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Cognitive-Behavioral Therapy and Tai Chi Chih for Patients With Rheumatoid Arthritis

1. april 2013 oppdatert av: Perry Nicassio, University of California, Los Angeles

Behavioral Treatments for Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a chronic illness. Patients with RA often experience significant pain and depression. This study will evaluate two programs designed to improve the symptoms of RA: cognitive-behavioral therapy (CBT) and Tai Chi Chih (TCC), compared to a health education seminar.

Studieoversikt

Status

Fullført

Forhold

Intervensjon / Behandling

Detaljert beskrivelse

Rheumatoid arthritis is a progressive inflammatory illness marked by severe functional declines, significant economic and social costs, and significant psychological distress. Environmental and psychosocial factors such as stress, mood disturbance, and coping mechanisms may contribute to changes in important health outcomes, including disability and disease activity in RA. This study will compare CBT with TCC, a relaxation-based intervention, combining elements of slow gentle movement with meditation, against a more traditional health education seminar. Outcome measures will include psychological adaptation, mood disturbance, sleep quality, physiological adaptation, and disease severity.

Two hundred-ten patients will be randomly assigned to either CBT, TCC, or a control group. The CBT intervention will have three phases: 1) education on the nature of the adjustment process in chronic illness, 2) coping skill development, and 3) generalization and application of skills to everyday situations. Participants in the CBT group will attend 12 weekly group sessions of about 2 hours each. Participants in the TCC group will learn to perform 18 movements under the guidance of an expert TCC teacher. TCC participants will have 50 to 60 minute biweekly sessions during the 12-week study. Control group participants will attend weekly group educational sessions; these sessions will provide general knowledge about arthritis health and illness, and will include lectures, demonstrations, and question-and-answer sessions with experts in rheumatology, sleep science, and behavioral medicine.

Participants will be assessed prior to beginning treatment, at mid-treatment (Week 6) and again at the end of treatment (Week 12 to 13). The long term effect of interventions will be assessed at follow-up interviews 4 months and 8 months after the end of formal treatment. Psychosocial adaptation, mood disturbance and sleep quality, self-reported pain, and immune function will be measured at all five assessment periods.

Studietype

Intervensjonell

Registrering (Faktiske)

106

Fase

  • Ikke aktuelt

Kontakter og plasseringer

Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.

Studiesteder

  • Forente stater
    • California
      • Los Angeles, California, Forente stater, 90095
        • Cousins Center for Psychoneuroimmunology, UCLA

Deltakelseskriterier

Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.

Kvalifikasjonskriterier

Alder som er kvalifisert for studier

18 år og eldre (Voksen, Eldre voksen)

Tar imot friske frivillige

Nei

Kjønn som er kvalifisert for studier

Alle

Beskrivelse

Inclusion Criteria:

  • Diagnosis of RA as defined by the American College of Rheumatology (ACR) and consistent with revised criteria for RA
  • Stable disease-modifying drug regimen for 3 months prior to study entry, with no change in drug dosage for at least 3 months prior to study entry
  • Relatively stable disease course for 3 months prior to study entry
  • If treated with corticosteroids, must be on a stable dosage for 3 months prior to study entry
  • If taking prednisone, must be on a dosage less than or equal to 10 mg/day or equivalent
  • Resides in Greater Los Angeles area

Exclusion Criteria:

  • Inactive RA conditions defined as "in remission"
  • Experiencing frequent, severe disease flares that require changes in primary disease-modifying regimen
  • Serious medical conditions, including: diabetes, congestive heart failure, renal failure requiring specific treatment, cancer (unless cured for period of 5 years or more), unregulated endocrine disorders (including thyroid disorders), chronic uncontrolled infection, or any uncontrolled medical condition that may interfere with the study
  • Use of analgesics (e.g., opioids) other than acetaminophen or non-steroidal anti-inflammatory agents prescribed for RA treatment, tramadol (Ultram) or Tylenol with codeine on an as-needed basis, or propoxyphen (Darvocet, Wygesic)
  • Use of oxycodone (Percocet), hydrocodone (Vicodin), morphine, or hydromorphone (Dilaudid)
  • Use of high levels of methotrexate (greater than 7.5 mg)
  • Use of nitrogen mustard, cyclosporine, monoclonal antibodies, or cyclophosphamide within the 6 months prior to study entry
  • Serious psychiatric conditions, such as bipolar disorder, psychotic disorders, or organic brain syndromes
  • At risk for suicide
  • Dependent on canes, walkers, or other assistive devices
  • Unable to commit to study schedule/itinerary or unwilling to be assigned to any of the 3 treatment groups

Studieplan

Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.

Hvordan er studiet utformet?

Designdetaljer

  • Primært formål: Behandling
  • Tildeling: Randomisert
  • Intervensjonsmodell: Parallell tildeling
  • Masking: Enkelt

Våpen og intervensjoner

Deltakergruppe / Arm
Intervensjon / Behandling
Eksperimentell: 1
Participants will partake in cognitive behavioral therapy for 12 weeks.
Atferdsmessig: Cognitive Behavioral Therapy
The CBT intervention will have three phases: 1) education on the nature of the adjustment process in chronic illness, 2) coping skill development, and 3) generalization and application of skills to everyday situations. Participants in the CBT group will attend 12 weekly group sessions of about 2 hours each.
Eksperimentell: 2
Participants will partake in tai chi chih for 12 weeks.
Atferdsmessig: Tai Chi Chih
Participants in the TCC group will learn to perform 18 movements under the guidance of an expert TCC teacher. TCC participants will have 50- to 60-minute biweekly sessions during the 12-week study.
Aktiv komparator: 3
Participants will act as a control and attend educational sessions for 12 weeks.
Atferdsmessig: Health Education Seminar
Control group participants will attend weekly group educational sessions; these sessions will provide general knowledge about arthritis health and illness, and they will include lectures, demonstrations, and question-and-answer sessions with experts in rheumatology, sleep science, and behavioral medicine.

Hva måler studien?

Primære resultatmål

Resultatmål
Tidsramme
Disease activity
Tidsramme: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Health functioning
Tidsramme: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Inflammation, measured by levels of IL-1, IL-6, and tumor necrosis factor (TNF)-alpha
Tidsramme: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up

Sekundære resultatmål

Resultatmål
Tidsramme
Mood disturbances
Tidsramme: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Coping
Tidsramme: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up
Helplessness
Tidsramme: Measured at Week 12 and Months 4 and 8 follow-up
Measured at Week 12 and Months 4 and 8 follow-up

Samarbeidspartnere og etterforskere

Det er her du vil finne personer og organisasjoner som er involvert i denne studien.

Sponsor

University of California, Los Angeles

Samarbeidspartnere

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)

Etterforskere

  • Hovedetterforsker: Perry M. Nicassio, PhD, University of California, Los Angeles

Publikasjoner og nyttige lenker

Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.

Generelle publikasjoner

Studierekorddatoer

Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.

Studer hoveddatoer

Studiestart

1. februar 2004

Primær fullføring (Faktiske)

1. mars 2009

Studiet fullført (Faktiske)

1. mars 2009

Datoer for studieregistrering

Først innsendt

7. november 2003

Først innsendt som oppfylte QC-kriteriene

7. november 2003

Først lagt ut (Anslag)

10. november 2003

Oppdateringer av studieposter

Sist oppdatering lagt ut (Anslag)

4. april 2013

Siste oppdatering sendt inn som oppfylte QC-kriteriene

1. april 2013

Sist bekreftet

1. april 2013

Mer informasjon

Begreper knyttet til denne studien

Nøkkelord

Ytterligere relevante MeSH-vilkår

Andre studie-ID-numre

  • R01AR049840 (U.S. NIH-stipend/kontrakt)
  • NIAMS-095

Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .

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