Rheumatoid Arthritis: van Achterberg T

Repping-Wuts H, van Riel P, van Achterberg T. · No affiliation provided · Rheumatology (Oxford). · Pubmed #18927188 No free full text.

This publication has no abstract.

Repping-Wuts H, Hewlett S, van Riel P, van Achterberg T. · Radboud University Nijmegen Medical Centre, The Netherlands. · J Adv Nurs. · Pubmed #19243466 No free full text.

Abstract: AIM: This paper is a report of a study conducted to compare the knowledge, attitudes and current management of rheumatoid arthritis-related fatigue in British and Dutch rheumatology nurses. BACKGROUND: After pain, fatigue is the most important symptom for patients with rheumatoid arthritis, but little is known about the current management of this fatigue by healthcare professionals. METHODS: A questionnaire was mailed in 2007 to rheumatology nurses who were members of British Health Professionals in Rheumatology (N = 267) and the Dutch Society of Rheumatology Nurses (N = 227). Descriptive statistics, independent samples t-test and Pearson chi-square tests were used for statistical analysis. RESULTS: A total of 494 nurses returned questionnaires (response rate 48%). In general, their knowledge about rheumatoid arthritis fatigue was in accordance with the literature and all indicated a positive attitude towards assessing and managing rheumatoid arthritis-related fatigue. However, respondents reported contradictory views about managing fatigue. Although they believed that other team members could help patients, they seldom referred patients on to other professionals. Although nurses believed that other advice besides pacing and balance between activity and rest might help, they did not offer this to patients. Despite acknowledging that there is poor communication about fatigue between patients and nurses, respondents reported that it is patients rather than nurses who raise the issue of fatigue in consultations. CONCLUSION: British and Dutch rheumatology nurses are sympathetic but do not know how to manage rheumatoid arthritis-related fatigue. Strategies to support self-management for this fatigue, and to increase communication between healthcare professionals and patients, should be initiated to help improve patient outcomes for rheumatoid arthritis-related fatigue.

Repping-Wuts H, Repping T, van Riel P, van Achterberg T. · Department of Rheumatology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. · Patient Educ Couns. · Pubmed #19118972 No free full text.

Abstract: OBJECTIVE: To describe nurse-patient and rheumatologist-patient interaction in fatigue communication at the rheumatology out-patient clinic. METHODS: Consultations of 20 rheumatoid arthritis (RA) patients with the nurse specialist and the rheumatologist were videotaped and analysed using the Medical Interview Aural Rating Scale (MIARS). Subsequently, patients were asked to fill out a concern questionnaire asking how worried they felt and how satisfied they were with attention given by both healthcare professionals. Finally, patients were interviewed on reasons for being not or not completely satisfied with the care received. RESULTS: Fatigue was discussed in 42% of the rheumatologists' consultations and 83% of the nurse specialists' consultations. RA patients more often used implicit cues instead of explicit concerns related to fatigue. Almost 72% of the patients felt worried about fatigue and in general they were more satisfied with the nurse specialist's attention to fatigue than with the attention from the rheumatologist. CONCLUSION: Fatigue is not structurally communicated at the rheumatology out-patient clinic and exploring and acknowledging communication techniques can help patients to express their concerns about fatigue. PRACTICE IMPLICATIONS: Healthcare professionals must recognise fatigue as a severe problem for RA patients and start the conversation on fatigue instead of waiting for the patient to mention fatigue spontaneously.

Repping-Wuts H, van Riel P, van Achterberg T. · Department Rheumatology/495, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. · Clin Rheumatol. · Pubmed #18622574 No free full text.

Abstract: To describe rheumatologists' knowledge, attitude and current management of fatigue in patients with rheumatoid arthritis (RA), a postal questionnaire was sent to all rheumatologists (N = 204) and trainees (N = 49), members of the Dutch Society of Rheumatology. The overall response rate was 44% (N = 110). In general, rheumatologists' knowledge about RA-related fatigue was in accordance with the literature but they perceive a lack of their own knowledge about aetiology and evidence-based interventions to prevent and treat fatigue. The majority of the rheumatologists believe that fatigue is a multi-disciplinary diagnosis and is preferably managed by the nurse specialist (34%). Assuming that the patient will raise the issue, most of the rheumatologists pay attention to fatigue during the first consultation and less often during follow-up consultations. There is a need for knowledge about causes and treatments for RA-related fatigue to ensure that patient outcomes are improved.

Repping-Wuts H, Fransen J, van Achterberg T, Bleijenberg G, van Riel P. · Department of Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. · J Clin Nurs. · Pubmed #17931330 No free full text.

Abstract: AIM: To determine whether persistent severe fatigue in patients with rheumatoid arthritis can be predicted by inflammation and disability. METHODS: A follow-up study with a one-year duration was performed. From an existing rheumatoid arthritis cohort, 150 consecutive patients, with established rheumatoid arthritis, were asked to assess fatigue, using the subscale Checklist Individual Strength-fatigue of the Checklist Individual Strength at baseline and 12 months later. The Checklist Individual Strength-fatigue scores were classified into 'normal' (score between 8-27), 'moderate' (score between 27-34) or 'severe' (score 35 or above) fatigue. Disease-related variables were: tender joints, swollen joints, general health, disability and laboratory measures (erythrocyte sedimentation rate, rheumatoid factor and haemoglobin). Predictors of persistent severe fatigue were identified by multiple logistic regression analyses with backward selection (selection criteria: p<0.05). RESULTS: At baseline, 137 patients agreed to participate and 123 patients completed the study. Severe fatigue was experienced by as many as 50% of the patients, both at baseline and at the end of the study (n = 123). Moreover, 49 patients (40%) experienced severe fatigue at baseline as well as at follow-up, which we called 'persistent severe fatigue'. Persistent severe fatigue was predicted by mean general health and disability at baseline [odds ratio (OR) = 2.03 and 2.83, respectively] in this group of rheumatoid arthritis patients with a low-to-moderate level of disease activity and disability. CONCLUSION: The data show that severe fatigue is not resolved spontaneously in rheumatoid arthritis patients, and persistent severe fatigue is mainly predicted by general health and disability. The relation with inflammation or a low level of haemoglobin, which is often assumed in clinical practice, was not found. RELEVANCE TO CLINICAL PRACTICE: Fatigue in patients with rheumatoid arthritis has to be considered as a symptom that needs to be addressed by professionals in the same way as pain and disability. In current care, fatigue is insufficiently addressed.

Repping-Wuts H, Uitterhoeve R, van Riel P, van Achterberg T. · Department of Rheumatology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands. · Int J Nurs Stud. · Pubmed #17662291 No free full text.

Abstract: OBJECTIVE: Interest in fatigue research has grown since the finding that fatigue is, besides pain, the symptom most frequently reported by patients with rheumatoid arthritis (RA). The aim of this study was to explore the experience of fatigue from the patients' perspective. METHODS: Twenty-nine patients with RA filled-out written questionnaires on fatigue severity, disability, quality of life and sleep disturbance, and disease activity was calculated using the Disease Activity Score (DAS28). All patients were individually interviewed and asked about fatigue. Qualitative analyses were completed using software program "The Observer". Basic codes, a code plan and coding rules were developed by two researchers through a consensus-based review process. Frequencies of the central codes were calculated by the program SPSS. RESULTS: RA fatigue is verbalised as a physical everyday experience with a variety in duration and intensity. Its sudden onset and exhausting nature is experienced as frustrating and causing anger. Patients mentioned having RA as the main cause of their fatigue. The consequences of fatigue are overwhelming and influence patients' everyday tasks, attitudes and leisure time. Patients described how they have to find their own management strategies by trial and error and described pacing and rest, relaxation and planning activities as the most appropriate interventions. Downward comparison and acceptance as part of the disease are also reported as successful coping strategies for fatigue. Most patients did not discuss fatigue with clinicians explicitly, accepting that they were told that fatigue is part of the disease and believing that they have to manage it alone. CONCLUSION: The results show that RA fatigue is experienced as being different from "normal" fatigue. Patients do not expect much support from health care professionals, assuming that they have to manage fatigue alone as it is part of the disease. These results will help professionals caring for RA patients to communicate about fatigue, to explore the nature of fatigue individually and to develop tailored interventions.