Sedentary behaviour interventions in rheumatoid arthritis and osteoarthritis: a systematic scoping review of intervention content, perceived acceptability and efficacy.

Abstract

Background: Sedentary behaviour (SB) is receiving increasing attention as a potential target for behavioural change interventions in people with Rheumatoid Arthritis (RA), to improve RA outcomes. The primary aim of this review was to describe the design and content of existing SB interventions in RA with a focus on the use of digital technology and Behaviour Change Techniques (BCTs). Secondary aims were to understand how SB is conceptualised in intervention studies, and report data on participants' perceptions of acceptable and/or engaging components, adherence, and intervention efficacy.

Methods: Six databases (Cochrane Library, Medline, PubMed, Excerpta Medica database (EMBASE), APA Psychnet and OVID Journals) were searched from inception-October 2024. Inclusion criteria required publications to report on a behaviour change intervention targeting SB (directly or indirectly) in people with RA, and assessed SB as an outcome. Interventions in people with Osteoarthritis (OA) were also included, for a broader understanding.

Results: Initial searches returned 1,530 articles. Following screening, 30 articles underwent full text review, and 8 articles reporting interventions in RA (3/8, 38%) and OA (5/8, 62%) met the inclusion criteria. Only one RA intervention was specifically focused on SB, with the remaining seven targeting physical activity (PA), self-management or health outcomes. A hybrid delivery approach (in-person + digital, i.e., text messages and/or emails, apps, websites) was adopted by six interventions. Reporting of BCTs was inconsistent, but 'Goals and Planning' and 'Feedback and Monitoring' were used by all interventions. There was heterogeneity in the definition of SB and limited data on acceptable/engaging components. However, most studies reported measures of intervention/study adherence, and two interventions demonstrated preliminary evidence of intervention effects on SB and/or patient/clinician important outcomes.

Conclusion: This review highlights a focus on hybrid delivery of interventions targeting SB in people with RA and/or OA, offering opportunities for personalisation and saving personal and healthcare resources. More standardised approaches to reporting intervention design (e.g. employing established definitions and validated measures of SB) and content (e.g. BCTs), alongside evaluation of intervention acceptability/engagement is required. This is critical to further understanding of interventions likely to be accepted by people with RA, and thus more likely effective at reducing SB and improving RA outcomes.