A goal management intervention for patients with polyarthritis and elevated levels of depressive symptoms: a quasiexperimental study

Abstract

Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis. Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes. Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group. Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed. ä IMPLICATIONS FOR REHABILITATIONPeople with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation. Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis. The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals. The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up. ARTICLE HISTORY

Goal adjustment by people living with long-term conditions: A scoping review of literature published from January 2007 to June 2018.

“…The first was a protocol for randomized controlled trial of a psycho-educational programme (Right on Target) (Arends et al, 2013). The second evaluated the Right on Target intervention using a quasi-experimental design (Arends et al, 2018), and the third evaluated a psychological intervention (Self-system therapy) using a randomized controlled trial design (Eddington et al, 2015). The aims of the remaining quantitative studies (n = 7; 13%) were varied.…”

“…Neutral Associations: Seven studies reported neutral associations between goal disengagement and health and/or wellbeing variables. Four were in people with cancer (Mens & Scheier, 2016;Schroevers et al, 2008;Thompson et al, 2013;Zhu et al, 2015); one in people with myocardial infarction (Garnefski et al, 2009b), one in people with arthritis (Arends et al, 2018) and one in people with vasculitis (Mayor, 2018). Three studies reported neutral associations between goal reengagement and recovery and /or wellbeing variables; one in people with cancer (Zhu et al, 2015), one in people with arthritis (Arends et al, 2018) and the final one in people with vasculitis (Mayor, 2018).…”

“…The need for goal adjustment, disengagement and reengagement is considered in a weekly goal review. Right on Target (Arends et al, 2013(Arends et al, , 2018) is a group-based psychosocial educational programme. It is designed to enhance participants' awareness of, and response to, threatened personal goals.…”

“…Evaluating the effectiveness of other interventions reported to support goal adjustment within our reviewthe Goal setting and Action Planning framework (Scobbie et al, 2011(Scobbie et al, , 2013; SMARTER goal setting framework (Hersh et al, 2012); Right on Target (Arends et al, 2013(Arends et al, , 2017(Arends et al, , 2018 and the Health Through Activity programme (Lyons et al 2018) could go some way to addressing this evidencepractice gap. Our findings also suggested candidate psychological interventions that may be worthy of further development and evaluation includingmindfulness; cognitive behaviour therapy, motivational intervening and acceptance and commitment therapy.…”

Associations of Age and Pain With 9-Year Functional Health Trajectories

“…With increasing age, individuals show higher investment in strategies of accommodative coping (Brandtstädter & Greve, 1994; Brandtstädter, Rothermund, Kranz, & Kühn, 2010; Rothermund & Brandstädter, 2003). Moreover, accommodative goal management strategies in later life have been found to be associated with better physical and functional health (Arends, Bode, Taal, & Van de Laar, 2018; Hall et al, 2010; Kelly, Wood, & Mansell, 2013).…”