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Objective: Facilitated self‐management interventions have the potential to enhance resilience and well‐being. We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12‐week online peer‐led symptom management intervention. Methods: We conducted a secondary data analysis from a randomized control trial comparing a peer health‐coached intervention to a waitlist control. Participants completed the Connor‐Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy‐Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12. Results: One hundred and seventy‐three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (P < 0.001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of −1.41 (95% confidence interval [CI] −2.41 to −0.41), pain interference of −0.86 (95% CI −1.65 to −0.08), and depressive symptoms of −1.99 (95% CI −3.16 to −0.81). Conclusion: For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions. [ABSTRACT FROM AUTHOR]

Objective: Supported self‐management interventions for individuals with systemic sclerosis (SSc) are needed. We examined the effects of a 12‐week resilience‐building energy management program (called RENEW) for fatigue and other patient‐reported outcomes. Methods: Participants, who had physician‐diagnosed SSc, moderate to severe fatigue, and were ≥18 years old, were randomly assigned to RENEW or waitlist control in a 2:1 ratio. The RENEW intervention included an educational website/application plus nine virtual peer‐led health coaching sessions. The primary outcome was change in the Functional Assessment of Chronic Illness Therapy‐Fatigue scale. Secondary outcomes were change in Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms and Connor‐Davidson Resilience Scale. Outcomes were assessed at baseline, 6 weeks, and 12 weeks. Multiple imputation was conducted; linear mixed models were used to assess group differences. A three‐way interaction with group, time, and SSc duration was examined in each model. Results: Among 173 participants (mean ± SD age 54.5 ± 11.7 years; 93% female, 85% White), 47% had diffuse cutaneous SSc; 57% were ≤5 years from diagnosis. At 12 weeks, compared to controls, RENEW participants had a clinically meaningful fatigue improvement (β = −4.7; 95% confidence interval −6.7 to −2.7; P < 0.001) and improvement in all secondary outcomes. Among RENEW participants, individuals with shorter disease duration had greater improvements in fatigue at 12 weeks. Conclusion: An mHealth supported self‐management intervention improved fatigue and other outcomes, particularly in newly diagnosed patients. This program may be broadly scalable for SSc symptom management. [ABSTRACT FROM AUTHOR]

Objective: This double-blind randomized controlled trial aimed to test the efficacy of self-administered acupressure for pain and physical function improvement for older adults with knee osteoarthritis (OA).Methods: Participants were community-dwelling adults with symptomatic knee OA (n = 150, mean age 73 years), randomized to 1 of 3 groups: verum acupressure, sham acupressure, or usual care. Participants in the verum and sham groups, but not those in the usual care group, were taught to self-apply acupressure once daily, 5 days/week for 8 weeks. Assessments were collected during center visits at baseline, and at 4 and 8 weeks. In addition, pain level was assessed weekly by phone using a numeric rating scale (NRS). Outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale (primary), and subjective and objective physical function measures and the NRS and physical function measures (secondary). Linear mixed regression analysis was conducted to test between-group differences in mean changes from baseline for the outcomes at 8 weeks.Results: Compared with usual care, both verum and sham acupressure participants experienced significant improvements in WOMAC pain (mean difference -1.27 units [95% confidence interval (95% CI) -1.95, -0.58] and -1.24 units [95% CI -1.92, -0.55], respectively), NRS pain (-0.74 units [95% CI -1.24, -0.24] and -0.51 units [95% CI -1.01, -0.01], respectively), and WOMAC function (-4.83 units [95% CI -6.99, -2.67] and -4.21 units [95% CI -6.37, -2.04], respectively) at 8 weeks. There were no significant differences between the verum and sham acupressure groups on any of the outcomes.Conclusion: Self-administered acupressure is superior to usual care in pain and physical function improvement for older adults with knee OA. The reason for the benefits is unclear, and the placebo effect may play a role. [ABSTRACT FROM AUTHOR]

Objective Although it has been well established that fatigue is common among older adults with osteoarthritis (OA), relatively little is known about how fatigue in daily life affects physical activity. The purposes of this study were to examine the relationship between momentary fatigue and subsequent physical activity among people with OA who reported clinically relevant levels of fatigue and to examine moderators of this relationship. Methods People with knee or hip OA and clinically relevant fatigue participated in physical performance assessments, completed questionnaires, and underwent a home monitoring period in which fatigue severity was measured 5 times/day over 5 days (n = 172). Physical activity was concurrently measured via a wrist-worn accelerometer. Multilevel modeling was used to examine the relationship of momentary fatigue and subsequent activity controlling for other factors (e.g., age, body mass index, pain, and depression). Results Fatigue was the strongest predictor of reduced subsequent activity. Only functional mobility (Timed Up and Go) moderated the relationship between fatigue and activity. The relationship between fatigue and activity was strongest for people with high functional mobility. Conclusion Momentary fatigue is a robust and important variable associated with decreased physical activity. Further, the moderating effect of functional mobility suggests this factor should be considered when intervening on fatigue. While people with better functional mobility may benefit from an activity-based treatment approach (such as learning activity pacing techniques to reduce the impact of fatigue on activity), those with worse functional mobility may benefit from treatment focusing on underlying impairments. [ABSTRACT FROM AUTHOR]