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

Rebecca Pedley, Linda E Dean, Ernest H. Choy, Karl Gaffney, Tanzeel Ijaz, Lesley Kay, Karina Lovell, Christine Molloy, Kathryn Martin, Jonathan Packham, Stefan Siebert, Raj Sengupta, Gary Macfarlane, Rosemary Hollick* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.
Original languageEnglish
JournalRheumatology Advances in Practice
Publication statusAccepted/In press - 8 Oct 2020


  • axial spondyloarthritis
  • fibromyalgia
  • telephone-based cognitive behavioural therapy
  • feasibility

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