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Mindfulness Sessions Eased Arthritis Symptoms

Major Finding: Patients with inflammatory rheumatic joint diseases who participated in a 10-session mindfulness-based group intervention experienced significant mean treatment effects in several outcomes at post-treatment and at 12 months, including psychological distress (–4.7 and –3.7, respectively), self-efficacy pain (8.2 and 9.1), and self-efficacy symptoms (8.8 and 13.1).

Data Source: A trial of 71 patients in Norway who were randomized to a mindfulness-based group intervention known as the Vitality Training Program or to a control group. Patients in the control group received routine care plus a compact disc with mindfulness-based home exercises for individual voluntary use.

Disclosures: The study was supported by Diakonhjemmet Hospital. The investigators reported that they did not have any competing financial interests.


 

FROM ANNALS OF THE RHEUMATIC DISEASES

Patients with inflammatory joint diseases who participated in a 10-session mindfulness-based group intervention experienced significant lessening of psychological distress and improvement in self-efficacy, emotional processing, and overall well-being at 6 and 12 months, judging from the results from a randomized controlled trial.

"These lasting improvements indicate that the participants may have incorporated some mindfulness strategies into their daily lives and that these strategies have strengthened their ability to respond to their stressful experiences in a more flexible way," according to Heidi A. Zangi, Ph.D., of the department of rheumatology at Diakonhjemmet Hospital, Oslo, Norway, and her associates (Ann. Rheum. Dis. 2011 Dec. 20 [doi: 10.1136/annrheumdis-2011-200351]).

For the study, which was conducted at three rheumatology departments in Norway between March 2007 and June 2009, Dr. Zangi and her associates randomized 71 adults aged 20-70 years who were diagnosed with an inflammatory rheumatic joint disease at least 1 year earlier to a mindfulness-based group intervention known as the Vitality Training Program (VTP) or to a control group. Patients assigned to the control group received routine care plus a compact disc with mindfulness-based home exercises for individual voluntary use.

The investigators described VTP as an intervention aimed at "strengthening the personal resources of individuals and enhancing their capacity to engage responsibly and satisfactorily in the process of everyday living." Such an approach, they wrote, advocates "the importance of nonjudgmental attention to unwanted thoughts, feelings, and bodily experiences without attempting to avoid or change them."

The VTP consisted of 10 group sessions over a period of 15 weeks, plus a "booster session" that took place about 6 months after the end of the course. Patients in the control group were informed that they would have the opportunity to participate in the VTP after completion of data collection. Patients in both groups received routine medical care throughout the study.

Of 814 patients who were invited to enroll in the study, 71 participated. Of these, 36 were randomized to the VTP arm and 35 to the control arm. The primary outcome measure was psychological distress as measured by the 20-item version of the General Health Questionnaire. In this tool, a sum score can range from 0 (no distress) to 60 (high distress). Co-primary outcomes were self-efficacy, as measured by the pain and symptoms subscales of the Arthritis Self-Efficacy Scale, and emotion-focused coping, as measured by the Emotional Approach Coping Scale.

Secondary outcomes were assessed by numerical rating scales ranging from 0 to 10 (where 10 is very bad) and included pain, fatigue, and patient-reported global assessment of disease activity. All patients were assessed at baseline, at post-treatment, and at 12 months.

The mean age of patients was 54 years, and 79% were women. After adjusting for gender, age, disease duration, and education, the researchers observed significant mean treatment effects in favor of the VTP at post-treatment and at 12 months for the following outcomes: psychological distress (–4.7 and –3.7, respectively), self-efficacy pain (8.2 and 9.1), self-efficacy symptoms (8.8 and 13.1), emotional processing (0.4 and 0.3), fatigue (–0.8, –1.1), self-care ability (1.2 and 1.0), and overall well-being (0.8 and 0.6). No significant group differences were found in emotional expression, pain, or disease activity.

Dr. Zangi and her associates acknowledged certain limitations of the study, including the fact that all outcome measures were patient reported, and that so few of the patients invited to participate chose to do so, "which probably reflects a selection bias in the direction of highly motivated individuals," they wrote. "Consequently, the results cannot be generalized to the whole population of persons with inflammatory arthritis. However, from our clinical experience we know that there are waiting lists for the existing VTP courses, and that the low uptake may partly be explained by unwillingness to participate in a randomized controlled trial."

The study was supported by Diakonhjemmet Hospital. The investigators reported that they did not have any competing financial interests.

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