A MINDFULNESS-BASED GROUP INTERVENTION SIGNIFICANTLY REDUCED PSYCHOLOGICAL DISTRESS AND FATIGUE IN PATIENTS WITH INFLAMMATORY ARTHRITIS: RESULTS FROM A RANDOMISED CONTROLLED TRIAL

Background: In spite of substantial advances in medical treatment, many patients with inflammatory arthritis (IA) still have to deal with disease-related symptoms such as pain, fatigue and psychological distress. Vitality Training (VT) is a group intervention within the newer tradition of mindfulness- and acceptance-based therapies and has previously been tested in persons with chronic musculoskeletal pain. It aims at increasing individuals' psychological flexibility and strengthening their ability to cope with current life situation. Objectives: To evaluate effects of VT on psychological distress, self-efficacy and disease-related symptoms in persons with IA. Methods: Patients from 3 rheumatology clinics in Norway were asked to participate in the study and were randomised to either the VT group with a 15-weeks 10-session process-oriented group intervention comprising a combination of mindfulness-based training, creative exercises and group reflections; or a waiting list control group that got a CD with mindfulness-based home exercises. Both groups received usual care throughout the trial. Primary outcomes assessed post-treatment and 12 months after inclusion included psychological distress measured by General Health Questionnaire-20 (0 - 60, 0 = no distress) and self-efficacy pain and symptoms measured by Arthritis Self-Efficacy Scales (10 - 100, 100 = high self-efficacy). Secondary outcomes included pain, fatigue and patient assessed disease activity measured by Numerical Rating Scales (0 - 10, 0 = no pain/fatigue/disease activity). Results: Seventy-one patients were randomised, 36 to VT and 35 to control; 79% were female, mean (SD) age 54 (9.1) and disease duration 16 (12.7) years, with the diagnoses rheumatoid arthritis (59%), ankylosing spondylitis (21%), psoriatic arthritis (10%) and other inflammatory arthritis (10%). Sixty-eight patients (96%) were available for follow-up post-treatment (34 in each group), and 67 (94%) completed 12 months assessments (34 in VT and 33 in control). Significant treatment effects in favour of the VT group were found post-treatment and 12 months in psychological distress, fatigue, self-efficacy pain and symptoms. Outcomes for pain and disease activity were of smaller magnitude (table). Table 1. Adjusted mean differences (95% CI) between the VT group and control group post-treatment and 12 months, and overall p-values, estimated with mixed models linear repeated measures analysis Post-treatment (n=68)12 months (n=67)P-value Psychological distress-4.7 (-1.8, -7.6)-3.7 (-1.1, -6.3)0.002 Self-efficacy pain8.2 (14.2, 2.1)9.1 (14.8, 3.4)0.001 Self-efficacy symptoms8.8 (14.6, 3.0)13.1 (19.3, 6.7)<0.001 Pain-0.4 (0.22, -0.97)-0.6 (0.02, -1.28)0.06 Fatigue-0.8 (-0.2, -1.5)-1.1 (-0.4, -1.8)0.002 Disease activity-0.3 (0.23, -0.89)-0.7 (-0.05, -1.38)0.07 Conclusions: VT significantly improved psychological distress, fatigue and self-efficacy post-treatment, and improvements were maintained at 12 months follow-up. The results show that a mindfulness-based group intervention can be an important complement to medical disease management in persons with IA. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 748Session: Abstract Session: Effectiveness of rheumatology rehabilitation: the future looks bright (Oral Presentations )