Feasibility, acceptability and change in health following a telephone-based CBT intervention for patients with Axial Spondyloarthritis

Objective: To assess the feasibility and acceptability of a telephone-based Cognitive Behaviour Therapy (tCBT) intervention for individuals with axial spondyloarthritis (axSpA), with and without co-morbid fibromyalgia and measure change in patient reported health outcomes.
Methods: A convenience sample of individuals recruited from British Society of
Rheumatology Biologics Registry for Ankylosing Spondylitis (BSRBR-AS) sites were offered a course of tCBT (framed as ‘coaching’). Patient reported outcomes were measured at baseline and on course completion. Semi-structured qualitative interviews assessed intervention acceptability. Thematic analysis was informed by the Theoretical Framework of Acceptability (TFA).
Results: 42 participants attended for initial assessment. Those completing at least one tCBT session (n=28) were younger, more likely to meet classification criteria for fibromyalgia (57% vs 29%) and reported higher disease activity. Modest improvements were reported across a range of disease activity and wider health measures, with 62% patients self-rating their health as improved (median 13 weeks post intervention). 26 participants were interviewed (including six who discontinued after initial assessment). tCBT was widely acceptable, offering a personalised approach. Despite low or unclear expectations, participants
described improved sleep and psychological well-being, and gained new skills to support self-management. Reasons for non-uptake of tCBT centered on lack of perceived need and fit with individual value systems. Many felt tCBT would be most useful closer to diagnosis.
Conclusion: Higher uptake among axSpA patients with co-morbid fibromyalgia suggests these individuals have additional needs. Findings are helpful in identifying patients most likely to engage with and benefit from tCBT, and maximise participation.