ObjectivesTo identify, appraise and synthesise qualitative studies on the experience of living with rheumatoid arthritis (RA)-related fatigue.MethodsWe conducted a qualitative metasynthesis encompassing a systematic literature search in February 2017, for studies published in the past 15 years, in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, SveMed, PsychINFO and Web of Science. To be included, the studies had to report the experience of living with fatigue among adults with RA. The analysis and synthesis followed Malterud’s systematic text condensation.ResultsEight qualitative articles were included, based on 212 people with RA (69% women) and aged between 20 and 83 years old. The synthesis resulted in the overall theme ‘A vicious circle of an unpredictable symptom’. In addition, the synthesis derived four subthemes: ‘being alone with fatigue’; ‘time as a challenge’; ‘language as a tool for increased understanding’ and ‘strategies to manage fatigue’. Fatigue affects all areas of everyday life for people with RA. They strive to plan and prioritise, pace, relax and rest. Furthermore, they try to make use of a variety of words and metaphors to explain to other people that they experience that RA-related fatigue is different from normal tiredness. Despite this, people with RA-related fatigue experience feeling alone with their symptom and they develop their own strategies to manage fatigue in their everyday life.ConclusionsThe unpredictability of RA-related fatigue is dominant, pervasive and is experienced as a vicious circle, which can be described in relation to its physical, cognitive, emotional and social impact. It is important for health professionals to acknowledge and address the impact of fatigue on the patients’ everyday lives. Support from health professionals to manage fatigue and develop strategies to increase physical activity and maintain work is important for people with RA-related fatigue.

The impact of a personalised action plan delivered at discharge to patients with COPD on readmissions: a pilot study Background: Self-management interventions in COPD, including action plans, have the potential to increase quality of life and to reduce respiratory-related hospitalisations. However, knowledge is still sparse of the effectiveness of a personally tailored action plan introduced at or right after discharge from hospital. Aim: This pilot study aimed to test whether a personalised, stepwise action plan supported with a short instruction provided at or postdischarge after an acute exacerbation in chronic obstructive pulmonary disease admission as an addition to usual care reduces readmissions and symptom burden, including anxiety and depression levels at 3-month follow-up. Methods: The study was carried out in a randomised controlled design with follow-up after 3 months. In all, 75 participants were randomly assigned to either an intervention group that received an action plan, including the COPD Assessment Test (CAT), or to a control group that received usual care. The incidence of COPD-related readmissions was measured as the primary outcome. Results: Compared to the control group, the action plan group significantly reduced the incidence of readmissions. The action plan group showed a trend towards a significant decrease in HADS-depression, but none in HADS-anxiety. Significant improvements in CAT scores were observed for the participants in the intervention group. Only inferior minor differences were found in use of inhalation therapy. Conclusions: A personally tailored action plan introduced at or postdischarge combined with follow-up support is an effective self-management tool to support recovery and to reduce unnecessary readmissions. In future follow-up care, the healthcare professional must initiate the action plan at discharge and immediately after having the opportunity to follow the patient at home. This might require healthcare professionals working across healthcare sectors, who support patients until they have the needed confidence and competence in using the plan.

BackgroundPeople with Rheumatoid Arthritis (RA) experience fatigue as the most significant symptom of their illness. Despite a substantial body of knowledge about fatigue, there is a need for an overall comprehensive understanding of the experience of living with fatigue among people with RAObjectivesTo identify, appraise and synthesise qualitative studies on experiences of living with fatigue in people with RAMethodsWe conducted a qualitative meta-synthesis, inspired by Sandelowski and Barroso1. This included a systematic literature search conducted in February 2017, for studies published in the past 15 years, in the databases PubMed, Cinahl, Embase, SveMed, PsychInfo and Web of Science. To be included the studies had to include findings regarding the experience of adults with RA living with fatigue. The international Critical Appraisal Skills programme was used to assess the quality. The analysis and synthesis were inspired by Malterud’s systematic text condensation2 ResultsEight qualitative articles were included. The synthesis resulted in an overall theme ‘fatigue: the vicious cycle of an unpredictable symptom’. In addition, the analysis derived five subthemes, ‘being alone with fatigue‘, ‘necessary prioritising in everyday life’, ‘when time gets a different meaning’, ‘language as a tool for increased understanding’ and ‘strategies to manage fatigue’. Fatigue affects all areas of everyday life for people with RA. They strive to plan and prioritise, pace, relax and rest. In addition, they try to make use of a variety of words and language to help others understand that the RA-related fatigue they experience is not ‘normal’ fatigue. People with RA-related fatigue experience feeling alone with their symptom, but they develop their own strategies to manage fatigue in their everyday lifeConclusionsThe unpredictability of RA-related fatigue is dominant, pervasive and is experienced as a vicious cycle, which can be described in relation to its physical, cognitive, emotional, social and behavioural impact. Acknowledgement and support from health professionals can make a difference to people with RA-related fatigueReferences[1] Sandelowski, M & Barosso, J. 2007: Handbook for synthesizing qualitative research. New York, Springer.[2] Malterud, K. 2012: Systematic text condensation: a strategy for qualitative analysis. Scand J Public Health, 40, 795–805Disclosure of InterestNone declared