ABSTRACT
BackgroundFatigue is a difficult subject for both physicians and patients. It is barely addressed during consultations and can therefore burden patient-physician-relations. To improve communication regarding fatigue, we developed a checklist that includes suggestions for evaluating possible causes for fatigue. In this analysis, we describe our study population and report first results 3 and 6 months after using the checklist.ObjectivesThe aims of our study are to validate the use of our newly developed fatigue checklist and to demonstrate that addressing fatigue in daily clinical practice and offering possible interventions can improve fatigue.MethodsWe recruited n=110 SLE patients with fatigue from our university hospital-based lupus reference centre in Duesseldorf. Fatigue was measured using the FSS (Fatigue Severity Scale). Our checklist included signs of depression and anxiety using the PHQ-4 (Patient Health Questionnaire), BMI (body mass index), physical activity, anemia, hypothyroidism and vitamin D deficiency. For each applicable cause, we listed possible interventions for free selection by the treating physician, such as replacement therapy (vitamin D, vitamin B12, iron, folic acid, erythropoietin), physical activity programs and psychosomatic consultations that were discussed with the patients. We re-evaluated our patients after 3 (T1) and 6 months (T2).ResultsBaseline characteristics of patients are summarized in Table 1.Table 1.BMI=body mass index, TSH=thyroidea stimulating hormone, PHQ4=patient health questionnaire (cut-off >3 points), HAQ=health assessment questionnaire, IMET= Index for measuring restrictions on social participation (higher scores point towards more restrictions on social participation), FSS=fatigue severity scale (≥4 points equal severe fatigue)N = 110n (%)Mean (SD)Age (years)49.0 (12.34)Female sex99.0 (90.0)BMI (kg/m2)25.9 (5.55)Disease duration (years)19.1 (10.05)TSH (µIU/ml)1.5 (1.05)25-OH-Vitamin D (ng/ml)39.5 (15.35)Haemoglobin (g/dl)13.0 (1.64)Sports activities>4h/week6.0 (5.5)2-4h/week18.0 (16.4)1-2h/week16.0 (14.5)<1h/week28.0 (25.5)No sport42.0 (38.2)Depression (PHQ4 score)2.3 (1.63)Anxiety (PHQ4 score)2.0 (1.71)Functional status (HAQ score)0.8 (0.49)Participation (IMET score)2.8 (2.31)Fatigue (FSS score)5.3 (1.35)After 3 and 6 months, we re-evaluated 83 patients and saw a significant reduction in fatigue measured by the FSS score (T1: mean difference estimate 0.367 and p-value <0.001;T2: mean difference estimate 0.305;p-value <0.005).Figure 1.Comparing FSS-Scores from T0, T1 and T2[Figure omitted. See PDF]ConclusionThe preliminary analysis of our study shows for the first time that incorporation of a checklist procedure into the management of patients with fatigue may improve short-term outcome after 3 and 6 months of observation. The improvement of symptoms documented in our study occurred even though the suggested exercise program and psychosomatic counseling sessions were not available for use during the current observation period because of the COVID-19 pandemic. At present, the mechanisms behind the observed effect remain unclear. Our ongoing analysis will clarify whether an additional effect on fatigue will occur after all suggested interventions resulting from the use of the checklist have been executed. Finally, it will demonstrate whether the incorporation of our checklist into routine clinical practice is capable to reduce fatigue over a prolonged time period.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
ABSTRACT
Background: The pandemic had major negative effects and is a big challenge to all patient organisations in Europe. Our organisation (Deutsche Rheuma-Liga) with about 270.000 members is already equipped with various tools and skills for the support of our members. We are offering not only information, but exercise-programs, self-management courses, different events to meet and exchange. But after two years of the pandemic, the problems have piled up. Our members are missing the face-to-face contact. It was impossible, due to the limitation and restriction of contact, to conduct events, meetings, consultations, and exercise programs. Most of our offers came to a standstill. Objectives: Due to these problems, it was not only difficult to live with a chronic rheumatic disease, but there was also no possibility to get access to helpful information and advice or to use the various services, either. Especially the fear of Covid-19, which impact it has on RMDs, questions regarding the vaccination and the medication were increasing to a substantial extent. Methods: Three different measures were taken: Information needs: By improving our website, it was possible to provide digital content to our members. We offer essential and understandable information with additional links to the most current expert information on COVID-19, like the EULAR recommendations and those of our national rheumatologist society (DGRh). Activity needs: Different digital exercise-programs were developed by our nineteen national member organisations. We shared this services on the website of our umbrella organisation with all members, nationwide. Our campaign 'Keep on moving' shall encourage our members nationwide practising their exercise and developing innovative ideas into the daily routine. Results: Interaction needs: Regarding our 'Rheuma-Forum' (a digital exchange format for people with arthritis) I want to explain in detail with dates and facts how our organisation enhances the contact to our members and other people with arthritis who were looking to our organisation for information. We replied to questions and addressed the needs on an individual basis. Since the beginning of the pandemic, we implemented four Expert-Forums per year, addressing many comparable questions regarding the issues of COVID-19 (like RMDs and the covid vaccination, possible side effects). Our experts are well-known, specialized rheumatologists and trained RMD patients. The fgures speak for themselves.-4 Expert Forums with 857 Q&A within 65.396 accesses-4 Expert Forums with 677 Q&A within 28.180 accesses-1 Expert Forum within 242 Q&A within 10750 accesses Conclusion: We can be pleased that our strategy to provide information to our members and other people with arthritis via the digital way was successful. We already know that this will be an ongoing process. But we are on the right path to encourage our members in difficult pandemic times and give them important and valid information. Our example of the expert forum shall encourage patient organisations to try out new digital and interactive solutions not only in pandemic times.