1
|
Keny C, Dillon EC, Russell MM, Colley A, Yank V, Tang V. "It's Incapacitated Me in so Many Ways": Older Adults' Lived Experience With Postoperative Symptoms at Home After Major Elective Surgery. Ann Surg 2024; 279:736-742. [PMID: 38050761 PMCID: PMC10997446 DOI: 10.1097/sla.0000000000006170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
OBJECTIVE This qualitative study aimed to explore the challenges faced by older adults regarding the postoperative symptom experience after major elective surgery. BACKGROUND Although extensively studied in oncology settings, the impact of postoperative symptom burden remains largely underexplored in elective major surgery among older adults. METHODS We employed convenience sampling to recruit adults aged 65 years or above undergoing major elective surgery at the University of California, San Francisco. Semistructured interviews regarding the surgical experience were conducted at 1 and 3 months postoperatively. An inductive qualitative approach was used to identify emerging themes. Symptoms revealed by participants during interviews were also captured. RESULTS Nineteen participants completed a 1-month postoperative interview, and 17 additionally completed a 3-month interview. Three themes emerged: (1) postoperative symptoms significantly impacted valued life activities and psychosocial well-being, (2) participants felt "caught off guard" by the intensity and duration of postoperative symptoms, and (3) participants expressed the need for additional support, resources, and education on symptom management. The most frequently mentioned symptoms were postoperative pain (n=12, 63.1%), gastrointestinal discomfort (n=8, 42.1%), and anxiety/stress (n=8, 42.1%) at 1-month postsurgery compared with pain and depression (both n=6, 35.3%) at 3 months. CONCLUSIONS Study participants were surprised by the negative impact of postoperative symptoms on their psychosocial well-being and ability to engage in valued life activities. Symptom burden is an important patient-reported outcome that should be assessed postoperatively. Interventions to minimize postoperative symptom burden in older adults could optimize quality of life and participation in meaningful activities during surgical recovery.
Collapse
Affiliation(s)
- Christina Keny
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA
- Division of Geriatrics, Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA
- School of Nursing, University of California San Francisco, San Francisco, CA
| | - Ellis C. Dillon
- Center on Aging, University of Connecticut Health Center, Farmington, CT
| | - Marcia M. Russell
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Department of Surgery, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Alexis Colley
- Department of Surgery, University of California San Francisco, San Francisco, CA
| | - Veronica Yank
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Victoria Tang
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA
- Division of Geriatrics, Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA
| |
Collapse
|
2
|
Choi S. Association of hearing impairment with social participation restriction and depression: comparison between midlife and older adults. Aging Ment Health 2023; 27:2257-2266. [PMID: 37561088 DOI: 10.1080/13607863.2023.2245774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVES This study examined the association between hearing impairment and depression, focusing on the role of restricted social engagement as a mediator and whether the mediating relationship differed between midlife individuals (45-64) and older adults (65+). METHODS Individuals aged 45 and older from the cross-sectional National Health and Nutrition Examination Survey 2017-2018 were analyzed (N = 3,020). A multiple-group path analysis was conducted to compare midlife individuals (n = 1,774) and older adults (n = 1,246). RESULTS The results indicated that among U.S. adults aged 45 or older, 12.3% reported having serious difficulty hearing (21.2% among older adults vs. 7.4% among midlife adults). In both age groups, significant direct relationship between hearing impairment and depression, as well as indirect relationship via social participation restriction, were found. However, a significant difference was found in the relationship between restricted social participation and depression by age group (i.e. moderated mediation): The coefficient was greater among midlife adults than among older adults (Δbmidlife-older=1.109-0.383 = 0.726, p<.001). CONCLUSION These findings highlight that adverse psychosocial effects of hearing impairment are also an important concern for midlife adults. As the importance of social engagement was greater among midlife adults with hearing impairment, age-specific interventions should be adopted to reduce depression associated with hearing impairment.
Collapse
Affiliation(s)
- Sunha Choi
- Department of Public Administration, Seoul National University of Science & Technology, Seoul, South Korea
| |
Collapse
|
3
|
Mas-Herrero E, Singer N, Ferreri L, McPhee M, Zatorre RJ, Ripollés P. Music engagement is negatively correlated with depressive symptoms during the COVID-19 pandemic via reward-related mechanisms. Ann N Y Acad Sci 2023; 1519:186-198. [PMID: 36401802 DOI: 10.1111/nyas.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The COVID-19 pandemic has deeply affected the mental health of millions of people. We assessed which of many leisure activities correlated with positive mental health outputs, with particular attention to music, which has been reported to be important for coping with the psychological burden of the pandemic. Questionnaire data from about 1000 individuals primarily from Italy, Spain, and the United States during May-June 2020 show that people picked music activities (listening to, playing, singing, etc.) most often as the leisure experiences that helped them the most to cope with psychological distress related with the pandemic. During the pandemic, hours of engagement in music and food-related activities were associated with lower depressive symptoms. The negative correlation between music and depression was mediated by individual differences in sensitivity to reward, whereas the correlation between food-related activities and improved mental health outputs was explained by differences in emotion suppression strategies. Our results, while correlational, suggest that engaging in music activities could be related to improved well-being with the underlying mechanism being related to reward, consistent with neuroscience findings. Our data have practical significance in pointing to effective strategies to cope with mental health issues beyond those related to the COVID-19 pandemic.
Collapse
Affiliation(s)
- Ernest Mas-Herrero
- Department of Cognition, Development and Education Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain.,Cognition and Brain Plasticity Unit, Bellvitge Biomedical Research Institute, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Neomi Singer
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,International Laboratory for Brain, Music and Sound Research (BRAMS) and Center for Research in Brain, Language and Music (CRBLM), Montreal, Quebec, Canada.,Sagol Brain Institute and Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Laura Ferreri
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Laboratoire d'Étude des Mécanismes Cognitifs, Université Lumière Lyon 2, Lyon, France
| | - Michael McPhee
- Department of Psychology, New York University, New York, New York, USA.,Music and Auditory Research Laboratory (MARL), New York University, New York, New York, USA.,Center for Language, Music, and Emotion (CLaME), New York University, New York, New York, USA
| | - Robert J Zatorre
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada.,International Laboratory for Brain, Music and Sound Research (BRAMS) and Center for Research in Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Pablo Ripollés
- Department of Psychology, New York University, New York, New York, USA.,Music and Auditory Research Laboratory (MARL), New York University, New York, New York, USA.,Center for Language, Music, and Emotion (CLaME), New York University, New York, New York, USA
| |
Collapse
|
4
|
Engagement in leisure activities and depression in older adults in the United States: Longitudinal evidence from the Health and Retirement Study. Soc Sci Med 2022; 294:114703. [PMID: 35032746 PMCID: PMC8850653 DOI: 10.1016/j.socscimed.2022.114703] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 11/30/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022]
Abstract
Background Receptive cultural engagement (e.g. attending theaters and museums) can reduce depression in older adults. However, whether specific participatory leisure activities are associated with lower rates of depression remains unknown. We aimed to test whether engagement in a diverse range of leisure activities, all of which could involve artistic or creative elements, was associated with concurrent and subsequent depression. Methods Using longitudinal data from 19,134 participants aged over 50 in the Health and Retirement Study, engagement in leisure activities was measured every four years, and depression every two years, between 2008 and 2016. Leisure activities included: reading books, magazines, or newspapers; writing; baking/cooking something special; making clothes, knitting, or embroidery (sewing); working on hobbies/projects; going to sport, social, or other clubs; and attending non-religious organization meetings. A score of three or more on the Center for Epidemiologic Studies Depression Scale indicated depression. We fitted population-averaged panel data models using generalized estimating equations with a logit link. Results Engaging in some leisure activities, such as clubs, hobbies/projects, and baking/cooking was associated with reduced depression, independent of confounders. Concurrently, spending time on hobbies/projects (monthly OR = 0.80, 95% CI = 0.72–0.88; weekly OR = 0.81, 95% CI = 0.73–0.89) and clubs (monthly OR = 0.85, 95% CI = 0.77–0.94; weekly OR = 0.78, 95% CI = 0.69–0.88) was associated with lower odds of depression versus not engaging. Longitudinally, the odds of depression two years later were reduced amongst people engaging in weekly baking/cooking (OR = 0.85, 95% CI = 0.75–0.95), hobbies (OR = 0.81, 95% CI = 0.71–0.92), and clubs (OR = 0.82, 95% CI = 0.71–0.94). Writing, reading, sewing, and attending non-religious organizations were not consistently associated with depression. Conclusions Engagement in some leisure activities is associated with reduced odds of depression. We should consider how older adults can be supported to actively participate in leisure activities as health-promoting behaviors. Some leisure activities associated with reduced odds of depression in older adults. Going to sport, social, or other clubs most strongly associated with less depression. Doing hobbies/projects and baking/cooking something special also associated. No evidence that more artistic or creative activities were associated with depression.
Collapse
|
5
|
Uda M, Hashimoto M, Uozumi R, Torii M, Fujii T, Tanaka M, Furu M, Ito H, Terao C, Yamamoto W, Sugihara G, Nakagami Y, Mimori T, Nin K. Factors associated with anxiety and depression in rheumatoid arthritis patients: a cross-sectional study. Adv Rheumatol 2021; 61:65. [PMID: 34715944 DOI: 10.1186/s42358-021-00223-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 10/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of anxiety and depression symptoms in rheumatoid arthritis (RA) patients is vital. Previous study findings on this topic are conflicting, and the topic remains to be thoroughly investigated. This study aimed to clarify the association of RA disease activity with anxiety and depression symptoms after controlling for physical disability, pain, and medication. METHODS We conducted a cross-sectional study of RA patients from the XXX Rheumatoid Arthritis Management Alliance cohort. We assessed patients using the Disease Activity Score (DAS28), Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS). Anxiety and depression symptoms were defined by a HADS score ≥ 8. We analyzed the data using multivariable logistic regression analyses. RESULTS Of 517 participants, 17.6% had anxiety symptoms and 27.7% had depression symptoms. The multivariable logistic regression analysis demonstrated that DAS28 was not independently associated with anxiety symptoms (odds ratio [OR] [95% confidence interval; CI] 0.93 [0.48-1.78]; p = 0.82) and depression symptoms (OR [95% CI] 1.45 [0.81-2.61]; p = 0.22). However, DAS28 patient global assessment (PtGA) severity was associated with anxiety symptoms (OR [95% CI] 1.15 [1.02-1.29]; p = 0.03) and depression symptoms (OR [95% CI] 1.21 [1.09-1.35]; p < 0.01). Additionally, HAQ-DI scores ≤ 0.5 were associated with anxiety symptoms (OR [95% CI] 3.51 [1.85-6.64]; p < 0.01) and depression symptoms (OR [95% CI] 2.65 [1.56-4.50]; p < 0.01). Patients using steroids were more likely to have depression than those not using steroids (OR [95% CI] 1.66 [1.03-2.67]; p = 0.04). CONCLUSIONS No association was found between RA disease activity and anxiety and depression symptoms in the multivariable logistic regression analysis. Patients with high PtGA scores or HAQ-DI scores ≤ 0.5 were more likely to experience anxiety and depression symptoms, irrespective of disease activity remission status. Rather than focusing solely on controlling disease activity, treatment should focus on improving or preserving physical function and the patient's overall sense of well-being.
Collapse
Affiliation(s)
- Miyabi Uda
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Motomu Hashimoto
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Clinical Immunology, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Ryuji Uozumi
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mie Torii
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takao Fujii
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Masao Tanaka
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Ito
- Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Chikashi Terao
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan.,Clinical Research Center, Shizuoka General Hospital, Shizuoka, Japan.,The Department of Applied Genetics, The School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Okayama, Japan
| | - Genichi Sugihara
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yukako Nakagami
- Department of Psychiatry, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Kyoto University Health Service, Kyoto, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Ijinkai Takeda General Hospital, Kyoto, Japan
| | - Kazuko Nin
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, 53 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| |
Collapse
|
6
|
Varshney S, Sharma M, Kapoor S, Siddharth M. Association between rheumatoid arthritis and periodontitis in an adult population - A cross sectional study. J Clin Exp Dent 2021; 13:e980-e986. [PMID: 34667492 PMCID: PMC8501867 DOI: 10.4317/jced.57562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/23/2021] [Indexed: 12/31/2022] Open
Abstract
Background This investigation was aimed to analyse the existence of an association between rheumatoid arthritis and periodontitis among Indian subjects.
Material and Methods This observational study included a total of 110 individuals between 18-78 years of age, which were divided equally into RA (Rheumatoid Arthritis) and NRA (Non-Rheumatoid Arthritis) groups. General, Oral and a complete Periodontal examination included recording of Gingival Index (GI), Plaque index (PI), Pocket Probing Depth (PPD), Clinical attachment level (CAL) in a questionnaire form. Laboratory and rheumatologcal parameters like C-reactive protein (CRP), Erythrocyte sedimentation rate (ESR) and Disease Activity Score 28(DAS 28), Health Assessment Questionnaire–Disability Index (HAQ), Rheumatoid factor (RF) were also respectively estimated.
Results Prevalence of moderate or severe periodontitis was higher in RA than in NRA group. (41.8% vs 23.6%, p= 0.047). Periodontal structural damage represented by clinical attachment level was more in RA patients (2.89 mm v/s 2.54mm, p=0.261). Mean score of HAQ was co-related significantly in patients with CAL ≥ 2mm than with CAL < 2mm (0.69 v/s 0.455, p=0.0415). Through logistic regression analysis, periodontitis and CAL were related to RA with OR (Odds Ratio) of 2.1 and 2.89 respectively.
Conclusions Indian RA patients have higher odds for periodontitis and CAL may act as a risk indicator for RA. Key words:Chronic periodontitis, rheumatoid arthritis, disease activity score 28, health assessment questionnaire, rheumatoid factor, c-reactive protein , erythrocyte sedimentation rate.
Collapse
Affiliation(s)
- Shailesh Varshney
- Periodontist, MDS, Department of Periodontology, School of Dental Sciences, Greater Noida
| | - Manish Sharma
- Post Graduate Student, Department of Periodontology , School of Dental Sciences, Greater Noida
| | - Sanjeev Kapoor
- Rheumatologist, MD, DM, Maharaj Agrasen Hospital, Punjabi Bagh, Arthritis Unit, Department of Rheumatology, New Delhi
| | - M Siddharth
- Periodontist, MDS, Department of Periodontology, School of Dental Sciences, Greater Noida
| |
Collapse
|
7
|
Tański W. The Role of Clinical Activity, Loneliness, and Satisfaction with e-Health Services as Factors Affecting Quality of Life in Patients with Rheumatoid Arthritis During the SARS-CoV-2 Pandemic. Psychol Res Behav Manag 2021; 14:1581-1590. [PMID: 34675699 PMCID: PMC8502048 DOI: 10.2147/prbm.s332141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION During the SARS-CoV-2 pandemic, most primary and specialist care outpatient clinics have started to offer their patients teleconsultation appointments as well as electronic prescriptions and referrals. For many patients, it was the only available way to access medical care. PURPOSE The aim of the study was to assess the quality of life in rheumatoid arthritis (RA) patients and determine whether loneliness and satisfaction with telemedicine service can affect their perceived QoL during the SARS-CoV-2 pandemic. MATERIAL AND METHODS One hundred and forty-three RA patients (mean age 45.83±13.5 years) were included in the study. The De Jong-Gierveld Loneliness Scale (DJGLS), The Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) and the questionnaire of satisfaction with teleconsultations were used in the study. The following statistical tests were used in the study: Spearman correlation test, multivariate linear regression. A significance level of 0.05 was used in the analysis. RESULTS The patients presented a moderate level of loneliness (DJGLS; 31.1 points). The mean ASQoL score was 11.49±4.64. The correlation analysis showed a significant positive relationship between the level of loneliness and QoL - the higher the level of loneliness, the poorer the QoL (rho=0.283; p=0.001). An analysis of the relationship between satisfaction with teleconsultations and perceived QoL showed a statistically significant negative relationship - the higher the level of satisfaction with teleconsultations, the better the QoL (b=-0.166; p=0.047). The linear multivariate regression analysis showed that the loneliness (rho=0.1; p=0.01) was significant (p<0.05) independent predictor of QoL. CONCLUSION During the SARS-CoV-2 pandemic, RA patients experienced loneliness and their QoL was low. Teleconsultation visits proved to be unsatisfactory and negatively perceived by patients. Higher severity of RA symptoms (weakness, fatigue), being unemployed and loneliness during the blockade are independent determinants of reduced QoL in RA patients.
Collapse
Affiliation(s)
- Wojciech Tański
- Department of Internal Medicine, 4th Military Teaching Hospital, Wroclaw, Poland
| |
Collapse
|
8
|
Kılıç N, Parlar Kılıç S. The effect of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis: A randomized controlled trial. Int J Nurs Pract 2021:e13015. [PMID: 34569129 DOI: 10.1111/ijn.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 12/01/2022]
Abstract
AIMS The aim of this study was to investigate the effects of progressive muscle relaxation on sleep quality and fatigue in patients with rheumatoid arthritis. METHODS This randomized controlled study was conducted with 72 patients with rheumatoid arthritis who applied to the rheumatology outpatient clinic of a university hospital between January and May 2018. The data were collected using the Patient Information Form, Pittsburgh Sleep Quality Index and Fatigue Severity Scale. After the patients in the intervention group completed the forms, patients were given training with regard to the application of progressive muscle relaxation which they subsequently performed, and the Pittsburgh Sleep Quality Index and Fatigue Severity Scale forms were repeated after 6 weeks. RESULTS After performing progressive muscle relaxation for 6 weeks, the total score of the Pittsburgh Sleep Quality Index and the fatigue score decreased among patients in the intervention group; no change was observed among the patients in the control group. A statistical difference was found between the two groups in terms of the Pittsburgh Sleep Quality Index's and Fatigue Severity Scale's mean scores. CONCLUSION Progressive muscle relaxation can be recommended to enhanced sleep quality and reduce fatigue in patients with rheumatoid arthritis.
Collapse
Affiliation(s)
- Nermin Kılıç
- Nursing Department, Bingol University Faculty of Health Sciences, Bingol, Turkey
| | - Serap Parlar Kılıç
- Department of Internal Medicine Nursing, Inonu University Faculty of Nursing, Malatya, Turkey
| |
Collapse
|
9
|
Sleep disturbances in chronic rheumatic diseases: Is disease activity the major determinant factor? LA TUNISIE MEDICALE 2021; 99:890-897. [PMID: 35261017 PMCID: PMC9003582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Sleep disturbances are closely related to chronic pain processes, especially in patients with inflammatory and mechanical joint diseases. OBJECTIVES This study aims to report sleep characteristics in patients with rheumatoid arthritis (RA) and knee osteoarthritis also to determine the responsibility of disease activity in the occurrence of sleep disturbances during chronic rheumatic diseases. METHODS We conducted a comparative study between two groups of patients: the first with RA, the second with primary knee osteoarthritis. We reported sociodemographic and medical data (clinical and biological inflammatory syndrome data). Then, we assessed depression, anxiety, and sleep disturbances with respectively Beck Depression Inventory, Beck Anxiety Inventory and Medical Outcome Study Sleep Scale (MOS-SS). RESULTS Seventy RA patients aged 51.9 years, with an average of 77.1% female were studied. The mean disease duration was 6.9 years. All sleep domains were altered in these patients. Forty patients with knee osteoarthritis aged 57.5 years with an average of 70% female were included. The mean disease duration was 4 years. The most impaired domains in this group were somnolence and sleep disturbance. Multivariate analysis concluded that risk factors independently related to RA were: disease activity score, functional disability, depression, anxiety, and body mass index. Disease activity score were the only parameter to influence all domains of sleep. CONCLUSION So we result that disease activity is a risk factor independently related to sleep disturbances in rheumatoid arthritis. Furthermore, mood disorders and obesity also deteriorate several sleep domains. These factors must be considered in the management of chronic rheumatic disorders.
Collapse
|
10
|
Pelle E, Zaccarin S, Furfaro E, Rivellini G. Support provided by elderly in Italy: a hierarchical analysis of ego networks controlling for alter-overlapping. STAT METHOD APPL-GER 2021; 31:133-158. [PMID: 33897316 PMCID: PMC8056998 DOI: 10.1007/s10260-021-00565-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 12/02/2022]
Abstract
Providing support outside the household can be considered an actual sign of an active social life for the elderly. Adopting an ego–network perspective, we study support Italian elders provide to kin or non–kin. More specifically, using Italian survey data, we build the ego–centered networks of social contacts elders entertain and the ego–networks of support elders provide to other non–cohabitant kin or non–kin. Since ego–network data are inherently multilevel, we use Bayesian multilevel models to analyze variation in support ties, controlling for the characteristics of elders and their contacts. This modeling strategy enables dealing with sparseness and alter–alter overlap in the ego support network data and to disentangle the effects related to the ego (the elder), the dyad ego–alter, the kind of support provided, as well as social contacts and contextual variables. The results suggest that the elderly in Italy who provide support outside their household — compared to all elders in the sample — are younger, healthier, more educated, and embedded in a more diversified ego–network of social contacts. The latter also conveys both the type and the recipient of the support, with the elderly who entertain few relationships with kin being more prone to provide aid to non–kin. Further, a “peer homophily” effect in directing elder support to a non–kin is also found.
Collapse
Affiliation(s)
- Elvira Pelle
- Department of Communication and Economics, University of Modena and Reggio Emilia, Viale Allegri, 9, Reggio Emilia, Italy
| | - Susanna Zaccarin
- Department of Economics, Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Emanuela Furfaro
- Department of Statistical Science, Catholic University of Milan, Milan, Italy
| | - Giulia Rivellini
- Department of Statistical Science, Catholic University of Milan, Milan, Italy
| |
Collapse
|
11
|
Hafkamp FJ, de Vries J, Gosens T, den Oudsten BL. The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty. J Arthroplasty 2021; 36:78-87. [PMID: 32893058 DOI: 10.1016/j.arth.2020.07.071] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms. METHODS Patients (N = 345) completed the Hip injury and Osteoarthritis Outcome Score or the Knee injury and Osteoarthritis Outcome Score to examine their preoperative and postoperative pain, stiffness, and function, presurgery, and 3, 6, and 12 months postsurgery. Presurgery anxiety and depressive symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale and the 9-item Patient Health Questionnaire. Latent trajectory analysis was used to identify different subgroups in trajectories. The step-3 method was used to assess subgroup characteristics. RESULTS The effect of time on pain, function, and stiffness was different between subgroups of patients. Knee patients belonged mainly to classes with least improvement. Least improvement in pain was characterized by a combination of high levels of both anxiety and depressive symptoms. Anxiety and depressive symptoms were independently related to less reduction in stiffness while little improvement in function was characterized by higher depressive symptoms. CONCLUSION The results of this study indicate that anxiety and depressive symptoms were significantly, but differently, related to the distinct physical symptoms examined.
Collapse
Affiliation(s)
- Frederique J Hafkamp
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopedics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
12
|
Shaw Y, Bradley M, Zhang C, Dominique A, Michaud K, McDonald D, Simon TA. Development of Resilience Among Rheumatoid Arthritis Patients: A Qualitative Study. Arthritis Care Res (Hoboken) 2020; 72:1257-1265. [PMID: 31282121 DOI: 10.1002/acr.24024] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 07/02/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Resilience, the ability to recover from and adapt successfully to stressful situations, is a valuable resource for patients who live with chronic conditions. This qualitative study examines the development of resilience among rheumatoid arthritis (RA) patients. We aimed to describe the resilience development process and to describe strategies used by patients to cultivate resilience. METHODS Our approach combined ethnographic data collection and narrative analysis methods. Semistructured interviews were conducted with adult RA patients in the US. Interviewees were asked to discuss their experiences with diagnosis, living with RA, coping with challenges, treatment, and health care providers. The interviews were audiorecorded, transcribed, and analyzed to describe the stages of resilience development and to identify patients' strategies for building/maintaining resilience. RESULTS Eighteen patients were interviewed, ages 27-80 years and with RA duration of 5-41 years. Patient responses to challenging situations were grouped into 3 stages: 1) lacking capacity to handle the situation, 2) struggling but growing in capacity to handle the situation, and 3) attaining mastery. Patients used 10 strategies to cultivate resilience: perseverance, exchanging social support, pursuing valued activities, flexibility, positive reframing, acceptance, humor, avoiding threatening thoughts, equanimity, and maintaining a sense of control. CONCLUSION RA patients acquire resilience in a dynamic process of learning in response to new challenges. Patients use a combination of behavioral and emotion management strategies to cultivate resilience. Awareness of these strategies may benefit patients, health care providers, and researchers developing behavioral interventions and social support programs in the context of RA and other chronic diseases.
Collapse
Affiliation(s)
- Yomei Shaw
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University Hospitals of Geneva, Geneva, Switzerland
| | | | | | | | - Kaleb Michaud
- FORWARD, The National Databank for Rheumatic Diseases, Wichita, Kansas, and University of Nebraska Medical Center, Omaha
| | | | | |
Collapse
|
13
|
Lwin MN, Serhal L, Holroyd C, Edwards CJ. Rheumatoid Arthritis: The Impact of Mental Health on Disease: A Narrative Review. Rheumatol Ther 2020; 7:457-471. [PMID: 32535834 PMCID: PMC7410879 DOI: 10.1007/s40744-020-00217-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
Over 60% of rheumatoid arthritis (RA) patients achieve a good response after 12 months of treatment when following the European league against rheumatism (EULAR) guidelines for treatment. However, almost half of patients still suffer from moderate to severe disease activity despite this. In addition, mental health problems may remain despite reduced measures of inflammation systemically and within joints. Depression is two times more common in RA patients than in the general population, and intriguingly a bi-directional relationship with RA has been shown in cross-sectional studies. Chronic inflammation impairs the physiological responses to stress including effective coping behaviours, resulting in depression, which leads to a worse long-term outcome in RA. In RA patients, the pain score is not always solely related to inflammatory arthritis and immunological disease activity by Bąk et al. (Patient Prefer Adherence 13:223-231, [1]). Non-inflammatory pain secondary to anxiety, depression, sleep disturbance and the psychosocial situation needs to be considered whilst fibromyalgia, mechanical pain and neuropathic pain can also contribute to overall pain scores by Chancay et al. (Women's Midlife Health 5:3, [2]). Hence, the UK National Institute for Health and Care Excellence (NICE) guideline for the management of RA included psychological interventions for fatigue, low mood and social well-being (NICE NG100, 2018) [3], and the NICE clinical guidelines (CG91) [4] suggest managing mental health and depression in chronic medical conditions to improve treatment outcomes. This is a narrative review of the impact of mental health on RA disease activity in terms of patient-reported outcomes (PROs).
Collapse
Affiliation(s)
- May N Lwin
- University Hospital Southampton, Southampton, UK.
| | - Lina Serhal
- University Hospital Southampton, Southampton, UK
| | | | | |
Collapse
|
14
|
The Relationship Between Anxiety, Depression, Suicidal Ideation and Quality of Life in Patients with Rheumatoid Arthritis. Psychiatr Q 2020; 91:53-64. [PMID: 31768910 DOI: 10.1007/s11126-019-09680-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic disease and many patients with RA experience lifelong anxiety and depression. The aim of this study is to provide an assessment of anxiety, depression, suicidal ideation, disease activity and quality of life in patients with RA. Fifty patients were included in the study. Hospital Anxiety and Depression Scale (HADS), Short Form Health Survey (SF-36), Beck Scale for Suicide Ideation (BSSI) and Disease Activity Score (DAS-28) were applied. A statistically negative correlation was found between HADS-A and HADS-D scores and all subscales of SF-36. There was a statistically negative correlation between the DAS-28 score and the subscales of the SF-36 except mental health and bodily pain. Suicidal ideation was associated with anxiety and depression and BSSI scores of patients suffering from anxiety and depression are higher than the patients not suffering from anxiety and depression. There was a statistically negative correlation between BSSI and the subscales of SF-36 excepting physical role. This study indicated that anxiety, depression, quality of life, disease activity and suicidal ideation are related to each other in patients with RA. The presence of concomitant anxiety and depression may lead to suicide and poor quality of life and may worsen the prognosis of the RA.
Collapse
|
15
|
Brenner P, Citarella A, Wingård L, Sundström A. Use of antidepressants and benzodiazepine-related hypnotics before and after initiation of TNF-α inhibitors or non-biological systemic treatment in patients with rheumatoid arthritis, psoriatic arthritis or ankylosing spondylitis. BMC Rheumatol 2020; 4:9. [PMID: 32072134 PMCID: PMC7014636 DOI: 10.1186/s41927-019-0106-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/18/2019] [Indexed: 12/27/2022] Open
Abstract
Background Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS) are autoimmune disorders associated with an increased risk for depression, anxiety and sleeping problems. The objective of this study was to analyze use of antidepressants and benzodiazepine-related hypnotics (BRH) in Sweden before and after first time treatment with anti-TNF and non-biological systemic (NBS) treatments among patients with the above diagnoses, and to correlate such use with that of randomly selected population controls. Methods Patients and dispensed drugs were identified in nationwide Swedish healthcare registers. Proportions of subjects filling prescriptions of antidepressants and BRH from 2 years before start of treatment (index-date), and 2 years after index date were assessed. Using the period -6 months to index-date as reference, prevalence rate ratios were computed for 6 months' intervals before and after index. For up to ten randomly selected population controls per patient, the same measures were calculated. Results A total of 6256 patients started anti-TNF treatment, and 13,241 NBS treatment. The mean age at index was 52.0 for the anti-TNF group and 56.1 for NBS. Use of antidepressants and BRH was similar in both treatment groups (10.4-12.8%), significantly more common than in the controls (6.6 to 7.6%). For all patients, proportions filling prescriptions for antidepressants and BRH decreased directly or soon after the index; no such changes were seen in the controls, who all showed a slow but steady increase in use over time. Starters of anti-TNF treatment did not show clearer decreases in use of psychotropics than those initiating NBS. Conclusions Decreased rates of dispensed psychotropic drugs after the time of anti-TNF and NBS treatment initiation were seen among patients with autoimmune disorders but not population controls. This may correspond to treatment effects of anti-TNF and NBS also on psychiatric symptoms among these patients.
Collapse
Affiliation(s)
- Philip Brenner
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Anna Citarella
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Louise Wingård
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| | - Anders Sundström
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, SE-171 76 Stockholm, Sweden
| |
Collapse
|
16
|
Parmelee PA, Scicolone MA, Cox BS, DeCaro JA, Keefe FJ, Smith DM. Global Versus Momentary Osteoarthritis Pain and Emotional Distress: Emotional Intelligence as Moderator. Ann Behav Med 2019; 52:713-723. [PMID: 30010708 DOI: 10.1093/abm/kax044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Pain and emotional well-being are complexly associated both globally and in the moment. Emotional regulation strategies may contribute to that complexity by shaping the pain-well-being association. Purpose Using emotional intelligence (EI) as an integrative conceptual framework, this study probed the role of emotional regulation in the associations of osteoarthritis pain with emotional well-being in varying time frames. Perceived attention to, clarity, and regulation of emotions were examined as predictors of well-being, and as moderators of the well-being-pain association, at global and momentary (within-day) levels. Methods In a microlongitudinal study, 218 older adults with physician-diagnosed knee osteoarthritis self-reported global pain, depressive symptoms, and EI (mood attention, clarity, and repair). Momentary pain and positive and negative affect were then assessed four times daily for 7 days. EI subscales were examined as moderators of the pain-well-being association at global and momentary levels, controlling demographics and general health. Results Global and momentary pain were positively associated with mood clarity and negatively with attention, but not with repair. Clarity and repair negatively predicted depression, and buffered effects of pain on depression. Momentary negative affect was negatively predicted by mood clarity and repair; again, clarity and mood repair buffered effects of momentary pain on negative affect. Only mood repair predicted positive affect, with no interactions emerging. Conclusions Attention to mood states exacerbates the experience of pain in both short and long terms. In contrast, both mood clarity and ability to repair moods appear important to both momentary and longer-term emotional well-being.
Collapse
Affiliation(s)
- Patricia A Parmelee
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Monica A Scicolone
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Brian S Cox
- Alabama Research Institute on Aging, The University of Alabama, Tuscaloosa, AL, USA
| | - Jason A DeCaro
- Department of Anthropology, The University of Alabama, Tuscaloosa, AL, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Dylan M Smith
- Program in Public Health, Department of Family, Population, and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| |
Collapse
|
17
|
Examining the cross-sectional and longitudinal effects of anxiety sensitivity on indicators of disease severity among patients with inflammatory arthritis. J Anxiety Disord 2019; 67:102117. [PMID: 31445391 DOI: 10.1016/j.janxdis.2019.102117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 07/08/2019] [Accepted: 07/24/2019] [Indexed: 12/29/2022]
Abstract
Few studies have investigated anxiety sensitivity (AS) in the context of inflammatory arthritis (IA), despite evidence of a relationship between AS and pain. This study examined cross-sectional and longitudinal relationships between AS and indicators of IA severity in 148 participants with IA. AS and its factors (social, physical, cognitive) were self-reported. Arthritis severity was physician-assessed (disease activity scales) and self-reported (physical function; pain and fatigue). Cross-sectional correlations assessed the association between AS and arthritis severity outcomes. Longitudinal multivariable mixed-effect regressions assessed the association of AS total and AS factors at each visit with disease severity outcomes. All AS factors were significantly and positively correlated (at the same visit) with function, pain, and fatigue. AS total significantly predicted pain, fatigue, and function. Cognitive AS significantly predicted fatigue, and physical AS significantly predicted pain and fatigue. Social AS significantly predicted pain, fatigue, function and weighted joint count (articular burden). AS is associated with several indicators of disease severity among those with IA; unique findings emerged across factors with the broadest disease impact by social AS. The AS factors, especially social AS, may contribute to the development and severity of IA symptoms, which may have implications for interventions.
Collapse
|
18
|
Theis KA, Brady TJ, Helmick CG, Murphy LB, Barbour KE. Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life. ACR Open Rheumatol 2019; 1:412-423. [PMID: 31777821 PMCID: PMC6857987 DOI: 10.1002/acr2.11050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. METHODS Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. RESULTS An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). CONCLUSION Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.
Collapse
Affiliation(s)
- K. A. Theis
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - T. J. Brady
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - C. G. Helmick
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - L. B. Murphy
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| | - K. E. Barbour
- National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaGA
| |
Collapse
|
19
|
Kata A, Dutt M, Sudore RL, Finlayson E, Broering JM, Tang VL. What Matters? The Valued Life Activities of Older Adults Undergoing Elective Surgery. J Am Geriatr Soc 2019; 67:2305-2310. [PMID: 31400227 DOI: 10.1111/jgs.16102] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/10/2019] [Accepted: 07/05/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Valued life activities are those activities an individual deems particularly important or meaningful. Surgery in older adults can affect their ability to perform valued activities, but data are lacking. We characterized these activities and assessed performance of them following surgery. DESIGN Retrospective observational study. SETTING Preoperative program for older adults undergoing elective surgery at an academic hospital. PARTICIPANTS Older adults (N = 194) in the program from February 2015 to February 2018. MEASUREMENTS A preoperative written questionnaire asked, "What are the activities that are most important to you to be able to do when you return home from surgery?" Participants could list up to three activities. Content analysis was used to develop domains of valued life activities and categorize responses. Postoperative questionnaires and medical records were used to determine ability to perform activities 6 months after surgery. RESULTS Of 194 participants (mean age = 74.9 ± 9.1 y), 57.7% were female; 33.5% had more than two comorbid conditions. We elicited 510 valued activities, with a mean of 2.6 (± .7) activities per participant. Content analysis revealed five categories: (1) recreational activities (28.9%); (2) mobility (24.9%); (3) activities of daily living (ADLs; 17.5%); (4) instrumental activities of daily living (IADLs; 16.9%); and (5) social activities (12.0%). Ultimately, 154 participants had surgery, of which 27.3% were unable to perform one of their valued activities at 6 months. Performance varied between activity categories; 91.9% of mobility activities, 90.8% of ADLs, 80.3% of IADLs, 77.3% of social activities, and 65.5% of recreational activities were able to be performed after surgery. CONCLUSION Older adults expressed a wide range of valued life activities. More than one-quarter were unable to engage in at least one valued life activity after surgery, with recreation the most commonly affected. Assessment of valued life activities should be incorporated into the perioperative management of older adults. J Am Geriatr Soc 67:2305-2310, 2019.
Collapse
Affiliation(s)
- Anna Kata
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California
| | - Meghan Dutt
- California Northstate University, College of Medicine, Elk Grove, California
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California.,Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, California
| | - Emily Finlayson
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California.,Department of Surgery, University of California, San Francisco, California
| | | | - Victoria L Tang
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, California.,Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, San Francisco, California
| |
Collapse
|
20
|
Theis KA, Murphy LB, Baker NA, Hootman JM. When You Can't Walk a Mile: Walking Limitation Prevalence and Associations Among Middle-Aged and Older US Adults with Arthritis: A Cross-Sectional, Population-Based Study. ACR Open Rheumatol 2019; 1:350-358. [PMID: 31777813 PMCID: PMC6858050 DOI: 10.1002/acr2.11046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 05/24/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE We examined walking limitations and associated characteristics among middle-aged and older US adults with arthritis, overall, and by sex. METHODS Using 2005-2006 Arthritis Conditions and Health Effects Survey (ACHES) data (n = 1793), we estimated "a lot" and "any" ("a lot" or "a little" combined) walking limitation for more than 1 mile (1.6 km) among US adults 45 years or older with arthritis and examined associations (sociodemographics, arthritis symptoms and effects, psychosocial measures, and physical health) with walking limitations in unadjusted and multivariable (MV) adjusted logistic regression models using prevalence ratios (PRs) and 95% confidence intervals, accounting for the complex survey design. RESULTS Respondents frequently reported "a lot" (48%) and "any" (72%) limitation for more than 1 mile. Women reported higher prevalence of all levels of walking limitation versus men (eg, 51% vs 42% for "a lot" overall); additionally, the gap for walking limitations between women and men widened with age. Limitation was high for both sexes at all ages, affecting 1-in-3 to 4-in-5, depending on level of walking limitation. The strongest MV associations for "a lot" of walking limitation among all respondents included substantial and modest arthritis-attributable life interference (PR = 2.5 and 1.6, respectively), age 75 years or older (PR = 1.5), and physical inactivity and fair/poor self-rated health (PR = 1.4 for both). CONCLUSION Walking limitations among middle-aged and older adults are substantial. Existing proven interventions that improve walking ability and physical function may help this population to reduce and delay disability.
Collapse
Affiliation(s)
- K. A. Theis
- Centers for Disease Control and PreventionAtlantaGeorgia
| | - L. B. Murphy
- Centers for Disease Control and PreventionAtlantaGeorgia
| | | | - J. M. Hootman
- Centers for Disease Control and PreventionAtlantaGeorgia
| |
Collapse
|
21
|
Arends RY, Bode C, Taal E, Van de Laar MAFJ. A goal management intervention for patients with polyarthritis and elevated levels of depressive symptoms: a quasiexperimental study. Disabil Rehabil 2018; 42:957-966. [PMID: 30453793 DOI: 10.1080/09638288.2018.1513086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: Goal was to establish whether an intervention that aims to increase goal management competencies is effective in decreasing elevated levels of depressive symptoms and increasing well-being in patients with polyarthritis.Materials and methods: Eighty-five persons with polyarthritis and elevated levels of depressive symptoms participated in the goal management intervention consisting of six group-based meetings. A quasiexperimental design with baseline measurement, follow-up at 6 months and a reference group of 151 patients from an observational study was applied. Primary outcome was depression; secondary outcomes were anxiety, purpose in life, positive affect, satisfaction with participation, goal management strategies, and arthritis self-efficacy. A linear mixed model procedure was applied to evaluate changes in outcomes.Results: No improvement was found for depressive symptoms and no changes were found for the secondary outcomes, except for positive affect that improved in the intervention group. This increase was mediated by an increase in goal adjustment. Furthermore, goal maintenance decreased and self-efficacy for other symptoms increased in the intervention group.Conclusion: This study indicates that interventions designed to aid patients with arthritis with goal management skills are potentially helpful for increasing positive affect, although further studies are needed.Implications for rehabilitationPeople with polyarthritis have to manage their disease in combination with possibly conflicting roles and personal goals, resulting in an ongoing process of finding equilibrium in a constantly changing situation.Based on a person-focused view, the program Right on Target focused on coping with threatened activities and life goals due to arthritis.The program consisted of six group-based meetings led by a trained nurse and a personal trajectory wherein participants were stimulated to try out various behavioral options related to an own threatened activity in concordance with their personal goals.The program seemed effective in increasing flexible goal adjustment and self-efficacy and participants experienced more positive affect directly after the program and at 6-month follow-up.
Collapse
Affiliation(s)
- Roos Y Arends
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Christina Bode
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Erik Taal
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands
| | - Mart A F J Van de Laar
- Department of Psychology, Health & Technology, Arthritis Centre Twente, University of Twente, Enschede, The Netherlands.,Department for Rheumatology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| |
Collapse
|
22
|
The extra-articular impacts of rheumatoid arthritis: moving towards holistic care. BMC Rheumatol 2018; 2:32. [PMID: 30886982 PMCID: PMC6390577 DOI: 10.1186/s41927-018-0039-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022] Open
Abstract
Although treat-to-target has revolutionised the outcomes of patients with rheumatoid arthritis (RA) there is emerging evidence that attaining the target of remission is insufficient to normalise patients’ quality of life, and ameliorate the extra-articular impacts of RA. RA has a broad range of effects on patient’s lives, with four key “extra-articular” impacts being pain, depression and anxiety, fatigue and rheumatoid cachexia. All of these are seen frequently; for example, studies have reported that 1 in 4 patients with RA have high-levels of fatigue. Commonly used drug treatments (including simple analgesics, non-steroidal anti-inflammatory drugs and anti-depressants) have, at most, only modest benefits and often cause adverse events. Psychological strategies and dynamic and aerobic exercise all reduce issues like pain and fatigue, although their effects are also only modest. The aetiologies of these extra-articular impacts are multifactorial, but share overlapping components. Consequently, patients are likely to benefit from management strategies that extend beyond the assessment and treatment of synovitis, and incorporate more broad-based, or “holistic”, assessments of the extra-articular impacts of RA and their management, including non-pharmacological approaches. Innovative digital technologies (including tablet and smartphone “apps” that directly interface with hospital systems) are increasingly available that can directly capture patient-reported outcomes during and between clinic visits, and include them within electronic patient records. These are likely to play an important future role in delivering such approaches.
Collapse
|
23
|
|
24
|
Withers MH, Gonzalez LT, Karpouzas GA. Identification and Treatment Optimization of Comorbid Depression in Rheumatoid Arthritis. Rheumatol Ther 2017; 4:281-291. [PMID: 28815445 PMCID: PMC5696284 DOI: 10.1007/s40744-017-0072-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Indexed: 12/20/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) suffer from high rates of depression but depression often remains undiagnosed and untreated among RA patients. Because of its high prevalence and its profound impact on functional disability and health-related quality of life, prompt recognition and management of comorbid depression is urgently needed in patients with RA. Rheumatologists face the challenge of addressing depression in their clinical interactions with patients. The purpose of this paper is to present the prevalence of comorbid depression in RA, to delineate the consequences of depression among RA patients, to discuss the barriers to the identification of depression among RA patients, and to outline a set of recommendations to identify and treat comorbid depression that could be implemented within the rheumatology clinic setting. A comprehensive approach to the management of both physical and mental health needs of RA patients can aid in improving patient overall quality of life. New clinical protocols should be developed to include routine depression screening as part of the rheumatology visit. Patient education to address misconceptions, knowledge gaps, and destigmatize depression is also recommended. More counseling resources, including emotional support groups, are necessary to provide treatment for those suffering from depression. Such interventions could help mitigate disability, improve quality of life, patient function, and overall satisfaction.
Collapse
Affiliation(s)
- Mellissa H Withers
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Louella T Gonzalez
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | |
Collapse
|
25
|
White DK, Neogi T, Zhang Y, Niu J, Katz PP. Association of Slow Gait Speed With Trajectories of Worsening Depressive Symptoms in Knee Osteoarthritis: An Observational Study. Arthritis Care Res (Hoboken) 2017; 69:209-215. [PMID: 27158972 DOI: 10.1002/acr.22928] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/15/2016] [Accepted: 04/26/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate the association of slow gait speed, defined as walking slower than is necessary for the community, with trajectories of depressive symptoms over 7 years among people with or at high risk of knee OA. METHODS Using data from the Osteoarthritis Initiative, we described trajectories of depressive symptoms measured annually with the Center for Epidemiologic Studies Depression Scale. We categorized speed during a 20-meter walk of <1.2 meters/second as slow gait speed. We used a group-based method to agnostically identify homogeneous clusters of depressive symptom trajectories. We then examined the association of slow gait speed with depressive symptom trajectories, using multinomial logistic regression adjusted for potential confounders. RESULTS From the 3,939 participants included (mean ± SD age 61.4 ± 9.2 years, body mass index 28.4 ± 4.7, 58% women, and 63% with a college degree), we identified 5 trajectories. The first 3 were stable over time and included 74% of the sample. The remainder had worsening depressive symptoms over time. Slow gait speed was associated with 2.1 times the odds of having the worst depressive symptoms trajectory compared to those without slow gait speed. CONCLUSION Slow gait speed may represent an important risk factor for worsening depressive symptoms over time in people with or at high risk of knee OA, and may signal the need for rehabilitation.
Collapse
Affiliation(s)
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | | |
Collapse
|
26
|
Kim B, Park S, Bishop-Saucier J, Amorim C. Community-Based Services and Depression from Person-Environment Fit Perspective: Focusing on Functional Impairments and Living Alone. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:270-285. [PMID: 28339325 DOI: 10.1080/01634372.2017.1310166] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Guided by the Person-Environment Fit perspective, we investigated the extent to which personal and environmental factors influence depression among community-dwelling adults. The data came from the special section about community-based service utilization in the 2012 Health and Retirement Study (N=1,710). Although community-based service was not significantly associated with depression after controlling for covariates, respondents with functional limitations and living alone were less likely to be depressed when using community-based services. This study demonstrates the different associations between community-based services and depression depending on personal needs. It discusses the importance of community-based services for aging-in-place policy, particularly among vulnerable populations.
Collapse
Affiliation(s)
- BoRin Kim
- a University of New Hampshire , Durham , New Hampshire , USA
| | - Sojung Park
- b George Warren Brown School of Social Work , Washington University in St. Louis , Missouri , USA
| | | | - Carrie Amorim
- c The Institute of Professional Practice, Inc. , Concord , New Hampshire , USA
| |
Collapse
|
27
|
Masood A, Salim B, Nasim A, Khalid Z, Afzal A. Are we missing the diagnosis of depression in patients with rheumatoid arthritis at a tertiary care facility? Pak J Med Sci 2017; 33:300-305. [PMID: 28523026 PMCID: PMC5432693 DOI: 10.12669/pjms.332.11856] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: To determine if we are missing clinical depression in patients with Rheumatoid Arthritis and its relationship with functional disability and level of formal education in such patients. Methods: The data for this cross-sectional, analytical study was gathered from May 2015 till December 2015 and comprised of 128 with Rheumatoid arthritis diagnosed according to ACR/EULAR 2010 criteria. The study was conducted at Fauji Foundation Hospital Rawalpindi. Functional status was assessed with Modified Health Assessment Questionnaire (mHAQ) and Beck’s Depression Inventory (BDI) was used for evaluation of symptoms of depression. The relation between depression, functional disability and educational status was established using Pearson correlation coefficient. Results: The study included 128 patients with no previous diagnosis of depression. 122 (95.3%) were females and 6 (4.7%) were males. The mean age was 51.75 ± 9.25 years. Mean duration of disease was 8.95 ± 7.1 years. According to this study, the diagnosis of clinical depression was missed in 47.7% of patients with Rheumatoid Arthritis who had been under regular follow up at a tertiary care facility. About 18% were keen to seek professional help for depressive symptoms while 62.6% had functional disability (mild – severe). There is a positive correlation with BDI (Pearson’s correlation +1) and functional disability. No correlation could be established between level of education and depression as out of 79 (61.7%) patients with no basic education, 45.5% had depression. In remaining 49 (38.2%) patients, with some formal education, 51.3% had clinical depression. Conclusion: Almost half of the patients with Rheumatoid Arthritis coming to a tertiary care set up had clinical depression but were never diagnosed or referred to a Psychiatrist. There is a positive correlation between depression and functional disability; however no statistically significant correlation could be established with the level of formal education. The study further emphasizes the importance of early recognition and swift referral of such patients to a psychiatrist since it is known to improve both treatment outcomes and functional status.
Collapse
Affiliation(s)
- Ammara Masood
- Dr. Ammara Masood, MRCP, SCE (Rheumatology). Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Babur Salim
- Dr. Babur Salim, FCPS(Med), FCPS (Rheumatology). Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amjad Nasim
- Dr. Amjad Nasim, FCPS (Med). Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Ziaullah Khalid
- Dr. Ziaullah Khalid, MBBS. Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| | - Amir Afzal
- Amir Afzal, Statistician. Dept. of Rheumatology, Fauji Foundation Hospital, Rawalpindi, Pakistan
| |
Collapse
|
28
|
Guo G, Fu T, Yin R, Zhang L, Zhang Q, Xia Y, Li L, Gu Z. Sleep quality in Chinese patients with rheumatoid arthritis: contributing factors and effects on health-related quality of life. Health Qual Life Outcomes 2016; 14:151. [PMID: 27852301 PMCID: PMC5111274 DOI: 10.1186/s12955-016-0550-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 10/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Poor sleep quality is common in rheumatoid arthritis (RA) patients and may lead to disease aggravation and decreased health-related quality of life (HRQoL). The increasing prevalence of poor sleep in RA patients is associated with adverse demographic, clinical, and psychological characteristics. However, there are currently no known reported studies related to the effects of sleep quality on HRQoL in RA patients from China. This cross-sectional study aims to evaluate the contributors of poor sleep and the effects of sleep quality on HRQoL in Chinese RA patients. METHODS A self-report survey was administered to 131 RA patients and 104 healthy individuals using the Pittsburgh Sleep Quality Index (PSQI) for sleep quality. RA patients completed the Hospital Anxiety and Depression Scale for anxiety and depression, the 28-joint Disease Activity Score for disease activity, the 10 cm Visual Analog Scale for pain, the Health Assessment Questionnaire-Disability Index for functional capacity and the Short Form 36 health survey for HRQoL. Blood samples were taken to gain some biochemical indicators (e.g., erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor, and anti-cyclic citrullinated peptide). Independent samples t-tests, Chi square analysis, logistic regression modeling and linear regression were used to analyze these data. RESULTS Our results found that the prevalence of poor sleep (PSQI ≥ 5) was 78.6% and the mean global score of PSQI was 7.93 (SD 3.98) in patients, which were significantly higher than the controls (18.7% and 3.88 (SD 1.89), respectively). There were significant correlations among synthetic disease-modifying antirheumatic drugs, erythrocyte sedimentation rate, pain, disease activity, functional capacity, anxiety/depression and sleep quality in RA patients. Meanwhile, logistic regression models identified disease activity and depression as predictors of poor sleep quality. Poor RA sleepers had impaired HRQoL than good RA sleepers, and sleep quality was independently and significantly associated with social function and mental components summary. CONCLUSIONS The majority of Chinese RA patients suffered from poor sleep, which significantly impairs their HRQoL. The data suggested the need for holistic assessment and management of RA patients and the importance of objective interventions to improve their sleep quality and finally to improve their HRQoL.
Collapse
Affiliation(s)
- Genkai Guo
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
| | - Ting Fu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
- School of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Rulan Yin
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
- School of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Lijuan Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
- School of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Qiuxiang Zhang
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
- School of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Yunfei Xia
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
| | - Liren Li
- School of Nursing, Nantong University, 19th Qixiu Road, 226001 Nantong, People’s Republic of China
| | - Zhifeng Gu
- Department of Rheumatology, Affiliated Hospital of Nantong University, 20th Xisi Road, 226001 Nantong, People’s Republic of China
| |
Collapse
|
29
|
Plach SK, Napholz L, Kelber ST. Social, Health, and Age Differences Associated with Depressive Disorders in Women with Rheumatoid Arthritis. Int J Aging Hum Dev 2016; 61:179-94. [PMID: 16248289 DOI: 10.2190/2tr5-81fg-h7a6-l9dp] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Depression in women with rheumatoid arthritis (RA) may be related to social role experiences, physical health, and age. The purpose of this study was to examine the social and health factors contributing to depression in two age groups of women with RA. One-hundred and thirty-eight midlife and late-life women with a diagnosis of RA participated in this cross sectional survey study. Multiple regression analysis indicated that social role balance, functional status, number of co-existing health problems, and age were significant predictors of depression in midlife and late-life women with RA. Role balance was the strongest factor contributing to a woman's depression score. Compared to midlife women, late-life women reported significantly higher role balance and lower depression scores, despite poorer functional status and more concomitant health problems.
Collapse
Affiliation(s)
- Sandra K Plach
- College of Nursing, University of Wisconsin-Milwaukee, WI 53201, USA.
| | | | | |
Collapse
|
30
|
Björk M, Thyberg M, Valtersson E, Katz P. Validation and internal consistency of the Swedish version of the Valued Life Activities scale. Clin Rehabil 2016; 30:1211-1219. [DOI: 10.1177/0269215515616665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
Objective: The objective was to create a linguistically and culturally validated Swedish version of the Valued Life Activities scale. The aim was also to describe its content and concurrent validity and its internal consistency in persons with rheumatoid arthritis. Methods: The Valued Life Activities scale was translated to Swedish and culturally adapted. In order to describe the content validity, both the Swedish and original Valued Life Activities scale were linked to the International Classification of Functioning, Disability and Health. The concurrent validity and internal consistency were evaluated in 737 patients with rheumatoid arthritis. To establish concurrent validity, the scale was correlated to disease activity, activity limitations, and life satisfaction. Internal consistency was assessed with Cronbach’s alpha. Results: The equivalence of meaning between the Swedish and the original Valued Life Activities scale was ensured by harmonization review. Content validity was high when linked to the International Classification of Functioning, Disability and Health. Concurrent validity showed a strong correlation with the activity limitations (r = 0.87), moderate with life satisfaction (r = –0.61), and weak with disease activity (r = 0.38). Internal consistency was excellent (Cronbach’s alpha = 0.97). Conclusions: The Swedish Valued Life Activities scale has been tested in a large and well-characterized sample and found to be a linguistically valid and culturally adapted self-reported measure of participation. Content validity of the Valued Life Activities scale was excellent, concurrent validity strong, and the internal consistency excellent. Since both individual preferences and International Classification of Functioning, Disability and Health concepts of disability are taken into account, the Swedish Valued Life Activities scale appears to be a promising new scale addressing important aspects of participation.
Collapse
Affiliation(s)
- Mathilda Björk
- Department of Rheumatology and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
| | - Mikael Thyberg
- Department of Pain and Rehabilitation Center and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Eva Valtersson
- Department of Activity and Health and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | |
Collapse
|
31
|
Associations between DSM-IV mental disorders and subsequent onset of arthritis. J Psychosom Res 2016; 82:11-16. [PMID: 26944393 PMCID: PMC4884652 DOI: 10.1016/j.jpsychores.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 12/24/2015] [Accepted: 01/17/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We investigated the associations between DSM-IV mental disorders and subsequent arthritis onset, with and without mental disorder comorbidity adjustment. We aimed to determine whether specific types of mental disorders and increasing numbers of mental disorders were associated with the onset of arthritis later in life. METHOD Data were collected using face-to-face household surveys, conducted in 19 countries from different regions of the world (n=52,095). Lifetime prevalence and age at onset of 16 DSM-IV mental disorders were assessed retrospectively with the World Health Organization (WHO) Composite International Diagnostic Interview (WHO-CIDI). Arthritis was assessed by self-report of lifetime history of arthritis and age at onset. Survival analyses estimated the association of initial onset of mental disorders with subsequent onset of arthritis. RESULTS After adjusting for comorbidity, the number of mood, anxiety, impulse-control, and substance disorders remained significantly associated with arthritis onset showing odds ratios (ORs) ranging from 1.2 to 1.4. Additionally, the risk of developing arthritis increased as the number of mental disorders increased from one to five or more disorders. CONCLUSION This study suggests links between mental disorders and subsequent arthritis onset using a large, multi-country dataset. These associations lend support to the idea that it may be possible to reduce the severity of mental disorder-arthritis comorbidity through early identification and effective treatment of mental disorders.
Collapse
|
32
|
Abstract
Up to 50% of patients with autoimmune diseases show an impairment of health-related quality of life and exhibit depression-like symptoms. The immune system not only leads to inflammation in affected organs, but also mediates behavior abnormalities including fatigue and depression-like symptoms. This review focuses on the different pathways involved in the communication of the immune system with the neuronal network and the body's timing system. The latter is built up by a hierarchically organized expression of clock genes. As discussed here, the activation of the immune system interferes with high amplitude expression of clock genes, an effect which may play a pivotal role in depression-like behavior in autoimmune diseases.
Collapse
Affiliation(s)
- Christopher R Pryce
- Preclinical Laboratory for Translational Research into Affective Disorders, Department of Psychiatry, Psychotherapy & Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Adriano Fontana
- Institute of Experimental Immunology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland.
| |
Collapse
|
33
|
Arends RY, Bode C, Taal E, Van de Laar MAFJ. Exploring preferences for domain-specific goal management in patients with polyarthritis: what to do when an important goal becomes threatened? Rheumatol Int 2015; 35:1895-907. [PMID: 26265022 PMCID: PMC4611014 DOI: 10.1007/s00296-015-3336-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/30/2015] [Indexed: 12/31/2022]
Abstract
Usually priorities in goal management—intended to minimize discrepancies between a given and desired situation—are studied as person characteristics, neglecting possible domain-specific aspects. However, people may make different decisions in different situations depending on the importance of the personal issues at stake. Aim of the present study therefore was to develop arthritis-related vignettes to examine domain-specific goal management and to explore patients’ preferences. Based on interviews and literature, situation-specific hypothetical stories were developed in which the main character encounters a problem with a valued goal due to arthritis. Thirty-one patients (61 % female, mean age 60 years) evaluated the face validity of the newly developed vignettes. Secondly, 262 patients (60 % female, mean age 63 years) were asked to come up with possible solutions for the problems with attaining a goal described in a subset of the vignettes. Goal management strategies within the responses and the preference for the various strategies were identified. The 11 developed vignettes in three domains were found to be face-valid. In 90 % of the responses, goal management strategies were identified (31 % goal maintenance, 29 % goal adjustment, 21 % goal disengagement, and 10 % goal re-engagement). Strategy preference was related to domains. Solutions containing goal disengagement were the least preferred. Using vignettes for measuring domain-specific goal management appears as valuable addition to the existing questionnaires. The vignettes can be used to study how patients with arthritis cope with threatened goals in specific domains from a patient’s perspective. Domain-specific strategy preference emphasizes the importance of a situation-specific instrument.
Collapse
Affiliation(s)
- Roos Y Arends
- Department of Psychology, Health and Technology, Arthritis Centre Twente, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Christina Bode
- Department of Psychology, Health and Technology, Arthritis Centre Twente, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Erik Taal
- Department of Psychology, Health and Technology, Arthritis Centre Twente, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
| | - Mart A F J Van de Laar
- Department of Psychology, Health and Technology, Arthritis Centre Twente, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands. .,Department for Rheumatology, Arthritis Centre Twente, Medisch Spectrum Twente, Enschede, The Netherlands.
| |
Collapse
|
34
|
Imran MY, Saira Khan EA, Ahmad NM, Farman Raja S, Saeed MA, Ijaz Haider I. Depression in Rheumatoid Arthritis and its relation to disease activity. Pak J Med Sci 2015; 31:393-7. [PMID: 26101498 PMCID: PMC4476349 DOI: 10.12669/pjms.312.6589] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/09/2014] [Accepted: 12/09/2014] [Indexed: 01/25/2023] Open
Abstract
Objectives: To determine the level of depression in Rheumatoid Arthritis and its relationship with severity of Rheumatoid Arthritis. Methods: This cross sectional analytical study was conducted from March 2014 to May 2014. Total 102 cases of Rheumatoid Arthritis (RA) diagnosed as per ACR (American College of Rheumatology) 1987 criteria were enrolled from Rheumatology Department, Fatima Memorial Hospital. Severity of Rheumatoid Arthritis was assessed by Health Assessment Questionnaire (HAQ) and disease activity score (DAS - 28) while severity of depression was measured by Beck Depression Inventory (BDI) scale II questionnaire. The relationship between depression and disease activity (severity) of Rheumatoid Arthritis was assessed by calculating correlation coefficient between depression, disease activity score (DAS 28) of Rheumatoid Arthritis and health assessment questionnaire (HAQ). Results: Out of 102 patients, 77(75.5%) were females and 25(24.5%) males. The mean age of patients was 43.5± 11.9 years and the mean duration of disease was 7.8 ± 5.5 years.71.5% of Rheumatoid Arthritis patients were found to have some degree of depression and this was directly related to the severity of disease. Moderate and severe depression were present in 23 (22.5%) and 19(18.6%) patients respectively. Conclusion: In this study, almost three-fourths of Rheumatoid Arthritis patients were found to have depression. There was a strong association between Rheumatoid Arthritis disease activity and the level of depression. So it is imperative for clinicians treating Rheumatoid Arthritis patients to screen them for co morbid depression and manage it accordingly.
Collapse
Affiliation(s)
- Muhammad Yaser Imran
- Dr. Muhammad Yaser Imran, FCPS. Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Elaine Anwer Saira Khan
- Dr. Saira Elaine Anwer Khan, MRCP. Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Nighat Mir Ahmad
- Prof. Dr. Nighat Mir Ahmad, MD, FACP, FACR. Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Sumaira Farman Raja
- Dr. Sumaira Farman Raja, MBBS, FRCP, FACP, FACR. Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Muhammad Ahmed Saeed
- Dr. Muhammad Ahmed Saeed, FCPS medicine, FCPS Rheumatology. Department of Rheumatology, Fatima Memorial Hospital, Lahore, Pakistan
| | - Imran Ijaz Haider
- Prof. Dr. Imran Ijaz Haider, MRC Psychiatry. Department of Psychiatry. Fatima Memorial Hospital, Lahore, Pakistan
| |
Collapse
|
35
|
Leino M, Tuominen S, Pirilä L, Tuominen R. Effects of rheumatoid arthritis on household chores and leisure-time activities. Rheumatol Int 2015; 35:1881-8. [DOI: 10.1007/s00296-015-3313-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
|
36
|
Thyberg M, Arvidsson P, Thyberg I, Nordenfelt L. Simplified bipartite concepts of functioning and disability recommended for interdisciplinary use of the ICF. Disabil Rehabil 2014; 37:1783-92. [PMID: 25365700 DOI: 10.3109/09638288.2014.978506] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To argue for and propose bipartite concepts of functioning and disability, to tally with the structure of the ICF classification list, concepts of social models and clinical needs. METHOD The ICF concepts are discussed in relation to the history of ideas regarding disability concepts and the needs for such concepts in interdisciplinary rehabilitation. RESULTS Bipartite concepts are presented; they refer to actual functioning, simply body functions/structures and participation, including functioning in standardized environments. Participation refers to actually performed "activities", with "activities" simply denoting things that people may do. Bipartite concepts are congruent with the ICF classification and the structure of social models of disability, suitable for clinical and interdisciplinary use and easy to understand. The issue of standardized environments represents a methodological issue rather than the conceptual issue of defining functioning and disability. An individual perspective on activity and activity limitations, i.e. the middle part of the tripartite ICF concept, is somewhat similar to concepts of traditional language that were regarded as too generalizing already in 1912, when the interactional concept of "disability in a social sense" was introduced in rehabilitation practices. CONCLUSION Bipartite concepts of functioning and disability are recommended for interdisciplinary use of the ICF. IMPLICATIONS FOR REHABILITATION The ICF classification is useful, but the ICF concept of activities in an individual perspective is confusing. We suggest a use of the term "activities" simply to denote things that people may do and "participation" to denote actually performed activities. Estimations of ability should be explicit about how they are related to environmental factors.
Collapse
Affiliation(s)
- Mikael Thyberg
- Division of Rehabilitation Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Swedish Institute for Disability Research, Linköping University , Linköping , Sweden
| | | | | | | |
Collapse
|
37
|
Flurey CA, Morris M, Pollock J, Richards P, Hughes R, Hewlett S. A Q-methodology study of flare help-seeking behaviours and different experiences of daily life in rheumatoid arthritis. BMC Musculoskelet Disord 2014; 15:364. [PMID: 25361815 PMCID: PMC4223853 DOI: 10.1186/1471-2474-15-364] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 10/15/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Previous studies have not addressed rheumatoid arthritis (RA) patients' help-seeking behaviours for RA flares, and only one small qualitative study has addressed how patients experience daily life on current treatment regimes. Thus, this study aims to identify clusters of opinion related to RA patients' experiences of daily life on current treatments, and their help-seeking behaviours for RA flares. METHODS Using Q-methodology (a methodology using qualitative and quantitative methods to sort people according to subjective experience), two separate studies were conducted with the same sample of RA patients (mean age 55, 73% female). Thirty participants sorted 39 statements about daily life (Q-study 1) and 29 participants separately sorted 23 statements about flare help-seeking (Q-study 2). Data were examined using Q-factor analysis. RESULTS Daily life with RA (Q-study 1): Three factors relating to the experience of living with RA were extracted and explained. Patients belonging to Factor A (mean age 62, 86% female) use effective self-management techniques to control the daily impact of RA. Those in Factor B (mean age 55, 75% male) struggle to self-manage and cope. Whilst patients in Factor C (mean age 42, 100% female) prioritise life responsibilities over their RA, reporting less impact.Flare help-seeking (Q-study 2): Two factors explaining the experience of flare help-seeking (unrelated to the factors from Q-study 1) were extracted and explained. Factor X (68.8% on biologics) reported seeking help quickly, believing the medical team is there to help. Factor Y (0% on biologics) delay help-seeking, concerned about wasting the rheumatologist's time, believing they should manage alone. All participants agreed they sought help due to intense pain and persistent, unmanageable symptoms. CONCLUSIONS Patients with different characteristics appear to manage RA life in different ways and men may struggle more than women. Whilst all patients are prompted to seek help by persistent, unmanageable symptoms, some delay help-seeking. Further research is needed to quantify the severity of daily symptoms, the level of symptoms needed for patients to define themselves as in flare and to understand the support needs of RA men.
Collapse
Affiliation(s)
- Caroline A Flurey
- />University of the West of England, Bristol, UK
- />Academic Rheumatology Unit, The Courtyard, Bristol Royal Infirmary, Bristol, BS2 8HW UK
| | | | - Jon Pollock
- />University of the West of England, Bristol, UK
| | | | - Rodney Hughes
- />Ashford & St Peter’s Hospital Foundation Trust, Chertsey, UK
| | | |
Collapse
|
38
|
Wang SL, Chang CH, Hu LY, Tsai SJ, Yang AC, You ZH. Risk of developing depressive disorders following rheumatoid arthritis: a nationwide population-based study. PLoS One 2014; 9:e107791. [PMID: 25226167 PMCID: PMC4166666 DOI: 10.1371/journal.pone.0107791] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 08/13/2014] [Indexed: 11/21/2022] Open
Abstract
Background & Aims To evaluate the risk of depressive disorders among rheumatoid arthritis (RA) by using the Taiwan National Health Insurance Research Database (NHIRD). Methods We conducted a retrospective study of a matched cohort of 18 285 participants (3 657 RA patients and 14 628 control patients) who were selected from the NHIRD. Patients were observed for a maximum of 10 years to determine the rates of newly diagnosed depressive disorders, and Cox regression was used to identify the risk factors associated with depressive disorders in RA patients. Results During the 10-year follow-up period, 205 (11.2 per 1000 person-years) RA patients and 384 (5.1 per 1000 person-years) control patients were diagnosed with depressive disorders. In RA patients, most depressive disorders (n = 163, 80%) developed with five years of being diagnosed with RA. The incidence risk ratio of depressive disorders between RA patients and control patients was 2.20 (95% confidence interval [CI], 1.84–2.61, P<.001). After adjusting for age, sex, and comorbidities, RA patients were 2.06 times more likely to develop depressive disorders (95% CI, 1.73–2.44, P<.001) compared with the control patients. Hyperthyroidism (HR = 1.67) was an independent risk factor for depressive disorders in patients with RA. Conclusions The likelihood of developing depressive disorders is greater among RA patients than among patients without RA. Symptoms of depression should be sought in patients with RA.
Collapse
Affiliation(s)
- Shu-Li Wang
- Department of Dental Laboratory Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Cheng-Ho Chang
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Li-Yu Hu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Albert C. Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Zi-Hong You
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Chia-Yi Branch, Chia-Yi, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- * E-mail:
| |
Collapse
|
39
|
Östlund G, Björk M, Thyberg I, Thyberg M, Valtersson E, Stenström B, Sverker A. Emotions related to participation restrictions as experienced by patients with early rheumatoid arthritis: a qualitative interview study (the Swedish TIRA project). Clin Rheumatol 2014; 33:1403-13. [PMID: 24838364 DOI: 10.1007/s10067-014-2667-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 04/22/2014] [Accepted: 05/02/2014] [Indexed: 11/26/2022]
Abstract
Psychological distress is a well-known complication in rheumatoid arthritis (RA), but knowledge regarding emotions and their relationship to participation restrictions is scarce. The objective of the study was to explore emotions related to participation restrictions by patients with early RA. In this study, 48 patients with early RA, aged 20-63 years, were interviewed about participation restrictions using the critical incident technique. Information from transcribed interviews was converted into dilemmas and linked to International Classification of Functioning, Disability, and Health (ICF) participation codes. The emotions described were condensed and categorized. Hopelessness and sadness were described when trying to perform daily activities such as getting up in the mornings and getting dressed, or not being able to perform duties at work. Sadness was experienced in relation to not being able to continue leisure activities or care for children. Examples of fear descriptions were found in relation to deteriorating health and fumble fear, which made the individual withdraw from activities as a result of mistrusting the body. Anger and irritation were described in relation to domestic and employed work but also in social relations where the individual felt unable to continue valued activities. Shame or embarrassment was described when participation restrictions became visible in public. Feelings of grief, aggressiveness, fear, and shame are emotions closely related to participation restrictions in everyday life in early RA. Emotions related to disability need to be addressed both in clinical settings in order to optimize rehabilitative multi-professional interventions and in research to achieve further knowledge.
Collapse
Affiliation(s)
- Gunnel Östlund
- Division of Social Work, School of Health, Care and Social Welfare, Mälardalen University, 631 05, Eskilstuna, Sweden,
| | | | | | | | | | | | | |
Collapse
|
40
|
Singer JP, Blanc PD, Dean YM, Hays S, Leard L, Kukreja J, Golden J, Katz PP. Development and validation of a lung transplant-specific disability questionnaire. Thorax 2013; 69:437-42. [PMID: 24355825 DOI: 10.1136/thoraxjnl-2013-204557] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lung transplant (LT) aims to extend survival and improve patient-centred outcomes (PCOs) by reducing disability and improving health-related quality of life (HRQL). Few PCO instruments have been validated in LT populations. We aimed to develop and validate a shortened version of the valued life activities (VLA) disability scale specific to LT. METHODS We used data from 140 subjects participating in an ongoing cohort study of LT. Subjects completed a survey battery, including VLA items, and physical assessments before LT. To develop a shortened LT-specific VLA (LT-VLA), we iteratively deleted items from a longer 32-item VLA battery, retaining the instrument's conceptual framework, scoring and performance characteristics. We evaluated LT-VLA validity by testing correlations with a HRQL measure (Short Form-12 Physical Function (SF-12 PF) subscale), forced vital capacity % (FVC%) predicted and 6 minute walk distance (6MWD). Responsiveness was evaluated in 84 subjects who completed assessments before and after LT. RESULTS The 15-item LT-VLA scoring closely matched the longer VLA (correlations ≥0.96) and had excellent internal consistency (Cronbach's α 0.92). The LT-VLA required only 3 min or less to administer. The LT-VLA, measured as mean difficulty in performing each of the 15 activities queried, correlated with FVC% predicted (r=-0.30), 6MWD (r=-0.38) and SF-12 PF (r=-0.47) (all p<0.01). The LT-VLA mean difficulty was responsive to change from before to after LT (63% improvement; effect size=1.60). CONCLUSIONS The LT-VLA is a short, easy to administer, valid and responsive disease-specific PCO instrument that may be useful in clinical and research applications for lung transplantation.
Collapse
Affiliation(s)
- Jonathan Paul Singer
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California, , San Francisco, USA
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Sariyildiz MA, Batmaz I, Bozkurt M, Bez Y, Cetincakmak MG, Yazmalar L, Ucar D, Celepkolu T. Sleep quality in rheumatoid arthritis: relationship between the disease severity, depression, functional status and the quality of life. J Clin Med Res 2013; 6:44-52. [PMID: 24400031 PMCID: PMC3881989 DOI: 10.4021/jocmr1648w] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate sleep quality and the related variables in patients with rheumatoid arthritis (RA). METHODS Ninety-four patients diagnosed with RA and fifty two healthy controls were enrolled in the study. Disease activity was assessed through the Disease Activity Score (DAS) 28 scale. All patients were assessed using the Rheumatoid Arthritis Quality of Life and Health Assessment Questionnaire scales, together with the Beck Depression Inventory. Radiological damage was calculated with the modified Larsen method. The Pittsburgh Sleep Quality Index (PSQI) was used for the evaluation of the sleep disturbance. RESULTS The patients with RA had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance domains and the total PSQI score compared to the healthy control group. According to the results of Spearman's analysis, there was a significantly correlation between the age, disease activity, CRP, pain, fatigue, depression, functional disability, quality of life, radiological damage, menopause status, duration of morning stiffness, ESR levels and the sleep disturbance. The logistic regression analysis indicated that depression and DAS 28 scores were predictors for poor sleep quality. CONCLUSION The sleep quality is disturbed in patients with RA. The poor sleep quality is especially associated with the disease activity and depression.
Collapse
Affiliation(s)
- Mustafa Akif Sariyildiz
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Ibrahim Batmaz
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Mehtap Bozkurt
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Yasin Bez
- Department of Psychiatry, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | | | - Levent Yazmalar
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Demet Ucar
- Department of Physical Medicine and Rehabilitation, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Tahsin Celepkolu
- Department of Family Physician, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| |
Collapse
|
42
|
Mostafa H, Radwan A. The relationship between disease activity and depression in Egyptian patients with rheumatoid arthritis. EGYPTIAN RHEUMATOLOGIST 2013. [DOI: 10.1016/j.ejr.2013.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
43
|
Kaptein SA, Backman CL, Badley EM, Lacaille D, Beaton DE, Hofstetter C, Gignac MAM. Choosing where to put your energy: a qualitative analysis of the role of physical activity in the lives of working adults with arthritis. Arthritis Care Res (Hoboken) 2013; 65:1070-6. [PMID: 23335584 DOI: 10.1002/acr.21957] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/08/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research points to many potential benefits of physical activity (PA) for those with arthritis. However, PA has not typically been examined within the context of other life roles. This study examined the perceptions of PA among individuals managing arthritis in addition to employment and other role demands. METHODS Eight focus groups were conducted with 24 women and 16 men (age range 29-72 years) who were currently or recently employed (within 2 years) and had osteoarthritis or inflammatory arthritis. Participants were recruited from community newspaper advertisements, rheumatology clinics, and arthritis groups. Discussions were audiotaped and transcribed. Transcripts were analyzed using qualitative content analysis. RESULTS All groups discussed the impact of arthritis on a range of PAs. Overall, participants discussed PA as positively influencing their health and well-being. Yet, several overarching themes highlighted the complexity of PA, including 1) PA as a potential cause of arthritis; 2) the reciprocal impact of arthritis on PA and PA on arthritis; 3) physical and psychological benefits and harms of PA, such as difficulty making PA decisions when living in pain or when faced with episodic symptoms; 4) perceived choices about engagement in PA (e.g., role overload); and 5) social support. CONCLUSION The relationships among work, health, and other roles were complex. Competing demands, pain, energy, episodic symptoms, support, and decisions to disclose one's illness at work influenced PA. Changes to PA not only affected physical health but also people's self-identity. PA interventions may be improved by taking into account the demands of multiple life roles.
Collapse
|
44
|
Arends RY, Bode C, Taal E, Van de Laar MAFJ. A goal management intervention for polyarthritis patients: rationale and design of a randomized controlled trial. BMC Musculoskelet Disord 2013; 14:239. [PMID: 23941633 PMCID: PMC3751421 DOI: 10.1186/1471-2474-14-239] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022] Open
Abstract
Background A health promotion intervention was developed for inflammatory arthritis patients, based on goal management. Elevated levels of depression and anxiety symptoms, which indicate maladjustment, are found in such patients. Other indicators of adaptation to chronic disease are positive affect, purpose in life and social participation. The new intervention focuses on to improving adaptation by increasing psychological and social well-being and decreasing symptoms of affective disorders. Content includes how patients can cope with activities and life goals that are threatened or have become impossible to attain due to arthritis. The four goal management strategies used are: goal maintenance, goal adjustment, goal disengagement and reengagement. Ability to use various goal management strategies, coping versatility and self-efficacy are hypothesized to mediate the intervention’s effect on primary and secondary outcomes. The primary outcome is depressive symptoms. Secondary outcomes are anxiety symptoms, positive affect, purpose in life, social participation, pain, fatigue and physical functioning. A cost-effectiveness analysis and stakeholders’ analysis are planned. Methods/design The protocol-based psycho-educational program consists of six group-based meetings and homework assignments, led by a trained nurse. Participants are introduced to goal management strategies and learn to use these strategies to cope with threatened personal goals. Four general hospitals participate in a randomized controlled trial with one intervention group and a waiting list control condition. Discussion The purpose of this study is to evaluate the effectiveness of a goal management intervention. The study has a holistic focus as both the absence of psychological distress and presence of well-being are assessed. In the intervention, applicable goal management competencies are learned that assist people in their choice of behaviors to sustain and enhance their quality of life. Trial registration Nederlands Trial Register = NTR3606, registration date 11-09-2012.
Collapse
|
45
|
Carlson M, Kuo A, Chou CP, Clark F. Relationship of Global Self-Evaluations of Activity to Psychosocial and Health-Related Aging Outcomes. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2013. [DOI: 10.3928/15394492-20130712-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors obtained older adults' self-rated judgments about the quality of their activity engagement considered as a whole (global activity evaluation) and, using cross-sectional survey data, tested the ability of such judgments to predict well-being. Participants were 460 community-dwelling older adults who responded to (1) global activity evaluations, (2) activity participation frequency scales, and (3) indices of life satisfaction, depression, and physical and mental health-related quality of life. Regression analyses indicated that global activity evaluations had a stronger relationship to psychosocial outcome indices than did participation frequency ratings, although both measurement approaches were associated with statistically significant predictions. However, global evaluations and participation frequency ratings were approximately equal in their ability to predict physical health-related quality of life. These relationships were fairly consistent across ethnic groups. Overall, the results suggest that ideally the two strategies for assessing activity should be incorporated in future research on activity and occupational therapy practice.
Collapse
|
46
|
Liu F, Woodrow J, Loucks-Atkinson A, Buehler S, West R, Wang PP. Smoking and alcohol consumption patterns among elderly Canadians with mobility disabilities. BMC Res Notes 2013; 6:218. [PMID: 23731926 PMCID: PMC3680044 DOI: 10.1186/1756-0500-6-218] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 05/30/2013] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Mobility disability is a major adverse health outcome associated with aging and an impediment to older adults' well-being and behaviors in social and leisure activities. It has been shown that lifestyle factors, including smoking and alcohol consumption, have been used as coping strategies to deal with the negative impact of disability. The aim of this study was to determine the prevalence of smoking and alcohol consumption among older Canadians with different levels of mobility disabilities and to examine factors associated with these two lifestyle patterns among those with disabilities. METHODS Secondary data analysis was performed using individuals (n = 6,038) aged 65 years and older from both the 2001 Participation and Activity Limitation Survey and the 2003 Canadian Community Health Survey. Multivariate logistic regressions examined the relationship between disability severity and smoking as well as alcohol consumption while controlling for potential confounding socioeconomic factors. RESULTS The proportion of current smokers among seniors with less-severe and more-severe mobility disabilities and those in the general population was comparable with 12.55%, 11.57% and 11.93%, respectively. Forty-eight percent of seniors in the general population consumed alcohol regularly, compared to only 12.85% with more-severe mobility disabilities. No significant association was shown between the severity level of mobility disabilities and smoking (odds ratio = 0.90, 95% confidence interval: 0.75, 1.08). However, seniors having more-severe disability were less likely to consume alcohol regularly (odds ratio = 0.76, 95% confidence interval: 0.65, 0.89). Other variables including age, gender, income, living status, and social participation also impacted these lifestyle patterns among the study population. CONCLUSIONS Smoking and alcohol patterns present different associations with the severity level of mobility disabilities. Compared with the general population, elderly Canadians with mobility disabilities had similar smoking prevalence but differ significantly in terms of alcohol consumption. Results from this research will be relevant to decision makers involved in program planning, health education, and policy development as it pertains to the prevention and management of age-related disability.
Collapse
Affiliation(s)
- Fang Liu
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland & Labrador, Canada
| | - Jennifer Woodrow
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland & Labrador, Canada
| | - Angela Loucks-Atkinson
- School of Human Kinetics and Recreation, Memorial University of Newfoundland, St. John’s, Newfoundland & Labrador, Canada
| | - Sharon Buehler
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland & Labrador, Canada
| | - Roy West
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland & Labrador, Canada
| | - Peizhong Peter Wang
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland & Labrador, Canada
| |
Collapse
|
47
|
Gibney SM, Drexhage HA. Evidence for a dysregulated immune system in the etiology of psychiatric disorders. J Neuroimmune Pharmacol 2013; 8:900-20. [PMID: 23645137 DOI: 10.1007/s11481-013-9462-8] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/17/2013] [Indexed: 02/06/2023]
Abstract
There is extensive bi-directional communication between the brain and the immune system in both health and disease. In recent years, the role of an altered immune system in the etiology of major psychiatric disorders has become more apparent. Studies have demonstrated that some patients with major psychiatric disorders exhibit characteristic signs of immune dysregulation and that this may be a common pathophysiological mechanism that underlies the development and progression of these disorders. Furthermore, many psychiatric disorders are also often accompanied by chronic medical conditions related to immune dysfunction such as autoimmune diseases, diabetes and atherosclerosis. One of the major psychiatric disorders that has been associated with an altered immune system is schizophrenia, with approximately one third of patients with this disorder showing immunological abnormalities such as an altered cytokine profile in serum and cerebrospinal fluid. An altered cytokine profile is also found in a proportion of patients with major depressive disorder and is thought to be potentially related to the pathophysiology of this disorder. Emerging evidence suggests that altered immune parameters may also be implicated in the neurobiological etiology of autism spectrum disorders. Further support for a role of immune dysregulation in the pathophysiology of these psychiatric disorders comes from studies showing the immunomodulating effects of antipsychotics and antidepressants, and the mood altering effects of anti-inflammatory therapies. This review will not attempt to discuss all of the psychiatric disorders that have been associated with an augmented immune system, but will instead focus on several key disorders where dysregulation of this system has been implicated in their pathophysiology including depression, schizophrenia and autism spectrum disorder.
Collapse
Affiliation(s)
- Sinead M Gibney
- Department of Immunology, Na1101, Erasmus MC, Dr. Molewaterplein 50, Erasmus MC, 3015 GE Rotterdam, The Netherlands.
| | | |
Collapse
|
48
|
Sverker A, Thyberg I, Ostlund G, Waltersson E, Thyberg M. Participation in work in early rheumatoid arthritis: a qualitative interview study interpreted in terms of the ICF. Disabil Rehabil 2013; 36:242-9. [PMID: 23639067 DOI: 10.3109/09638288.2013.789086] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To explore what work-related dilemmas are experienced by patients with early rheumatoid arthritis (RA), according to their own descriptions, and to interpret this in terms of participation categories of the International Classification of Functioning, Disability and Health (ICF). METHOD In 48 patients with early RA, qualitative interviews were analyzed, followed by linking of concepts to the activity/participation component of the ICF and interpretation of general themes. RESULTS Work-related dilemmas represented different societal perspectives on work related to acquiring, keeping and terminating a job, self-employment, part-time, full-time and non-remunerative employment. Dilemmas also represented participation priorities in economic self-sufficiency, self-care such as health care, and avoiding social relationships and recreation in favor of work. Leisure time was influenced because efforts of working took energy and time of day-to-day procedures. Embedded actions in work-related dilemmas were carrying out daily routine, mobility including using transportation, self-care, domestic life and social interaction. CONCLUSION The general themes societal perspectives, participation priorities and embedded actions, with the included ICF categories that are described in detail according to the experiences of the patients, can support clinical reasoning and research on quantitative relations to disease activity, body functions, ability and contextual factors.
Collapse
Affiliation(s)
- Annette Sverker
- Rehabilitation Section, NSC, County Council of Östergötland, Linköping University Hosptial , Linköping , Sweden
| | | | | | | | | |
Collapse
|
49
|
Woolf AD, Erwin J, March L. The need to address the burden of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2013; 26:183-224. [PMID: 22794094 DOI: 10.1016/j.berh.2012.03.005] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/12/2012] [Indexed: 10/28/2022]
Abstract
Musculoskeletal conditions are common in men and women of all ages across all socio-demographic strata of society. They are the most common cause of severe long-term pain and physical disability and affect hundreds of millions of people around the world. They impact on all aspects of life through pain and by limiting activities of daily living typically by affecting dexterity and mobility. They affect one in four adults across Europe [1]. Musculoskeletal conditions have an enormous economic impact on society through both direct health expenditure related to treating the sequelae of the conditions and indirectly through loss of productivity. The prevalence of many of these conditions increases markedly with age, and many are affected by lifestyle factors, such as obesity and lack of physical activity. The burden of these conditions is therefore predicted to increase, in particular in developing countries. The impact on individuals and society of the major musculoskeletal conditions is reviewed and effective prevention, treatment and rehabilitation considered. The need to recognise musculoskeletal conditions as a global public health priority is discussed.
Collapse
Affiliation(s)
- Anthony D Woolf
- Department of Rheumatology, Royal Cornwall Hospital, Truro, UK.
| | | | | |
Collapse
|
50
|
Tillmann T, Krishnadas R, Cavanagh J, Petrides KV. Possible rheumatoid arthritis subtypes in terms of rheumatoid factor, depression, diagnostic delay and emotional expression: an exploratory case-control study. Arthritis Res Ther 2013; 15:R45. [PMID: 23517876 PMCID: PMC3672797 DOI: 10.1186/ar4204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 03/12/2013] [Indexed: 01/16/2023] Open
Abstract
Introduction Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis has been implicated in the pathology of rheumatoid arthritis (RA), particularly as vulnerable personality types are exposed to chronic stress. Emotions are powerful modulators of stress responses. However, little is known about whether patients with RA process emotions differently to matched controls. In this study we: 1) assessed whether the trait emotional intelligence (trait EI) scores of patients with RA differ from healthy controls at the facet level; 2) explored any subgroups in RA, in terms of trait EI and common risk factors. Methods A total of 637 patients with RA were compared to 496 controls on the trait EI Questionnaire (TEIQue). RA subgroups were explored in terms of trait EI, rheumatoid factor status (RF+/-), depression and time from onset of symptoms until diagnosis (diagnostic delay). Results The RA group rated themselves lower on Adaptability, Stress-management, Emotion management, Self-esteem, Sociability, Assertiveness, Impulsiveness and Well-being, and higher on Empathy and Relationships than healthy controls. The RF- subtype reported more time with depression (25.2 vs. 11.3 months), a longer diagnostic delay (3.0 vs. 1.7 years), and greater emotional expression (5.15 vs. 4.72), than the RF+ subtype. These differences were significant at the P <0.05 level, but not following strict Bonferroni corrections and should therefore be treated as indicative only. RF- patients with a longer diagnostic delay reported depression lasting three times longer (42.7 months), when compared to three other subtypes (11.0 to 12.7 months). Conclusions RA patients and controls differ in their emotion-related personality traits, as operationalized by trait EI. These differences may make people with RA more susceptible to chronic stress and HPA-axis dysregulation. RA may be a highly heterogeneous illness where at least two subtypes may be characterized by personality, psychiatric and immunological differences. RF- status, as well as diagnostic delay and emotional expression, may predict future risk of depression. Research on the causes of RA could benefit from a systems science approach.
Collapse
|