Goal management training for patients with arthritis.

Existing self-management programs try to improve coping with rheumatic disease but revealed very limited effects and low participation rates. These programs narrowly focus on illness-related aspects. However, adaptation problems are more complex and include various domains of life. The new program starts from personal goals of the patients which are threatened by arthritis. It aims to broaden and improve patients competencies to manage these threatened personal goals in order to improve adaptation to arthritis.



The main objective of the study is to evaluate the goal management training in terms of the effect on depressive symptoms. Secondary objectives of the intervention are to study the effect of the intervention on the secondary outcome measures: anxiety symptoms, positive affect, purpose in life and social participation; use of and preference for goal management strategies; and disease related outcomes. Furthermore the cost-effectiveness and cost utility of the goal management intervention will be evaluated from a societal perspective.

16-07-2013: Changes to the design. A number of changes have been made, since the recruitment of participants went slow. Randomization is not performed and the waiting list control condition lapses. The intervention group will be compared to an existing cohort that ran from 2010 to 2011. The cohort exists of 330 patients with polyarthritis that participated in an observational study. Patients in the cohort will be selected based on the baseline criteria from the intervention study. These patients did not participate in an intervention at the time of the study, making it possible to compare the natural course of adaptation to the intervention group.

The main objective is to evaluate the goal management training in terms of the effect on depressive symptoms. It is expected that people with arthritis will experience lower levels of depressive symptoms after participation in the group training, compared to the control group.

T0: Baseline (all measures);

T1: Post-intervention (all measures);

T2: Only cost-effectiveness measures;

T3: Only cost-effectiveness measures;

T4: Follow-up (all measures).



Methods:

Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983). The depression subscale of the HADS is used to measure our primary outcome depressive symptoms.

The new training aims to teach patients to recognize personal goals which are threatened by arthritis and learn to apply beneficial goal management strategies to improve adaptation to arthritis. The training is to be delivered by specialized nurses in hospital settings to groups with 8-10 participants. The training consists of 6 group meetings, based on informing, learning, and practicing goal management strategies. In addition to the group sessions, participants work individually on a personal goal. This individual trajectory is discussed within the group.



Control condition: Participant in the control condition recieve care-as-usual and fill in the same questionnaires as the intervention condition.