The effects of an educational intervention on fatigue and activities of daily living in patients with systemic lupus erythematosus

Authors

1 Chronic Diseases Care Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

2 Nursing Care Research Center in Chronic Diseases, Medical and Surgical Nursing Department, Nursing and Midwifery School, Ahvaz, Iran

3 Epidemiology and Biostatistics Department, Public Health School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

4 Golestan Hospital Clinical Research Development Unit, Internal Medicine Department, Medicine School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Abstract

Background: Fatigue and decreased activities of daily living (ADL) are important problems in patients with systemic lupus erythematosus (SLE) and reduce their quality of life. Objectives: This study was conducted to examine the effect of fatigue and activity management education (FAME) program on fatigue severity and ADL in patients with SLE. Methods: A quasi-experimental study was conducted on 40 patients with SLE. The patients were selected consecutively and randomly allocated into an intervention (n = 20) and a control group (n = 20). The control group was treated as usual. However, in addition to the usual treatment, the intervention group received the FAME program. Data collection was done before and 8 weeks after the intervention using the Swedish Occupational Fatigue Inventory-20 (SOFI-20) questionnaire, the daily physical activity questionnaire, and a demographic characteristics form. Descriptive statistics, independent- and paired-samples t tests, and analysis of covariance were used to analyze the data. Results: The two groups were homogenous in terms of demographic characteristics (P > 0.05) unless their job (P = 0.002). The mean baseline fatigue and ADL scores were significantly different between the two groups (P < 0.0001). Hence, analysis of covariance was used to control the confounding effect of the aforementioned variable. Then, significant differences were found between the two groups respecting the mean fatigue (P < 0.0001) and mean ADL (P = 0.009) after the intervention. Conclusion: Considering the effectiveness of the FAME program in reducing fatigue and increasing ADL in patients with SLE, nurses are recommended to use similar programs in the care for these patients and help them improve their own fatigue and ADL.

Keywords


1.     Ghodke-Puranik Y, Niewold TB. Immunogenetics of systemic
lupus erythematosus: A comprehensive review. J Autoimmun
2015;64:125-36.
2.     Wang YF, Zhang Y, Lin Z, Zhang H, Wang TY, Cao Y, et al.
Identification of 38 novel loci for systemic lupus erythematosus
and genetic heterogeneity between ancestral groups. Nat Commun
2021;12:772.
3.     Azizoddin DR, Zamora-Racaza G, Ormseth SR, Sumner LA,
Cost C, Ayeroff JR, et al. Psychological factors that link
socioeconomic status to depression/anxiety in patients with
systemic lupus erythematosus. J Clin Psychol Med Settings
2017;24:302-15.
4.     Klein A, Polliack A, Gafter-Gvili A. Systemic lupus erythematosus
and lymphoma: Incidence, pathogenesis and biology. Leuk Res
2018;75:45-9.
5.     Rafie S, Akbari R, Yazdani Charati J, Elyasi F, Azimi-Lolaty H.
Effect of mindfulness-based metacognitive skills training on
depression, anxiety, stress, and well-being in patients with systemic
lupus erythematosus. J Mazandaran Univ Med Sci 2020;30:11-21.
6.     Rezaie AM. Effectiveness of treatment based on acceptance and
commitment, compassion-based therapy and combination therapy
on anxiety and dysfunctional attitudes in patients with systemic
lupus. J Health Psychol 2021;10:189-206.
7.     Zhao Q, Chen H, Yan H, He Y, Zhu L, Fu W, et al. The correlations
of psychological status, quality of life, self-esteem, social support
and body image disturbance in Chinese patients with systemic
lupus erythematosus. Psychol Health Med 2018;23:779-87.
8.     Tench CM, McCurdie I, White PD, D’Cruz DP. The prevalence
and associations of fatigue in systemic lupus erythematosus.
Rheumatology (Oxford) 2000;39:1249-54.
9.     Mertz P, Schlencker A, Schneider M, Gavand PE, Martin T,
Arnaud L. Towards a practical management of fatigue in systemic
lupus erythematosus. Lupus Sci Med 2020;7:e000441.
10.     Panopalis P, Yazdany J, Gillis JZ, Julian L, Trupin L, Hersh AO,
et al. Health care costs and costs associated with changes in work
productivity among persons with systemic lupus erythematosus.
Arthritis Rheum 2008;59:1788-95.
11.     Rizk A, Gheita TA, Nassef S, Abdallah A. The impact of obesity
in systemic lupus erythematosus on disease parameters, quality of
life, functional capacity and the risk of atherosclerosis. Int J Rheum
Dis 2012;15:261-7.
12.     Lira A, Albuquerque J, Lopes M. Nursing diagnoses profile
presented by renal transplanted patients. Rev Enferm 2007;15:13-9.13.     Wang SP, Lin LC, Lee CM, Wu SC. Effectiveness of a self-care
program in improving symptom distress and quality of life in
congestive heart failure patients: A preliminary study. J Nurs Res
2011;19:257-66.
14.     Wilcox S, DerAnanian C,AbbottJ, VrazelJ, Ramsey C, Sharpe PA,
et al. Perceived exercise barriers, enablers, and benefits among
exercising and nonexercising adults with arthritis: Results from a
qualitative study. Arthritis Rheum 2006;55:616-27.
15.     Booth FW, Chakravarthy MV, Gordon SE, Spangenburg EE.
Waging war on physical inactivity: Using modern molecular
ammunition against an ancient enemy. J Appl Physiol (1985)
2002;93:3-30.
16.     Neill J, Belan I, Ried K. Effectiveness of non-pharmacological
interventions for fatigue in adults with multiple sclerosis,
rheumatoid arthritis, orsystemic lupus erythematosus:Asystematic
review. J Adv Nurs 2006;56:617-35.
17.     Harrison S. Fatigue management for people with Multiple
Sclerosis. 2th ed. London: College of Occupational Therapists
2007.
18.     Tench CM, McCarthy J, McCurdie I, White PD, D’Cruz DP.
Fatigue in systemic lupus erythematosus: A randomized controlled
trial of exercise. Rheumatology (Oxford) 2003;42:1050-4.
19.     Ascheim JH. The adolescent and systemic lupus erythematosus:
A developmental and educational approach. Issues Compr Pediatr
Nurs 1981;5:293-307.
20.     Lomundal BK, Steinsbekk A. Five-year follow-up of a one-year
self-management program for patients with COPD. Int J Chron
Obstruct Pulmon Dis 2012;7:87-93.
21.     Bourbeau J. Clinical decision processes and patient engagement
in self-management. Disease Manage Health Outcomes
2008;16:327-33.
22.     Nolte S, Elsworth GR, Sinclair AJ, Osborne RH. The extent and
breadth of benefits from participating in chronic disease selfmanagement courses: A national patient-reported outcomes survey.
Patient Educ Couns 2007;65:351-60.
23.     O’RiordanR,DoranM,ConnollyD.Fatigueandactivitymanagement
education for individuals with systemic lupus erythematosus. Occup
Ther Int 2017;2017:4530104.
24.     Bogdanovic G, Stojanovich L, Djokovic A, Stanisavljevic N.
Physical activity program is helpful for improving quality of life
in patients with systemic lupus erythematosus. Tohoku J Exp Med
2015;237:193-9.
25.     Sultanian AR, Motamedzade Torghabe M, Shafii motlagh M,
Garkaz A, Mahdavi N. Persian version of Swedish Occupational
Fatigue Inventory (P-SOFI): Validity and reliability. Iran Occupat
Health 2014;11:34-43.
26.     Taylor NJ, Lawton R, Conner M. Development and initial
validation of the determinants of physical activity questionnaire.
Int J Behav Nutr Phys Act 2013,10:74.
27.     Aligol M, Mohammadi NK, Mohamadbeigi A, Hardy LL. Physical
activity and associated factors among women in a suburban area:
findings of a community-based study in Iran. J Fundam Appl Sci
2017;9(1,S): 1313-1326.
28.     Arriens C, Hynan LS, Lerman RH, Karp DR, Mohan C. Placebocontrolled randomized clinical trial of fish oil’s impact on fatigue,
quality of life, and disease activity in systemic lupus erythematosus.
Nutr J 2015;14:82.
29.     Lima GL, Paupitz J, Aikawa NE, Takayama L, Bonfa E,
Pereira RM. Vitamin D supplementation in adolescents and
young adults with juvenile systemic lupus erythematosus
for improvement in disease activity and fatigue scores:
A randomized, double-blind, placebo-controlled trial. Arthritis
Care Res (Hoboken) 2016;68:91-8.
30.     Islam MA, Khandker SS, Kotyla PJ, Hassan R. Immunomodulatory
effects of diet and nutrients in systemic lupus erythematosus (SLE):
A systematic review. Front Immunol 2020;11:1477.
31.     Fangtham M, Kasturi S, Bannuru RR, Nash JL, Wang C. Nonpharmacologic therapies for systemic lupus erythematosus. Lupus
2019;28:703-12.
32.     Nabors L, Ige TJ, Fevrier B. Peer support and psychosocial
pain management strategies for children with systemic lupus
erythematosus. J Immunol Res 2015;2015:238263.
33.     van Kessel K, Moss-Morris R, Willoughby E, Chalder T,
Johnson MH, Robinson E. A randomized controlled trial of
cognitive behavior therapy for multiple sclerosis fatigue.
Psychosom Med 2008;70:205-13.
34.     Moss-Morris R, Dennison L, Landau S, Yardley L, Silber E,
Chalder T. A randomized controlled trial of cognitive behavioral
therapy (CBT) for adjusting to multiple sclerosis (the saMS trial):
Does CBT work and for whom does it work? J Consult Clin
Psychol 2013;81:251-62.
35.     Keramiotou K, Anagnostou C, Kataxaki E, Galanos A, Sfikakis PP,
Tektonidou MG. The impact of upper limb exercise on function,
daily activities and quality of life in systemic lupus erythematosus:
A pilot randomised controlled trial. RMD Open 2020;6:e001141.
36.     Ayán C, de Pedro-Múñez A, Martínez-Lemos I. Effects of physical
exercise in a population with systemic lupus erythematosus:
A systematic review. Semergen 2018;44:192-206.
37.     Tarazi M, Gaffney RG, Pearson D, Kushner CJ, Werth VP. Fatigue
in systemic lupus erythematosus and other autoimmune skin
diseases. Br J Dermatol 2019;180:1468-72