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Feldthusen C1,2, Mannerkorpi K1,3
1University of Gothenburg, Sahlgrenska Academy, Centre for Person-Centered Care (GPCC), Gothenburg, Sweden, 2University of Gothenburg, Sahlgrenska Academy, Institute of Health and Care Sciences, Gothenburg, Sweden, 3University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Gothenburg, Sweden
Background: Persons with rheumatoid arthritis (RA) suffer from an autoimmune inflammatory joint disease. Although the pharmacological treatment of RA has improved substantially over the last decades over 80% of persons with RA describe suffering from fatigue of which about 40% describe severe fatigue. From a patient perspective fatigue is one of the most prominent symptoms having great impact on daily life.
Physical activity and exercise is an important part of RA-treatment and has been found to be the non-pharmacological intervention with the strongest evidence to reduce fatigue. However, for persons who are fatigued physical activity and exercise can be challenging and people with RA are found to be less physically active than the general population. Fatigue affects individuals differently due to personal and environmental circumstances, thus the management of fatigue needs to include several perspectives. A person-centered approach, emanating from each person's life-situation, preferences and resources is anticipated to strengthen a person's confidence and resources to enhance physical activity. To address fatigue in persons with RA by enhancing physical activity and balance in life, a person-centered treatment model have shown positive effects regarding fatigue, physical function and health.
Purpose: The aim of this study was to investigate the experience of the person-centered treatment model focusing on health-enhancing physical activity and daily balance to lessen fatigue to search for a deeper understanding about factors of importance for reducing fatigue in persons with RA.
Methods: Twelve participants, recruited from the intervention-group of the previous randomized controlled trial, participated in this qualitative interview study with semi-structured in-depth individual interviews. Interviews were analyzed by the methodology for qualitative content analysis.
Results: The analysis resulted in one overarching theme: Sustainable physical activity is important to handle fatigue. This insight was expressed by the participants but reaching this insight required bodily and mental experiences by themselves. The theme was developed from six categories describing barriers and facilitating factors for sustainable physical activity: I) Altered view of their physical activity and increased awareness of their fatigue, II) To mentally overcome the fatigue to be physically active, III) To make exercise easy, IV) To reach for balance, V) To receive support to be physically active and VI) To regard the RA-disease and feeling well in general.
Conclusion(s): Although having reached the insight that physical activity is important to handle fatigue, the participants struggled to overcome the fatigue in order to engage in physical activity. Barriers and facilitating factors for sustainable physical activity included both physical, psychological, social, and environmental aspects. Person-centered principles when coaching patients with fatigue to physical activity appears to promote sustainable physical activity behaviors by facilitating the patients' resources to overcome barriers to physical activity.
Implications: Physical activity is important to handle fatigue but each one have to reach this insight themselves and take responsibility for ones priorities. To come to this insight the participants had to reflect on their barriers and experience how to overcome them. This highlight the importance of applying a person-centered approach when coaching patients with fatigue to physical activity.
Keywords: Person-centered care, physical activity, fatigue
Funding acknowledgements: The University of Gothenburg Center for Person-centered care (GPCC), The Local Research and Development Board for Gothenburg and Södra Bohuslän
Physical activity and exercise is an important part of RA-treatment and has been found to be the non-pharmacological intervention with the strongest evidence to reduce fatigue. However, for persons who are fatigued physical activity and exercise can be challenging and people with RA are found to be less physically active than the general population. Fatigue affects individuals differently due to personal and environmental circumstances, thus the management of fatigue needs to include several perspectives. A person-centered approach, emanating from each person's life-situation, preferences and resources is anticipated to strengthen a person's confidence and resources to enhance physical activity. To address fatigue in persons with RA by enhancing physical activity and balance in life, a person-centered treatment model have shown positive effects regarding fatigue, physical function and health.
Purpose: The aim of this study was to investigate the experience of the person-centered treatment model focusing on health-enhancing physical activity and daily balance to lessen fatigue to search for a deeper understanding about factors of importance for reducing fatigue in persons with RA.
Methods: Twelve participants, recruited from the intervention-group of the previous randomized controlled trial, participated in this qualitative interview study with semi-structured in-depth individual interviews. Interviews were analyzed by the methodology for qualitative content analysis.
Results: The analysis resulted in one overarching theme: Sustainable physical activity is important to handle fatigue. This insight was expressed by the participants but reaching this insight required bodily and mental experiences by themselves. The theme was developed from six categories describing barriers and facilitating factors for sustainable physical activity: I) Altered view of their physical activity and increased awareness of their fatigue, II) To mentally overcome the fatigue to be physically active, III) To make exercise easy, IV) To reach for balance, V) To receive support to be physically active and VI) To regard the RA-disease and feeling well in general.
Conclusion(s): Although having reached the insight that physical activity is important to handle fatigue, the participants struggled to overcome the fatigue in order to engage in physical activity. Barriers and facilitating factors for sustainable physical activity included both physical, psychological, social, and environmental aspects. Person-centered principles when coaching patients with fatigue to physical activity appears to promote sustainable physical activity behaviors by facilitating the patients' resources to overcome barriers to physical activity.
Implications: Physical activity is important to handle fatigue but each one have to reach this insight themselves and take responsibility for ones priorities. To come to this insight the participants had to reflect on their barriers and experience how to overcome them. This highlight the importance of applying a person-centered approach when coaching patients with fatigue to physical activity.
Keywords: Person-centered care, physical activity, fatigue
Funding acknowledgements: The University of Gothenburg Center for Person-centered care (GPCC), The Local Research and Development Board for Gothenburg and Södra Bohuslän
Topic: Rheumatology; Disability & rehabilitation
Ethics approval required: Yes
Institution: Region Västra Götaland, Sweden
Ethics committee: The Regional ethical review board in Gothenburg,
Ethics number: 571-16
All authors, affiliations and abstracts have been published as submitted.
