Ab1591-HPR Brave New World: Do Patients With Rheumatic Diseases Want a Choice, and Have a Preference, in How They Manage Their Fatigue?

Background: The probability of developing an autoimmune inflammatory rheumatic disease (RMD) in one's lifetime is 1 in 12 for women and 1 in 20 for men. 1. Fatigue is reported as one of the most common symptoms of RMDs but remains poorly understood or treated. Studies have shown that fatigue is present in 1 in every 2 patients with RMDs 2. Up to 70% of patients experience a negative effect on quality of life as result of their fatigue 3. Fatigue management is not standardised in the United Kingdom and remains inadequately addressed in a real-world setting for RMD patients. 4. The EULAR 2023 overarching principles and recommendations for fatigue management in RMDs and MSK diseases advocates for, amongst others, shared decision making on treatment between patient and HCP and access to tailored physical activity interventions, and structured psychoeducational interventions 5,6. Objectives: The primary objective was to establish whether personal choice of fatigue management approaches was important to RMD patients with fatigue. The secondary objective was to determine which would be their preferred fatigue management approach when given that choice. Methods: A cross sectional survey using the JISC online survey tool was distributed to NHS Lothian RMD patients in Autumn 2023. All respondents had previously been referred to the fatigue management team between January 2020 and September 2023. Results: Of those who responded (n=50), 83% indicated that they would like the opportunity to choose their fatigue management plan. Respondents were then asked to choose their top preferences, Table 1. Table 1. Fatigue management options The most popular fatigue management option was a live online group fatigue programme, with 68% of respondents choosing this as their first or second option. This was followed by occupational therapy, which was a first or second option for 44% of the group. Conclusion: The majority of RMD patients would prefer to have a choice in their fatigue management approach, there is limited patient interest in physiotherapy as an option. Despite increasing recognition of the impact of fatigue on RMD patients 5 the only option provided by the majority of NHS hospitals are booklets, which were found to be of minimal interest in this study population. When clinicians and stakeholders consider which fatigue management options to fund, this study indicates increased weight should be given to live online groups and occupational therapy. REFERENCES: 1 Crowson, C.S., Matteson, E.L., Myasoedova, E., Michet, C.J., Ernste, F.C., Warrington, K.J., Davis, J.M., Hunder, G.G., Therneau, T.M. and Gabriel, S.E. (2011). The lifetime risk of adult-onset rheumatoid arthritis and other inflammatory autoimmune rheumatic diseases. Arthritis 6: e001084. doi:10.1136/ SjSopen-2019-001084. 5 Dures E, Farisoğullari B, Santos EJF, Molto A, Feldthusen C, Harris C, Elling-Audersch C, Connolly D, Elefante E, Estévez-López F, Bini I, Primdahl J, Hoeper K, Urban M, van de Laar MAFJ, Redondo M, Böhm P, Amarnani R, Hayward R, Geenen R, Rednic S, Pettersson S, Thomsen T, Uhlig T, Ritschl V, Machado PM. 2023 EULAR recommendations for the management of fatigue in people with inflammatory rheumatic and musculoskeletal diseases. Ann Rheum Dis. 2023 Nov 22:ard-2023-224514. doi: 10.1136/ard-2023-224514. Epub ahead of print. PMID: 38050029. 6 Clark NM, Janz NK, Dodge JA, Mosca L, Lin X, Long Q, Little RJ, Wheeler JR, Keteyian S, Liang J. The effect of patient choice of intervention on health outcomes. Contemp Clin Trials. 2008 Sep;29(5):679-86. doi: 10.1016/j.cct.2008.04.002. Epub 2008 Apr 20. PMID: 18515187; PMCID: PMC2577598. Acknowledgements: NIL. Disclosure of Interests: Joanne Dobson: None declared, Dervil Dockrell: None declared, Kathryn Berg: None declared, Helen Harris Galapagos.