A study of the impact of psychodynamic counselling on disease activity in early rheumatoid arthritis

Flood, Mary (1998) A study of the impact of psychodynamic counselling on disease activity in early rheumatoid arthritis. MSc(R) thesis, University of Glasgow.

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Abstract

Title A study of the impact of psychodynamic counselling on disease activity in early rheumatoid arthritis. Design; Prospective randomised controlled trial. Setting: Physiotherapy Department, Glasgow Royal Infirmary. Subjects: 22 female patients with disease duration of less than three years. Intervention: Individual counselling on a weekly basis of up to ten weeks, each session lasting fifty minutes. Control group received five early education talks on the subject of rheumatoid arthritis from various health professionals, each session lasting ninety minutes. Methods: Patients randomly allocated into either a counselling group (group1: n=13) or an education group (group 2 ; n=9). Every patient was assessed during the ten week period at Week 0, 5, and 10. Disease activity was measured using the modified disease activity score (DAS) based on the Eular Core Data Set. The Disease Activity Score is a combined index used to assess disease activity in Rheumatoid Arthritis. A change of 1.08. is assumed to signify a significant improvement or deterioration. (Appendix 2). Main Results There was no significant difference between the groups at baseline and no significant difference was found in disease activity between the groups. In terms of changes over the ten weeks there was a trend towards improvement in the counselled group for the following subjective variables:- early morning stiffness, number of swollen joints, number of tender joints and pain as reported on a visual analogue scale. Quality of life was measured using the Arthritis Impact Score 2 (AIMS2), Hospital Anxiety and Depression Score (HAD) and the Health Assessment Questionnaire (HAQ). No statistical significance was found between the groups for any of the quality of life measures. Conclusions This limited pilot study suggests that psychodynamic counselling over a ten week period does not provide a significantly large improvement in ameliorating disease activity when compared to early education talks. There is however a suggestion of a moderate effect in the counselled group. Implications for The NHS It is difficult to make any definitive statement about the implications of the study for the NHS. Counselling may need to be made available to patients at times when they perceive there to be a need. The brief nature of the intervention may also be a factor to be considered, with each individual having different requirements with respect to the numbers of sessions offered. The fact that individuals self-select when considering counselling, needs to be taken into account when carrying out a randomised trial. This study does, however, highlight the importance of the doctor-patient relationship in terms of helping the patient to deal with the on-going difficulties of negotiating the independent and dependent self.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Additional Information: Adviser: Roger Sturrock
Keywords: Counseling Psychology, Physiological psychology
Date of Award: 1998
Depositing User: Enlighten Team
Unique ID: glathesis:1998-71351
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 10 May 2019 10:49
Last Modified: 10 May 2019 10:49
URI: http://theses.gla.ac.uk/id/eprint/71351

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