Rheumatology occupational therapy-led fibromyalgia self- management education using motivational interviewing and mindfulness based cognitive therapy : a new approach

Fibromyalgia is a chronic musculoskeletal pain syndrome, which significantly affects patients’ quality of life. EULAR revised recommendations for the management of Fibromyalgia suggests non-pharmacological therapies and patient education should be treatment priority. This puts Rheumatology Occupational Therapists in an important role on the patients’ journey to self-management. This article reports on a new treatment approach in Rheumatology Occupational Therapy-led Fibromyalgia Self-Management Education (FSME), which incorporates Motivational Interviewing, and Mindfulness Based Cognitive Therapy approaches within the Canadian Practice Process Framework. The Fibromyalgia self-management education programme was devised and delivered by an Advanced Clinical Specialist Occupational Therapist using a comprehensive literature review of the evidence base. The evaluation of the self-management education programme included the Revised Fibromyalgia Impact Questionnaire as a condition specific outcome measure, the 5 Facet Mindfulness Questionnaire-Short Form to measure the effectiveness of the Mindfulness training on patient’s thought patterns, and the Canadian Occupational Performance Measure to evaluate the impact of the occupational therapy intervention on treatment goals. Preliminary results of the clinical practice evaluation suggests that Rheumatology Occupational Therapy-led FSME is highly effective in achieving health behaviour change, shift in patients’ awareness and reducing relapse in the long-term

Do Occupational therapy services fulfil the work related needs of rheumatology patients in the UK?

Background: Before becoming work disabled, people with inflammatory arthritis (IA) experience work instability, which threatens employment. Thus, many employed people with IA are at risk of losing their job. Rheumatology Occupational Therapists (OT) are best placed to provide vocational rehabilitation (VR) within the health service due to their inherent expertise of human occupation. However, currently we know little about the VR services delivered across the UK by Rheumatology OTs in the National Health Service (NHS). Objectives: To conduct a national survey of NHS Rheumatology OT VR provision to describe the services currently available for employed people with IA with job concerns because of arthritis. Methods: All NHS Hospitals in the UK with Rheumatology services were mailed a study invitation pack to partake in an online survey. Those who do not have an access to the internet were provided with a paper version of the survey, with a freepost envelope. The survey requested information on: personal and demographic factors, Rheumatology OT service provision and VR OT service provision. No personally identifiable data was collected. The data collected was primarily quantitative although participants were encouraged to provide additional comments. Results: 78 Rheumatology OTs completed the survey (England n=56; Scotland=14; Wales n=3; Northern Ireland=2). Nearly half of these OTs were a lone Rheumatology OT (n=32) within their setting. The majority were NHS grade band 6 (49%) and band 7 (42%). Although all responded ‘Yes’ to “Do you think it is appropriate for OTs to provide VR”, a third stated VR was not provided by their OT department. However, most OTs (n=70) said they provided patients with written, online or electronic information about work problems. Amongst those providing VR (n=56), most said there was no VR referral process from Rheumatology to the OT (n=46). Time spent providing VR varied greatly, as this was tailored to individual patient’s needs. Only one in ten OTs providing VR used a standardised assessment to identify work problems (i.e. Rheumatoid Arthritis Work Instability Scale (RA-WIS)). The VR interventions provided were; fatigue management (n=56); splinting (n=55); pacing (n=53); posture/ work positioning (n=52); joint protection (n=51); task rotation (n=51); alternative equipment (n=49); relaxation/ stress management (n=48); work station modification (n=47); changes to duties (n=47); changes to shift patterns (n=47); exercise at work (n=42); supported (graded) return to work after sick leave (n=40); enabling access in the workplace (n=35); injury prevention; and supporting disclosure (n=23). Half liaised with Occupational Health departments and line managers (n=28), but of these only 16 OTs reported to conduct work site visits. Following VR, 39 therapists followed-up employed patients to identify if they still worked. Conclusion: In the NHS, rheumatology OTs provides VR but the availability and quality varies widely with experience and service constraints. NHS-based job-retention VR provided by OTs includes job modifications, psychosocial and informational strategies, liaising with employers, occupational health and statutory services and multidisciplinary team referral to manage the condition. Barriers to accessing VR need identifying and NHS-wide referral pathways to rheumatology OT VR services could help standardise patients’ access to VR

Linguistic validation and cultural adaptation of the valued life activities scale in Turkey in people with Rheumatoid Arthritis

Background The Valued Life Activities Scale (VLAs) was specifically developed for people with rheumatoid arthritis (RA)1 to measure daily activities and participatory roles. The original VLAs items (75) were derived from content analysis of diaries completed by patients with RA or osteoarthritis. Revisions have been made to the scoring, items grouped into domains using factor analysis and the items were revised (and reduced to 33) based on participants' responses as to which items are most important to them2-5. Objectives To conduct the linguistic and cultural adaptation of the VLAs to Turkish prior to psychometric testing to validate the use of this questionnaire in Turkish people with RA. Methods The linguistic and cultural adaptation of the VLAs was conducted following guidelines for the process of cross-cultural adaptation of self-reported measures4. This involved the (i) initial forward translation of the British-English version of VLAs by two (informed and uninformed) native Turkish speakers; (ii) synthesis through consensus; (iii) back translation by two native English speakers who were blinded to the content of the questionnaire, and did not have medical backgrounds; and (iv) a final review conducted by an expert panel which consolidated all the versions and developed a pre-final Turkish VLAs (TUR-VLAs). Following this, to ensure the TUR-VLAs content is understandable and relevant to Turkish people with RA, face-to-face cognitive de-briefing interviews were conducted. Participants were recruited from rheumatology clinics ensuring a broad range of demographics such as participants' age, employment status and functional abilities. Results At the end of a four staged translation and cross-cultural adaptation process only minimal changes (e.g. “going to café” were used instead of going to the pub) were made to the questionnaire. Following this, cognitive de-briefing interviews were conducted with six participants (age: 45.16 (SD11.30) years; female:5 (83%); disease duration:13.83 (SD6.46) years; HAQ:9 (SD 2.76). Of these three people were employed, two were home-makers and one was retired. Participants found the TUR-VLAs content easily understandable, and relevant to Turkish people. As a result, no items were removed and no new items were added to TUR-VLAs. Conclusions The linguistic and cross-cultural adaptation of the VLAs to Turkish provides a basis for the first rheumatology occupational therapy assessment in Turkey. Following the psychometric testing of TUR-VLAs this instrument will be freely accessible for Turkish health professionals working in rheumatology for both clinical assessment and research purposes. References 1. Katz P, Yelin E (1994) Arthritis Care and Research 7(2):69-77. 2. Katz P, Yelin E (1995) Arthritis and Rheumatism 38(1):49-56 3. Katz P (1995) Arthritis Care and Research 8(4):272-278. 4. Katz P et al. (2006) Annals of the Rheumatic Diseases 65:763-769. 5. Katz P et.al. (2008) Arthritis Rheum (Arthritis Care Res) 59:1416–1423. 6. Beaton et.al. (2000) Spine (Phila Pa 1976). 15;25(24):3186-91. Acknowledgements We would like to extend our thanks to participating patients and the administrative staff from the Marmara University Hospital. Also many thanks to the EULAR Health Professionals Grant for funding this study

Rheumatology occupational therapists' line managers' views of a vocational rehabilitation programme delivered to patients with work problems

Background: Before becoming work disabled people with inflammatory arthritis experience work instability, which threatens employment. Occupational therapists (OT) are well–placed to assist patients to remain at work [1]. However, many OTs in the UK lack vocational rehabilitation (VR) skills [2]. Objectives: This study, nested within a pilot VR randomised controlled trial (RCT), aimed to explore the National Health Service (NHS) OTs' line managers' views of the VR training participating OTs received as part of the trial, and whether there are any potential barriers and facilitators to delivering the VR intervention in a future trial/clinical practice. Methods: As part of the trial, Rheumatology OTs (n=9) attended three-days training in VR and the use of a structured interview: the Work Experience Survey – Rheumatic Conditions (WES-RC)[3-5]. After training and intervention delivery, semi-structured telephone interviews with these OTs' line managers were conducted, recorded, transcribed and thematically analysed by two researchers to ensure validity. Results: All five OT line managers were contacted but only two agreed to be interviewed, although both provided rich data. Two main themes emerged were: (i) the impact of the VR training received, and (ii) the positive change in OT practice. Both line managers thought the training given was comprehensive. They reported positive practice changes, for example, the WES-RC helped the OTs identify and prioritise work problems of employed people with inflammatory arthritis (IA). As result, their practice now included work assessment and the VR programme. These changes in service provision were appreciated by the Rheumatology multi-disciplinary team, which works very closely across cases. The line managers identified the VR training OTs received as the most important facilitator to delivering the VR intervention in the future, suggesting this training should extent to their line managers to help understand and manage OT's role in VR. Potential barriers to delivering an OT VR intervention in a future trial/ clinical practice were: time and financial constraints around the attendance to comprehensive training in VR. Conclusions: Rheumatology OTs' line managers acknowledged the need for training OTs in VR, and importance of providing VR to IA patients with work problems. For the OT VR service to be successful, prior training of OTs and if possible their line managers in VR delivery was deemed important by these line managers. References: J Ross (2007) John Wiley and Sons. ISBN 978-0-470-02564. Barnes et al (2009) Work. COT: London. O'Brien R et al (2013) Musculoskeletal Care 11:99-105. Allaire S & Keysor J (2009) Arthritis Care and Research 61(7):988-995. Prior Y et al (2013) Turk J of Phys Med and Rehab 59 (Suppl 2), p76. Acknowledgements: We would like to thank to occupational therapists and their line managers at the participating NHS hospitals, and Arthritis Research UK for funding this project. Disclosure of Interest: None declared DOI: 10.1136/annrheumdis-2015-eular.1998 Citation: Ann Rheum Dis2015;74(Suppl2): 1352 Session: Occupational therap

Long Term Conditions Work Spillover Scale - British English

The British English version of the Long-Term Conditions Work Spillover Scale (LTCWSS) has been psychometrically tested in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), osteoarthritis (OA) and fibromyalgia (FM). The LTCWSS was forward translated, reviewed by an expert panel and cognitive debriefing interviews conducted, with changes to the LTCWSS made. The LTCWSS was tested with 831 employed participants who completed questionnaires: 267 men; 564 women; 53.5 (SD 8.9) years of age; with condition duration 7.7 (SD 8.0) years. The LTCWSS satisfied Rasch model requirements, and a LTCWSS Rasch transformation table was created, and a Reference Metric equating scales with the WALS, were created. Concurrent validity was strong with the: WLQ-25 Time, Mental-Interpersonal and Output Demands scales (RA rs =0.63-0.70; axSpA rs = 0.66-0.77; OA rs = 0.57-0.62; FM rs = 0.60-0.64). Internal consistency was consistent with group use (α = 0.80-0.89). Test-retest reliability was excellent (ICC (2,1) at 0.78-0.91. The British-English version of the LTCWSS is reliable and valid and can be used in both clinical practice and research,Ful details of testing of the LTCJSS and the LTCJSS Rasch transformation table (see supplementary materials for table) can be found at Hammond A, Tennant A, Ching A, Parker J, Prior Y, Gignac M, Verstappen S, O’Brien R. (2023). Psychometric testing of the British-English Long Term Conditions Job Strain Scale, Arthritis Work Spillover Scale and Work – Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions. Musculoskeletal Care published online 11.5.23 DOI: 10.1002/msc.1774

Development and psychometric testing of the British english measure of activity performance of the hand (MAP-HAND) questionnaire in Rheumatoid Arthritis

ackground The Measure of Activity Performance of the Hand (MAP-HAND) evaluates 18 daily activities performed using the hands. It was developed in Norway for people with rheumatoid arthritis (RA) using patient generated items and is the product of extensive development and testing. Items are scored on a 0-3 scale (no difficulty to not able to do)1. Objectives To develop a British English version of the MAP-HAND and psychometrically test it in a UK population of people with rheumatoid arthritis (RA). Methods Development involved (i) Phase1 (cross-cultural adaptation): forward translation to British English; synthesis; expert panel review to ensure uniformity; cognitive debriefing interviews, and (ii) Phase 2 (psychometric testing): through measuring internal consistency (Cronbach's alpha); test-retest reliability (linear weighted kappa and Intra-Class Correlations (ICC (2,1) based on Rasch transformed data); concurrent validity (Spearman's correlations) and Minimal Detectable Difference (MDC95). The internal construct validity, measured using exploratory factor analysis, Mokken Scaling and Rasch analysis was previously reported2. Participants from 17 Rheumatology clinics completed postal questionnaires of demographic questions, including the MAP-HAND (twice 3 weeks apart), Health Assessment Questionnaire (HAQ), ULHAQ (7 upper limb HAQ items), SF-36v2 Physical Function (PF), and Disability Arm Shoulder Hand (DASH) scale. Results In Phase1, cultural adaptations included e.g. opening a can, instead of opening hermetic cans. Cognitive debriefing interviews (n=31) were conducted with participants: age=63.42 (SD12.04) years; female: 26 (84%); RA duration=15.71 (SD12.61) years. All items were considered relevant by participants. In Phase2, 340 people completed the Test 1 questionnaire (age: 61.96 years (SD 12.09); RA duration: 14.44 years (SD 11.73); female: 251 (74%); Combination therapy: 190 (56%); Monotherapy: 91 (27%); no DMARDS: 34 (10%); Biologics: 25 (7.4%)). Of these 108 (32%) were employed, 245 (78%) lived with family/ spouse or significant others and 36 (10%) had children living at home. 273 (80%) completed the Test 2 MAP-HAND. Internal consistency (α=.96) was excellent. Test-retest reliability was good: at item-level linear weighted kappa scores were good (range 0.61-0.75)); at scale level, the ICC (2,1) score was 0.96 (95% CI 0.94, 0.97)). MAP-HAND correlated strongly with HAQ20 (rs=.88), ULHAQ (rs=.91), SF-36v2 (PF) Score (rs=-.80) and DASH (rs=.93), indicating strong concurrent validity. The MDC95 MAP-HAND score=3.99. Conclusions The British English version of the MAP-HAND has good validity and reliability in people with RA and can be used in both research and clinical practice. References 1. Paulsen T et al (2010) Development and psychometric testing of the patient-reported MAP-HAND in RA. Journal of Rehabilitation Medicine 42:636-644 2. Prior Y et al (2015) Psychometric testing of MAP-HAND in RA: Rasch Analysis. Rheumatology (Suppl) In press. Acknowledgements We would like to thank to participating NHS hospitals and patients for taking part and the Arthritis Research UK for funding this study

Biopsychosocial, work-related, and environmental factors affecting work participation in people with Osteoarthritis: a systematic review

Purpose: Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss. Methods: Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes. Results: Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss. Conclusions: Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions. Systematic review registration: PROSPERO 2019 CRD42019133343

Work-Health-Personal Life Perceptions Scale- British-English version

The British English version of the Work Health Personal Life Perceptions Scale (WHPLPS) has been psychometrically tested in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), osteoarthritis (OA) and fibromyalgia (FM). The WHPLPS was forward translated, reviewed by an expert panel and cognitive debriefing interviews conducted, with changes to the WHPLPS made. The WHPLPS was tested with 831 employed participants who completed questionnaires: 267 men; 564 women; 53.5 (SD 8.9) years of age; with condition duration 7.7 (SD 8.0) years. The WHPLPS parts 1 and 2 satisfied Rasch model requirements (but not part 3, except in axSpA) , and a WHPLPS Rasch transformation table was created for Part 1, as well as a Reference Metric equating scale with the WALS. Concurrent validity was moderate to strong with the: WLQ-25 Time, Mental-Interpersonal and Output Demands scales Internal consistency was consistent with group use (α = 0.80 and above). Test-retest reliability was good to excellent (ICC (2,1) at 0.81-0.89 (part 1), 0.73-0.86 (part 2). The British-English version of the WHPLPS parts 1 and 2 are reliable and valid and can be used in both clinical practice and research. Part 3 is only suitable for use in AxSpA and can be used for information only in other conditions. Full details of testing of the WHPLPS and the WHPLPS part 1 Rasch transformation table (see supplementary materials for table) can be found at Hammond A, Tennant A, Ching A, Parker J, Prior Y, Gignac M, Verstappen S, O’Brien R. (2023). Psychometric testing of the British-English Long Term Conditions Job Strain Scale, Arthritis Work Spillover Scale and Work – Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions. Musculoskeletal Care published online 11.5.23 DOI: 10.1002/msc.177

Long Term Conditions Job Strain Scale– British-English

The British English version of the Long-Term Conditions Job Strain Scale (LTCJSS) has been psychometrically tested in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), osteoarthritis (OA) and fibromyalgia (FM). The LTCJSS was forward translated, reviewed by an expert panel and cognitive debriefing interviews conducted, with changes to the LTCJSS made. The LTCJSS was tested with 831 employed participants who completed questionnaires: 267 men; 564 women; 53.5 (SD 8.9) years of age; with condition duration 7.7 (SD 8.0) years. The LTCJSS satisfied Rasch model requirements, and a LTCJSS Rasch transformation table was created, and a Reference Metric equating scales with the WALS, were created. Concurrent validity was strong with the: WLQ-25 Time, Mental-Interpersonal and Output Demands scales (RA rs =0.63-0.70; axSpA rs = 0.69-0.75; OA rs = 0.61-0.72; FM rs = 0.65-0.74). Internal consistency was consistent with group use (α = 0.93-0.96). Test-retest reliability was excellent (ICC (2,1) at 0.93-0.96. The British-English version of the LTCJSS is reliable and valid and can be used in both clinical practice and research,Ful details of testing of the LTCJSS and the LTCJSS Rasch transformation table (see supplementary materials for table) can be found at Hammond A, Tennant A, Ching A, Parker J, Prior Y, Gignac M, Verstappen S, O’Brien R. (2023). Psychometric testing of the British-English Long Term Conditions Job Strain Scale, Arthritis Work Spillover Scale and Work – Health-Personal Life Perceptions Scale in four rheumatic and musculoskeletal conditions. Musculoskeletal Care published online 11.5.23 DOI: 10.1002/msc.177