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Motivational Counseling and Text Reminders Improve Outcomes in Patients with RA

VBCR - August 2017, Vol 6, No 3 - Rheumatoid Arthritis
Anne Rowe

A recently published report has shown that individually tailored behavioral interventions comprised of motivational counseling and text message reminders may effectively reduce daily sedentary time in patients with rheumatoid arthritis (RA), resulting in improvements in patient outcomes, including cholesterol levels (Thomsen T, et al. Ann Rheum Dis. 2017 June 5. Epub ahead of print).

Tanja Thomsen, MScH, PhD Student, Occupational Therapist, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, University of Copenhagen, Glostrup, Denmark, and colleagues conducted an observer-blinded, randomized, controlled clinical trial aimed at helping patients become more physically active in a manner that was more likely to be maintained over time by focusing on realistic goals.

“In patients with chronic disease and mobility limitations, replacing sedentary behaviour with light intensity activities may prove more achievable than solely focusing on increasing moderate-to-vigorous physical activity,” Ms Thomsen and colleagues explained.

A total of 150 patients were randomly assigned on a 1:1 basis to intervention (n = 75) or nonintervention control (n = 75) groups. Patients in the intervention group received 3 individual motivational counseling sessions by healthcare workers, as well as text messages, with the goal of discouraging sedentary behavior during the 16-week intervention period. Patients in the control groups were told to continue with their typical lifestyles.

The primary end point of the trial was a change in daily sitting time, which was assessed objectively using an activity monitor, ActiPAL 3TM v.7.2.32. Participants wore the device 24 hours daily for 7 days at baseline and by the end of the intervention, and were asked to keep a diary of their daily sleeping time so investigators could distinguish sleep from time spent sitting and lying down while awake. Changes in pain, fatigue, physical function, general self-efficacy, quality of life, blood pressure, blood lipids, hemoglobin A1c, body weight, body mass index, waist circumference, and waist-hip ratio were also evaluated as secondary end points.

Mean daily sitting time decreased by –1.61 hours daily in the intervention group, and increased by 0.59 hours daily in the control group (between-group difference, –2.20; 95% confidence interval, –2.72 to –1.69; P <.0001).

There were also significant between-group differences in self-reported daily sitting time at work and during leisure time, fatigue, pain, physical function, quality of life, general self-efficacy, and in total cholesterol, in favor of the intervention.

In addition, patients who received counseling and text messages showed greater improvements in terms of weight, waist and hip circumference, waist-hip ratio, body mass index, and blood pressure compared with their counterparts who did not receive these interventions, although the between-group differences were not significant.

“Individual motivational counselling sessions during a 16-week period accompanied by individual SMS [short message service] reminders reduced daily sitting time by more than 2 hours compared with the control group. Patient-reported outcomes also improved and, to a lesser extent, cardiometabolic biomarkers,” Ms Thomsen and colleagues stated.

The investigators did note that there was a possibility the significant improvements seen in cholesterol levels and patient-reported outcomes in the intervention group could have been influenced by factors other than increased physical activity, such as healthy eating habits.

“Without neglecting the important and well-established health benefits of engaging in moderate-to-vigorous physical activity, our results indicate that patients with RA can achieve substantial health benefits by reducing sitting time. This would have implications for clinical practice and physical activity recommendations,” Ms Thomsen and colleagues said.

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Last modified: September 11, 2017
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