Mindfulness-based stress reduction to improve depression, pain and high patient global assessment in controlled rheumatoid arthritis.
Isabelle Gaboury, Patricia L Dobkin, Françoise Gendron, Pasquale Roberge, Marie-Claude Beaulieu, Nathalie Carrier, Pierre Dagenais, Sophie Roux, Gilles Boire
Rheumatology advances in practice 2022 DOI: 10.1093/rap/rkac074 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Pragmatic pilot study Qualitative Peer reviewed |
|---|---|
| Sample size | 28 |
| Population | Rheumatoid arthritis patients with clinically controlled inflammation and high depression scores (CES-D ≥16) and/or patient general assessment at least 2/10 higher than evaluator general assessment |
| Intervention | Mindfulness-based stress reduction (MBSR) |
| Duration | 12-month follow-up |
| Measures | CES-D, PGA, modified HAQ, SDAI, GAD-7, CHIP, sleep disturbance and pain |
| Topics | Depression Meditation |
| Keywords | Coping Function Mindfulness-based stress reduction Pain Patient general assessment Remission |
| Key points | Among patients who completed MBSR, anxiety, depression, emotion-oriented coping, sleep, and function significantly improved up to 12 months later, while pain, patient global assessment, the patient-evaluator gap, and disease activity index showed no significant change. The authors suggest larger studies are needed to evaluate MBSR's weaker impact on RA-related pain and patient global assessment. |
Abstract
The aim was to improve distressing patient-reported outcomes (PROs) that persisted in RA patients with clinically controlled inflammation (controlled RA). In a pragmatic pilot study, we offered mindfulness-based stress reduction (MBSR), a group intervention, to controlled RA patients who had high (≥16) Centre for Evaluation Studies depression (CES-D) scores and/or patient general assessment of disease activity (PGA) at least 2/10 larger than evaluator general assessment (EGA) (PGA-EGA: Delta). Evaluations before, 6 and 12 months after MBSR included CES-D, PGA, modified HAQ, simple disease activity index (SDAI), anxiety (general anxiety disorder 7; GAD-7), coping strategies (coping with health injuries and problems; CHIP), sleep disturbance and pain. Facilitators and obstacles to recruitment and participation were identified. A subset of patients was interviewed for qualitative analysis of their experience. Out of 306 screened patients, 65 were referred, 39 (60%) agreed and 28 (43%) completed MBSR. Anticipated burden, timing and frequency of group meetings, commuting issues, age extremes and co-morbidities were barriers to participation. Up to 12 months after MBSR, anxiety, depression, emotion-oriented coping, sleep and function significantly improved. Nonetheless, no significant impact was observed on pain, PGA, Delta or SDAI. The interviews revealed that benefits, including integration of effective coping strategies, were maintained. We addressed MBSR feasibility issues and selection of outcomes in controlled RA patients with distressing PROs. For patients who chose to participate in MBSR, lasting benefits were evident for anxiety, depression, sleep and function. Larger studies are required to evaluate the weaker impact of MBSR on RA-related pain and PGA.
Comparable studies
Other non-randomized and open-label trials on depression, most cited first.