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Effects of person-centered physical therapy on fatigue-related variables in persons with rheumatoid arthritis: a randomized controlled trial
Feldthusen C, Dean E, Forsblad-d'Elia H, Mannerkorpi K
Archives of Physical Medicine and Rehabilitation 2016 Jan;97(1):26-36
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To examine effects of person-centered physical therapy on fatigue and related variables in persons with rheumatoid arthritis (RA). DESIGN: Randomized controlled trial. SETTING: Hospital outpatient rheumatology clinic. PARTICIPANTS: Persons with RA aged 20 to 65 y (n = 70); intervention-group (n = 36) and reference-group (n = 34). INTERVENTION: The 12-week intervention, with 6-month follow-up, focused on partnership between participant and physical therapist, and tailored health-enhancing physical activity and balancing life activities. The reference-group continued with regular activities; both groups received usual healthcare. MAIN OUTCOME MEASURES: Primary outcome was general fatigue (visual analogue scale, VAS). Secondary outcomes included multidimensional fatigue (Bristol Rheumatoid Arthritis Fatigue -- Multi-Dimensional Questionnaire, BRAF-MDQ), and fatigue-related variables, ie, disease, health and function. RESULTS: At posttest, general fatigue improved more in the intervention-group than reference-group (p = 0.042). Improvement in median general fatigue reached minimal clinically important difference between and within groups at posttest and follow-up. Improvement was also observed for anxiety (p = 0.0099) and trends toward improvements was observed for most multidimensional aspects of fatigue (p = 0.023 to p = 0.048), leg strength/endurance (p = 0.024) and physical activity (p = 0.023). Compared with the reference-group at follow-up, intervention-group improvement was observed for leg strength/endurance (p = 0.001) and the trends toward improvements persisted for physical (p = 0.041) and living-related (p = 0.031) aspects of fatigue, physical activity (p = 0.019) and anxiety (p = 0.015) and self-rated health (p = 0.010) and self-efficacy (p = 0.046). CONCLUSIONS: Person-centered physical therapy focused on health-enhancing physical activity and balancing life activities, showed significant benefits on fatigue in persons with RA.

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