Development of Resilience Among Rheumatoid Arthritis Patients: A Qualitative Study

A survey exploring the nexus of psychological traits, nature connection, and quality of life among patients with rheumatoid arthritis

Background

As the recognition of psychological factors in chronic illness management grows, this study examined the interplay of psychological traits - grit, self-efficacy, resilience, and nature-relatedness - and their collective impact on the Quality of Life (QoL) among patients with rheumatoid arthritis (RA) in Malaysia.

Methods

A cross-sectional study was conducted among 222 patients with RA at a private hospital in Malaysia. Utilizing validated scales, including the Connor-Davidson Resilience Scale, Short Grit Scale, Nature Relatedness Scale, and Arthritis Self Efficacy Scale, data were collected. Pearson Product-moment Correlation analyses assessed the relationships between variables, and a multiple mediation analysis explored the mediating effects of resilience, grit, and self-efficacy on the relationship between nature-relatedness and QoL.

Findings

Of the 222 participants (86% female, mean age = 56.03, S.D. = 13.42), the analysis revealed a significant mediating role of resilience in the relationship between nature-relatedness and QoL among RA patients (b = -.117, SE = .042, 95% BCa CI [-.208, -.046]). Although grit and self-efficacy positively correlated with QoL, they did not serve as significant mediators in the nature-relatedness - QoL relationship. This highlights the pivotal role of building a sense of resiliency among patients with RA.

Interpretation

Individuals with RA are not only resilient in terms of their psychological traits such as grit, self-efficacy, and general resilience but also exhibit resilience in their connection and interaction with the natural environment (nature-relatedness). This holistic concept recognizes that fostering resilience in both psychological aspects and the context of one's environment is crucial for promoting overall well-being, particularly in the management of chronic illnesses like RA. It emphasizes the interconnectedness of psychological factors and environmental engagement in contributing to an individual's ability to cope and thrive despite health challenges.

Maintaining resilience over time: A qualitative exploration of the experiences of living with chronic musculoskeletal pain

BACKGROUND

Living with chronic pain can have several negative consequences. However, some individuals are more resilient despite pain. Although a large body of research exploring resilience-enhancing factors exists, there is a lack of research focused on the changes of individual's resilience over time.

OBJECTIVES

This study aims to explore how people with chronic musculoskeletal pain (CMP) describe their experience regarding the maintenance of resilience in the long term.

METHODS

Within the framework of the qualitative research strategy, semi-structured interviews and two focus groups with 17 purposefully selected research participants (ages 29-64) were conducted. The data were analysed by integrating thematic analysis and narrative analysis.

RESULTS

To maintain resilience in the long term, it is important to take responsibility for one's physical and mental well-being by practicing regular ability-adjusted physical activity, giving up unrealistic expectations, focussing on finding opportunities, not obstacles, maintaining a positive future perspective, and finding significance in life despite experiencing chronic pain. Financial support from the government and access to rehabilitation can facilitate better self-care for those with limited finances.

CONCLUSION

This study may be useful for healthcare professionals, psychologists, social workers, and other specialists who daily encounter patients with CMP and aspire to understand the main challenges and needs of this particular group of patients.

Latent class analysis of psychological resilience and influencing factors in patients with rheumatoid arthritis: a cross-sectional survey

OBJECTIVES

To investigate the latent class of psychological resilience in patients with rheumatoid arthritis (RA) and examine the factors influencing various latent types.

METHODS

A cross-sectional survey design was used in this study. A total of 480 patients with RA were enrolled from two tertiary care institutions in Chengdu, Sichuan Province, between May and November 2023, using the convenience sample approach. The General Information Questionnaire, CD-RISC-10, SSRS, ASES-8, and BRAF-MDQ were used to analyze the latent classes of psychological resilience in the respondents, and the factors influencing the latent classes were explored using one-way analysis of variance, analysis of variance, and multi-categorical logistic regression analysis.

RESULTS

Overall, 423 valid questionnaires were returned, indicating an 88.13% effective return rate. A latent class analysis revealed that RA patients were divided into three classes of psychological resilience: low-level (20.3%), moderate-level (31.0%), and high-level (48.7%) psychological resilience. A multi-categorical logistic regression analysis found that social support, self-efficacy, weariness, age, work status, and somatic pain all significantly influenced psychological resilience in RA patients.

CONCLUSION

Three classes of RA patients' psychological resilience were identified by this study, and these classes were strongly correlated with individual treatment components. It is crucial to take into account the psychological resiliency of female RA patients who do not have a job. In order to improve psychological resilience, healthcare staff should first increase their comprehension of treat-to-target. Furthermore, people with RA may become more psychologically resilient if they receive more social support. Key Points • Preliminary research found that psychological resilience in RA patients was associated with three latent classes. • In RA patients, psychological resilience was significantly influenced by self-efficacy, fatigue, age, work status, physical pain, and social support. • The fundamental goal of bolstering RA patients' psychological resilience is to reaffirm their place in the treatment process, for example, by improving patient compliance and achieving treat-to-target earlier.

Resilience partially mediates the association between perceived social isolation and life satisfaction in people with systemic sclerosis

Objectives

Systemic sclerosis (SSc) negatively affects quality of life, yet the factors influencing life satisfaction, a key aspect of well-being, remain unclear in this population. Social isolation is common in SSc, potentially linked to decreased life satisfaction, but the underlying mechanisms are unexplored. Resilience, a modifiable psychological resource, may act as a mediator in this relationship among people with SSc. This study aimed to examine the relationship between perceived social isolation and life satisfaction and to investigate whether resilience mediates this relationship.

Methods

The Patient-Reported Outcomes Measurement Information System Social Isolation Short Form, the Connor-Davidson Resilience Scale, and the Satisfaction with Life Scale were used to assess perceived social isolation, resilience, and life satisfaction. Linear regressions were conducted using the PROCESS macro for SPSS.

Results

Among 163 individuals with SSc who provided complete data at baseline (mean age = 54.7 ± 11.9 years), 47% had diffuse cutaneous SSc, and 57% had an early disease duration. Perceived social isolation was negatively associated with life satisfaction. Resilience partially mediated the association between perceived social isolation and life satisfaction in people with SSc.

Conclusions

Findings revealed a significant association between perceived social isolation and life satisfaction and the mediating role of resilience in this association among people with SSc. Results suggest resilience may act as a protective mediator, counteracting the negative influence of perceived social isolation on life satisfaction. Findings support the promotion of social connection and resilience to enhance life satisfaction in people with SSc.

Clinical Trials Registration #

NCT04908943.

Arthritis is associated with high nutritional risk among older Canadian adults from the Canadian Longitudinal Study on Aging

This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study on Aging, a nationally representative sample of 45-85-year-old community-dwelling Canadians (n = 41,153). The abbreviated Seniors in the Community: Risk Evaluating for Eating and Nutrition II (SCREEN II-AB) Questionnaire determined NR scores (continuous), and high NR (score < 38); the Older American Resources and Services scale measured functional impairment. NR scores and status (low/high) were modelled using multiple linear and logistic regressions, respectively. Analyses adjusted for demographic characteristics, functional impairment, and health (body mass index, self-rated general and mental health). Additional analyses stratified the models by functional impairment. People with arthritis had poorer NR scores (B: - 0.35, CI - 0.48, - 0.22; p < 0.05) and increased risks of high NR (OR 1.11, 95% CI 1.06, 1.17). Among those with functional impairment, the likelihood of high NR was 31% higher in people with arthritis compared to those without arthritis (95% CI 1.12, 1.53). Among those with no functional impairment, the likelihood of high NR was 10% higher in people with arthritis compared to those without (95% CI 1.04, 1.16). These relationships differed based on the type of arthritis. Arthritis is associated with high NR in community-dwelling older adults, both with and without functional impairment. Findings highlight the need for further research on these relationships to inform interventions and improve clinical practices.

Effect of Humor on Pain and Anxiety in Patients With Rheumatoid Arthritis: A Prospective, Randomized Controlled Study

Humor can contribute to nursing practices for relieving pain and anxiety in patients with rheumatoid arthritis (RA) during intravenous (IV) biologic treatment. This study used a prospective, randomized controlled study design to investigate the effect of humor on pain and state anxiety in patients with RA receiving IV infusion therapy. Two sample groups were formed: the intervention group (watching a comedy movie) (n = 18) and the control group (usual care) (n = 18). Both groups received IV biologic therapy. A significant difference was found between the groups' pain mean scores, but the effect size was small (P < .001, η² = 0.032). The mean visual analog scale scores decreased in both groups after the treatment; however, it decreased more in the intervention group (P < .001, Md = 2.44) than in the control group (P = .017, Md = 0.83). No significant difference was found between the groups' mean state anxiety scores, and the effect size was irrelevant (P > .05, η² = 0.001). There was a significant decrease in the anxiety levels of both groups (P < .001). During IV biologic infusion therapy, watching comedy movies is recommended as a nursing care intervention for reducing pain in patients with RA in cooperation with other health professionals.

Peer-Led Symptom Management Intervention to Enhance Resilience in People With Systemic Sclerosis: Mediation Analysis From a Randomized Clinical Trial

OBJECTIVE

Facilitated self-management interventions have the potential to enhance resilience and well-being. We examined whether resilience is a mediator of improving physical and psychological symptoms for people with systemic sclerosis (SSc) who participated in a 12-week online peer-led symptom management intervention.

METHODS

We conducted a secondary data analysis from a randomized control trial comparing a peer health-coached intervention to a waitlist control. Participants completed the Connor-Davidson Resilience Scale, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, and the Patient Reported Outcomes Measurement Information System measures of pain interference and depressive symptoms at the baseline and at weeks 6 and 12. Linear mixed effect regression models were used to assess the effect of intervention on changes in resilience. Causal mediation analyses were conducted to examine whether changes in resilience at week 12 mediated intervention effects on changes in fatigue, pain interference, and depressive symptoms at week 12.

RESULTS

One hundred and seventy-three eligible participants were enrolled. Participants in the intervention group reported improvements in resilience (P < 0.001). These changes in resilience mediated the intervention effects on fatigue with indirect effect of -1.41 (95% confidence interval [CI] -2.41 to -0.41), pain interference of -0.86 (95% CI -1.65 to -0.08), and depressive symptoms of -1.99 (95% CI -3.16 to -0.81).

CONCLUSION

For participants in the intervention who had positive improvements in their physical and psychological symptoms, increased resilience was a mechanism for these improvements. These findings support the importance of addressing resilience to improve symptoms in similar SSc interventions.

Study on the Correlation between 7-joint Ultrasound Score and Disease Activity in Patients with Rheumatoid Arthritis

Background

The objective of this study was to investigate the correlation between the 7-joint ultrasound score (US7) and disease activity in patients with rheumatoid arthritis (RA).

Methods

Forty-four patients with active RA were assessed, and the correlation between US7 and disease activity indicators such as the disease activity score (DAS28), rheumatoid factor (RF), the erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) was analyzed. In addition, the proportions of US7 points accounted for by different joint regions and joint surfaces were analyzed.

Results

RF, CRP, and ESR were significantly increased in the RA group compared with the control group (P < 0.05). In the RA group, DAS28 (r = 0.0.561, P < 0.01), RF (r = 0.635, P < 0.01), ESR (r = 0.585, P < 0.01), and CRP (r = 0.492, P < 0.01) were positively correlated with US7. In terms of contributions to US7, the most susceptible joint surface is the dorsal surface, and the most susceptible joint area is the dorsal wrist.

Conclusion

US7 is positively correlated with disease activity indicators of RA, which can objectively reflect disease activity in RA patients and provide a reference for clinical diagnosis and efficacy evaluation.

The mediting role of psychological resilience on the negative effect of pain in patients with rheumatoid arthritis: A cross-sectional study

The objective of this study was to investigate the direct effects of pain-induced depression and anxiety, as well as the mediating role of psychological resilience, on the psychological distress associated with rheumatoid arthritis. The method involved a sample of 196 patients with rheumatoid arthritis and applied the Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and visual analog scale for pain. Bivariate and path analyses were performed, and a multiple mediational model was utilized. Results showed that all correlations among study variables were significant (p < 0.01). A partial mediation effect of psychological resilience was observed, and direct effects among the variables (pain, psychological resilience, anxiety, and depression) were statistically significant, including the direct effect of psychological resilience on depression and anxiety. The indirect effects of pain through psychological resilience on depression and anxiety were also significant. Thus, the results suggest that psychological resilience partially mediates the effects of pain-induced anxiety and depression in patients with rheumatoid arthritis.

Resilience practices among a broad spectrum of individuals with physical disabilities during the COVID-19 pandemic: A qualitative photo elicitation study

This community-based study explored resilience practices among people living with physical disabilities (i.e., stroke, spinal cord injury, and other physical disabilities) during the COVID-19 pandemic. In this photo elicitation study, during 1:1 interviews, participants shared and described photos that reflected their pandemic-related experiences. Data were analyzed thematically to identify resilience-related practices. Our analysis revealed three themes: (1) reflecting on the importance of family, friends, and community (e.g., recalling past memories and strengthening existing connections); (2) engaging in social and recreational activities (e.g., experiencing the outdoors and gardening); and (3) reframing personal contexts and social environment (e.g., adjusting to new social norms and overcoming physical barriers to navigating safely during the pandemic). The resilience that participants identified encompassed not only individual strategies but also family and community supports. Resilience can be fostered through community initiatives that support more equitable responses to health emergencies for people with disabilities.

Brief Assessment of Adaptive and Maladaptive Coping Strategies During Pandemic

This study aimed to analyse the internal structure, internal consistency, and convergent and divergent validity for the Coping Strategies Scale. We found a two-factor solution (maladaptive coping; adaptative coping) with a second-order general factor (coping strategies) that demonstrated adequate factorial structure and internal consistency for a brief nine items instrument in a sample of 211 economically active Brazilians (M_age = 37.07; SD = 13.03). The adaptive strategies factor converged with quality of life and work. It also diverged from phobia, stress, and anxiety. Maladaptive coping strategies converged with phobia, stress, and anxiety and diverged from the quality of work and life. According to the results, we found that coping strategies are a vital personal resource to overcome daily adversity, including those from the current pandemic. The present instrument may impact worldwide, offering conditions to investigate and promote mental health positive outcomes by reinforcing coping assessment during pandemics.

Patient perspectives on long-term outcomes in rheumatoid arthritis. A qualitative study from the OMERACT patient outcomes in longitudinal studies working group

OBJECTIVES

To identify patient-centered domains with long-term relevance to people with rheumatoid arthritis (RA).

METHODS

We conducted semi-structured individual cognitive interviews of patients with RA with at least five years of disease duration, sampled from five different countries (United States, Italy, Spain, Mexico, and Argentina). Participants were encouraged to discuss their long-term concerns regarding RA. Interviews were transcribed and analyzed using qualitative content analysis within a constructivist/interpretivist theoretical framework.

RESULTS

Twenty-eight participants were interviewed, 24 were women. Six main themes, representing important aspects of the daily life of people with RA were generated: (i) Living with symptoms and functional limitations, (ii) Lack of participation, (iii) Partner and family issues, (iv) Risk of damage to vital organs, (v) Coping strategies, and (vi) Healthcare concerns, primarily expressed by participants from non-European countries lacking universal healthcare coverage. In addition, participants discussed the importance of contextual factors and how they impact long-term outcomes. These included attitudes towards disease, social support, or financial burdens.

CONCLUSIONS

We identified six domains of importance to people with RA that are seldom measured in longitudinal registries and should be considered in patient-centered longitudinal studies.

Importance of temporality and context in relation to life habit restrictions among patients with systemic lupus erythematosus: A psychosocial qualitative study

OBJECTIVE

Life habits (LH) encompass an individual's engagement in daily activities such as nutrition, fitness, personal care, communication, housing, and mobility, along with his/her social role (responsibility, interpersonal relationships, community life, education, employment, and recreation). This qualitative study explores the nature and context of LH restrictions in systemic lupus erythematosus (SLE) individuals across their SLE journey.

METHODS

Narrative interviews were conducted with adult SLE patients. Interview transcripts were subjected to a thematic content analysis, using the Disability Creation Process model as a framework.

RESULTS

Forty participants were interviewed. Three major themes were highlighted: (1) Temporality, capabilities, and environmental contexts: although all participants experienced LH restrictions at some point, the expression of these limitations depended on the individual's and SLE disease characteristics as well as on temporal (time of life and lupus course) and environmental (material, social, and societal) contexts. (2) Identity issues, illness stigma, and (fear of) discriminations: LH were discussed through the lens of participants' social roles and identities. While illness stigma can influence social relations, it is also expressed at a societal level. (3) Masking and minimizing strategies: due to illness stigma and fear of discrimination, participants developed strategies to manage their relationships, including masking and minimization. Their use was both advantageous and disadvantageous regarding LH.

CONCLUSIONS

For individuals with SLE, LH restrictions must be considered as an ongoing process that takes place within specific contexts. Our findings provide many opportunities for interventions that can benefit patients and their families, as well as healthcare providers.

Uncovering the Imprints of Chronic Disease on Patients' Lives and Self-Perceptions

Rheumatoid arthritis (RA) patients face psychological hardship due to physical discomfort, disabilities, and anxieties. Previous research indicated a bidirectional relationship and patient desire for emotional support from providers. This study examined lesser-understood RA experiences across the psychological and social contexts in relation to self-perception through the patients' expression of their struggles with these burdens. We conducted four semistructured focus groups and eleven interviews (total n = 31). A codebook was developed and refined through iterative transcript coding via NVivo-12. Four emerging themes were identified by inductive, thematic analysis: (1) the patients' healthy appearances were a myth, with subthemes revealing a conflict between an inclination to hide the disease and a desire for validation, while feeling embarrassed by symptom manifestations and disappointment at withdrawal from social interactions; (2) an identity crisis due to diminished functionality, autonomy, and sense of self; (3) RA constantly occupied the mind, as its unpredictability dictated daily schedules and altered plans; and (4) the disease's chronic nature influenced personal outlook to worry about or accept the uncertainty. Even with effective treatment, the invisibility of the disease, the fear and anticipation of flare-ups, and identity clashes caused emotional distress. The insights offer a different perspective on personalized medicine, complementing clinical treatments based on genetic or biomarker profile. For patient-centered holistic care, education is needed to prompt both patients and providers to discuss psychological issues for more customized, integrated interventions. The findings can help inform healthcare teams and families in recognizing and supporting these physical-psychological intertwined experiences, thereby ameliorating patients' wellbeing.

Experiences of self-care during the COVID-19 pandemic among individuals with rheumatoid arthritis: A qualitative study

Objectives

This study aimed to explore the impact of the coronavirus disease 2019 (COVID‐19) pandemic on self‐care of individuals living with rheumatoid arthritis (RA).

Methods

Guided by a constructivist, qualitative design, we conducted one‐to‐one in‐depth telephone interviews between March and October 2020 with participants with RA purposively sampled for maximum variation in age, sex and education, who were participating in one of two ongoing randomized‐controlled trials. An inductive, reflexive thematic analysis approach was used.

Results

Twenty‐six participants (aged 27–73 years; 23 females) in British Columbia, Canada were interviewed. We identified three themes: (1) Adapting to maintain self‐care describes how participants took measures to continue self‐care activities while preventing virus transmissions. While spending more time at home, some participants reported improved self‐care. (2) Managing emotions describes resilience‐building strategies such as keeping perspective, positive reframing and avoiding negative thoughts. Participants described both letting go and maintaining a sense of control to accommodate difficulties and emotional responses. (3) Changing communication with health professionals outlined positive experiences of remote consultations with health professionals, particularly if good relationships had been established prepandemic.

Conclusion

The insights gained may inform clinicians and researchers on ways to support the self‐care strategies of individuals with RA and other chronic illnesses during and after the COVID‐19 pandemic. The findings reveal opportunities to further examine remote consultations to optimize patient engagement and care.

Patient or Public Contribution

This project is jointly designed and conducted with patient partners in British Columbia, Canada. Patient partners across the United Kingdom also played in a key role in providing interpretations of themes during data analysis.

Use and detailed metric properties of patient-reported outcome measures for rheumatoid arthritis: a systematic review covering two decades

Introduction

The importance of patient-reported outcome measures (PROMs) for rheumatoid arthritis (RA) clinical studies has been recognised for many years. The current study aims to describe the RA PROMs used over the past 20 years, and their performance metrics, to underpin appropriate tool selection.

Methods

The study included a systematic search for PROMs that have been in use over the period 2000–2019, with detailed documentation of their psychometric properties, and a user-friendly presentation of the extensive evidence base.

Results

125 PROMs were identified with psychometric evidence available. The domains of pain, fatigue, emotional functions, mobility, physical functioning and work dominated, with self-efficacy and coping as personal factors. Domains such as stiffness and sleep were poorly served. The most frequently used PROMs included the Health Assessment Questionnaire Disability Index (HAQ), the Short Form 36 (SF-36), the EuroQoL and the Modified HAQ which, between them, appeared in more than 3500 papers. Strong psychometric evidence was found for the HAQ, and the SF-36 Physical Functioning and Vitality (fatigue) domains. Otherwise, all domains except stiffness, sleep, education and health utility, had at least one PROM with moderate level of psychometric evidence.

Conclusion

There is a broad range of PROMs for measuring RA outcomes, but the quality of psychometric evidence varies widely. This work identifies gaps in key RA domains according to the biopsychosocial model.

Resilience in women with primary Sjögren's syndrome

To assess the relationship between resilience and several diseases and individual features in primary Sjӧgren's Syndrome (SS) patients. Resilience was assessed using the Resilience Scale (RS-14). Disease activity, damage, and reported symptoms were assessed by means of ESSDAI (EULAR Sjögren's syndrome disease activity index), SSDDI (Sjӧgren's Syndrome Disease Damage Index) and ESSPRI (EULAR Sjӧgren's Syndrome Patient Reported Index). EuroQol, HADS (Hospital Anxiety and Depression Scale), SF-12 (Short-form 12 health survey), FAS (Fatigue Assessment Scale), FACIT-F (Functional Assessment of Chronic Illness Therapy - Fatigue), and IPAQ (International Physical Activity Questionnaire) questionnaires were submitted to evaluate physical and mental well-being of the recruited patients. Data about the autoimmune profile, systemic manifestations, and current therapy were collected. Educational qualifications and work activities were also considered. Descriptive, correlational, and linear regression analysis were performed. 74 consecutive women with primary SS and 74 sex and age-matched healthy subjects as a control group were recruited. SS patients displayed a moderate value of resilience (median 78.5) with no significant difference compared to controls (p = 0.38). An inverse relationship was found between resilience and mood disorders such as anxiety (p = 0.038) and depression (p < 0.001). Greater resilience was associated with a better perception of the quality of life (p = 0.02) and general health (p < 0.001), as well as with less fatigue (p = 0.008) and a more physically active lifestyle (p = 0.001). No significant relationship was found neither between resilience and age, socio-demographic and disease characteristics, nor with ESSDAI (p = 0.26), ESSPRI (p = 0.83) and SSDDI (p = 0.67). This is the first study assessing resilience in a large group of unselected primary SS patients. Most resilient primary SS patients are less depressed and show a better perception of their health. Greater resilience tends to correlate with less anxiety, physical and mental fatigue, and a more active lifestyle, while no association with disease activity and duration, damage, and socio-demographic features was detected. Considering the well-known role of resilience in helping to better cope with chronic illnesses, its assessment in SS patients should not be overlooked and the possible strategies for its improvement should be better explored and further implemented.

Psychosocial and clinical effects of the COVID-19 pandemic in patients with childhood rheumatic diseases and their parents

This study aimed to evaluate the psychological symptoms of children and adolescents with rheumatological diseases (RD) and their parents during the outbreak. A web-based questionnaire survey was conducted in a cross-sectional design in RD patients and healthy controls. The Hospital Anxiety and Depression Scale was used to evaluate parental psychiatric status; while the State-Trait Anxiety Inventory for Child was used for children. Four hundred and fifty-nine patients with RD and their parents completed the present study, as well as 336 healthy peers. The age and gender of the children were similar across groups. Under 12 years of age, the trait anxiety of the children and the psychological symptoms of parents were similar across groups; while over 13 years of age, anxiety and depression scores of the parents, as well as trait anxiety of the children were higher than the control groups’ (7.3 ± 3.4 vs 6.3 ± 3.8, p = 0.006 for parental anxiety; 6.6 ± 3.8 vs. 5.3 ± 3.9, p < 0.001 for parental depression; 36.1 ± 8.7 vs. 33.3 ± 7.9, p = 0.002 for child trait anxiety). In patient group, there were no differences in scale scores according to variables such as rheumatological disease diagnosis, the consulting of doctor for treatment, thinking that RD increases the risk of COVID-19, the history of rheumatic disease attack during the pandemic process, and the use of biological agents. The children’s trait anxiety was positively correlated with their parents’ anxiety (r = 0.414, p < 0.001) and depression (r = 0.300, p < 0.001) scores. These findings suggest that clinicians should pay attention to the psychiatric symptoms of both children with RD and their parents during the pandemic.

Developing the Resilience Framework for Nursing and Healthcare

Despite four decades of resilience research, resilience remains a poor fit for practice as a scientific construct. Using the literature, we explored the concepts attributed to the development of resilience, identifying those that mitigate symptoms of distress caused by adversity and facilitate coping in seven classes of illness: transplants, cancer, mental illness, episodic illness, chronic and painful illness, unexpected events, and illness within a dyadic relationship. We identified protective, compensatory, and challenge-related coping-concept strategies that healthcare workers and patients use during the adversity experience. Healthcare-worker assessment and selection of appropriate coping concepts enable the individual to control their distress, resulting in attainment of equanimity and the state of resilience, permitting the resilient individual to work toward recovery, recalibration, and readjustment. We inductively developed and linked these conceptual components into a dynamic framework, The Resilience Framework for Nursing and Healthcare, making it widely applicable for healthcare across a variety of patients.

Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy

Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.

Living with arthritis: a "training camp" for coping with stressful events? A survey on resilience of arthritis patients following the COVID-19 pandemic

Resilience is defined as “the capacity of individuals to cope successfully with significant change or adversity”. The challenge posed by the COVID-19 pandemic may potentially represent an overwhelmingly stressful event for patients with chronic diseases. Aim of our study was to investigate the levels of resilience in individuals with inflammatory arthritis living in Emilia Romagna, the third hardest-hit Italian region during the ongoing COVID-19 pandemic. To this purpose, we developed a survey consisting of four different sections assessing demographic characteristics, the 14-item resilience scale (RS14) and questionnaires evaluating depression and anxiety. Consecutive patients with inflammatory arthritis were recruited over a short time frame immediately after the end of national lockdown and compared with control individuals from the general population. One hundred twenty-two patients and 173 controls were included. Levels of resilience, as measured by RS14 score, were significantly higher in patients with inflammatory arthritis (82.6 ± 14.0 vs 79.0 ± 12.8, p = 0.018). After stratification for gender, the difference in RS14 score was maintained in women (p = 0.045), but not in men (p = 0.252). High resilience, defined as having a RS14 score > 90, was significantly more prevalent in patients than in controls (30% vs 16%, p = 0.009). In arthritis patients, no significant differences in RS14 were observed after stratification for specific diagnosis, age, or disease duration and activity. Our findings suggest that patients with inflammatory arthritis may be more resilient than the general population towards unexpected stressful events such as the ongoing COVID-19 pandemic.

Key Points • Living with inflammatory arthritis may foster resilience. • After COVID-19, patients with inflammatory arthritis were more resilient than the general population.

The experience of living with rheumatoid arthritis: A qualitative metasynthesis

AIMS AND OBJECTIVES

To develop a model of understanding of how rheumatoid arthritis (RA) affects daily life based on a third-order interpretation of qualitative findings.

BACKGROUND

Rheumatoid arthritis is a chronic condition subject to a progressive deterioration of joints, limiting the ability to move and causing severe impairment in patients' lives.

DESIGN

A qualitative metasynthesis.

METHODS

CINHAL, ProQuest, PsycINFO, PubMed, SCOPUS and Web of Science databases were searched for relevant studies applying appropriate criteria. Screening and selection of studies were performed following the PRISMA guidelines and the PRISMA checklist was completed. Thirty-eight qualitative articles were retrieved: in total, 17 were excluded for failing to meet inclusion criteria, and 21 were considered for synthesis. Data analysis followed a third-order interpretation of data for synthesising qualitative research.

RESULTS

Findings led to the creation of a model consisting of two overarching categories: "rheumatoid arthritis impact on life domains" and "Confronting the illness," and two cross-sectional codes: "Health" and "Independence and normality."

CONCLUSION

This meta-study provides a model that is both inclusive of participants' own viewpoint and solidly grounded in a health psychology model.

RELEVANCE TO CLINICAL PRACTICE

The model can be highly informative for both practitioners and researchers in developing tailored interventions of support and prevention.