mean disease duration=14 years) participated in a questionnaire study with measurements at baseline, after six and twelve months. Goal management was measured by TenFlex and GAS, fatigue was assessed by 3 visual analogue scales, asking for the severity and impact of fatigue and coping with fatigue. Results The studied aspects of fatigue and the use of goal management strategies were stable over the course of one year. In regression analyses higher use of goal adjustment was significantly related to less severe fatigue, less impact of fatigue and better coping with fatigue. Unexpectedly, higher goal reengagement was related to more severe fatigue. Goal maintenance and goal disengagement did not contribute to the explanation of fatigue. Conclusions The results indicated stability of goal management and levels of fatigue over one year. For patients with elevated levels of fatigue it might be beneficial to change the way they deal with fatigue by adjusting personal goals. The role of goal re-engagement in relation to fatigue should be further explored since previous studies with related symptoms showed opposite relationships. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4657