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Raunsbæk Knudsen L, Lomborg K, Ndosi M, Hauge EM, de Thurah A. The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study-protocol for a pragmatic randomised controlled trial. BMC Rheumatol 2021; 5:57. [PMID: 34924034 PMCID: PMC8686289 DOI: 10.1186/s41927-021-00226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis.
Methods A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal–Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the ‘superiority’ of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. Discussion The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. Trial registration: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1. See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00226-y.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,University Hospitals Bristol, Bristol, England
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ris I, Broholm D, Hartvigsen J, Andersen TE, Kongsted A. Adherence and characteristics of participants enrolled in a standardised programme of patient education and exercises for low back pain, GLA:D® Back - a prospective observational study. BMC Musculoskelet Disord 2021; 22:473. [PMID: 34022826 PMCID: PMC8141215 DOI: 10.1186/s12891-021-04329-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Low back pain is often long-lasting, and implementation of low-cost interventions to improve care and minimise its burden is needed. GLA:D® Back is an evidence-based programme consisting of patient education and supervised exercises for people with low back pain, which was implemented nationwide in primary care clinics in Denmark. To assess how the intervention was received and factors influencing adherence to the program, we aimed to evaluate participants' adherence to the intervention and identified characteristics related to the completion of GLA:D® Back. Specifically, we investigated: 1) level of attendance of participants enrolled in the programme, and 2) participant-related factors associated with low attendance. METHODS Primary care clinicians delivered GLA:D® Back, a standardised 10-week programme of 2 educational and 16 supervised exercise sessions, to patients with low back pain. Attendance was defined as low, medium or high based on self-reported number of attended sessions. Additional participant-reported data included demographic characteristics, pain, prognostic risk profiles, self-efficacy, illness-beliefs, function and clinician-reported physical performance tests. Results for high, medium, low, and unknown attendance were reported descriptively. Odds ratios for low attendance compared to medium/high attendance were calculated by including all baseline factors in a mixed-model logistic regression model. RESULTS Of 1730 participants, 52% had high, 23% medium, and 25% low levels of attendance. Level of attendance was not strongly associated with participants' individual factors, but in combination, prediction of low attendance was fair (AUC 0.77; 95% CI 0.74-0.79). The strongest indicator of low attendance was not completing the baseline questionnaire. CONCLUSIONS Most participants of a 10-week low back pain programme attended almost all session. Non-response to the baseline questionnaire was strongly associated with low attendance, whereas individual patient characteristics were weakly related to attendance. Not completing baseline questionnaires might be an early indicator of poor adherence in programs for people with persistent low back pain. TRIAL REGISTRATION The Health Research Ethics for Southern Denmark decided there was no need for ethical approval (S-20172000-93). The Danish data collection has obtained authorisation from the Danish Data Protection Agency as part of the University of Southern Denmark's institutional authorisation (DPA no. 2015-57-0008 SDU no. 17/30591). The trial was registred at ClinicalTrials.gov NCT03570463 .
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Affiliation(s)
- Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Daniel Broholm
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Anaesthesiology, Multidisciplinary Pain Centre, Vejle and Middelfart Hospitals, Østre Hougvej 55, 5500 Middelfart, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Chiropractic Knowledge Hub, Campusvej 55, 5230 Odense M, Denmark
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Primdahl J, Esbensen BA, Pedersen AK, Bech B, de Thurah A. Validation of the Danish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaires (BRAFs). Scand J Rheumatol 2021; 50:351-359. [PMID: 33605192 DOI: 10.1080/03009742.2020.1869301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective: This study aimed to validate the Danish versions of the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire (BRAF-MDQ) and BRAF Numerical Rating Scale version 2 (NRSv2).Method: We tested face and content validity, internal consistency, criterion validity, construct validity, and reproducibility for the BRAF-MDQ, and face and criterion validity and reproducibility for the BRAF-NRS.Results: In all, 224/236 patients (95%) completed the questionnaires [70% female, mean ± sd age 59 ± 13.04 years, disease duration 11.2 ± 9.49 years, Health Assessment Questionnaire (HAQ) 0.724 ± 0.70, and 28-joint Disease Activity Score-C-reactive protein 2.55 ± 1.24]. The unidimensionality for the physical and cognitive fatigue subscales was confirmed, whereas the living with fatigue and emotional fatigue subscales were not unidimensional. Cronbach's α was 0.94 for the BRAF-MDQ total and 0.78-0.92 for the four subscales. The correlations between BRAF-MDQ and various measures were: 36-item Short Form Health Survey (SF-36) vitality subscale, 0.75; Hospital Anxiety and Depression Scale (HADS) anxiety subscale, 0.65; HADS depression subscale, 0.62; visual analogue scale (VAS) pain, 0.62; VAS global, 0.73; and HAQ, 0.62. The intraclass correlation coefficient for agreement was 0.995. A Bland-Altman plot showed a mean ± sd difference of -1.9 ± 3.62 for BRAF-MDQ. Correlation coefficients between the BRAF-NRSv2 subscales and other subscales were: BRAF-MDQ subscales, 0.57-0.93; SF-36 vitality subscale, 0.54-0.68; and VAS fatigue, 0.66-0.82.Conclusions: The Danish BRAFs are considered valid and reliable for use among Danish patients with rheumatoid arthritis, despite the subscales living with fatigue and emotional fatigue not being unidimensional, as they are in the original version.
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Affiliation(s)
- J Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - B A Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A K Pedersen
- Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - B Bech
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - A de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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da Silva RVT, Silva FDC, Meireles SM, Natour J. Translation to Brazilian Portuguese, cultural adaptation and psychometric properties of 8-item ArthritisSelf-Efficacy Scale (ASES-8). SAO PAULO MED J 2019; 137:6-12. [PMID: 31116272 PMCID: PMC9721212 DOI: 10.1590/1516-3180.2018.0354071218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/07/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Self-efficacy refers to one's belief in one's ability to organize, perform actions and face challenges in order to achieve goals and motivation. High self-efficacy improves disease coping and adherence to treatment among patients with rheumatoid arthritis. The objective of this study was to translate, culturally adapt and test the reproducibility of the 8-item Arthritis Self-Efficacy Scale (ASES-8) questionnaire for use in Brazil. DESIGN AND SETTING Validation study conducted in university outpatient clinics. METHODS The questionnaire was translated into Brazilian Portuguese and then back-translated into English. The final version in Portuguese was tested on 30 patients with rheumatoid arthritis and was shown to be understandable and culturally adapted. A further 32 patients with rheumatoid arthritis were evaluated three times using the questionnaire. On the first occasion, two evaluators applied the questionnaire to check inter-evaluator reproducibility. After 15 days, one of the evaluators reassessed the patients to verify intra-evaluator reproducibility. At the first assessment, to test the construct validity of ASES-8, the Numerical Pain Scale, Health Assessment Questionnaire, Beck Depression Inventory and Short Form-36 questionnaire were also applied to all the patients. RESULTS The inter and intra-evaluator correlation coefficients for ASES-8 were high. Cronbach's alpha was higher than 0.90 for the questionnaire, indicating excellent internal consistency. There were moderate correlations between ASES-8 and most of the instruments tested, indicating good construct validity. CONCLUSION ASES-8 was translated and adapted to the Portuguese language for Brazil. This instrument is valid, reproducible and reliable for evaluating self-efficacy among patients with rheumatoid arthritis.
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Affiliation(s)
| | - Fabiana de Carvalho Silva
- PT, MSc. Doctoral Student, Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Sandra Mara Meireles
- PT, PhD. Physiotherapist, Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
| | - Jamil Natour
- MD, PhD. Associate Professor, Rheumatology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo (SP), Brazil.
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Siril H, Kaale A, Minja A, Kilewo J, Mugusi F, Sunguya B, Todd J, Kaaya S, Smith Fawzi MC. Improving communication about HIV prevention among people living with HIV and their at-risk social network members in Dar es Salaam, Tanzania. COGENT MEDICINE 2019; 6. [PMID: 31355302 PMCID: PMC6660010 DOI: 10.1080/2331205x.2019.1600230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although a number of HIV prevention programs have been implemented, such as mass media campaigns, high rates of unprotected and concurrent sexual partnerships, as well as low uptake HIV testing and limited HIV knowledge, persist in Tanzania. We examined the effect and predicting factors of HIV prevention communication among people living with HIV (PLH) exposed to NAMWEZA intervention, and their at-risk social network members (NMs) Quantitative data were collected from 326 participants at baseline and 24 months of follow-up. In-depth interviews with 20 PLH were conducted at follow-up. Results indicated specific communication about condom use and HIV testing increased; (mean increase of 0.28 (SD = 0.14) scores, P = 0.012 and 0.42 (SD = 0.11) scores, p < 0.001 respectively while general discussion about protecting other people from HIV did not change significantly; mean increase was 0.01 scores (SD = 0.005), p = 0.890. Positive predictors of communication included being single; OR = 1.10, p = 0.01, female; OR = 1.15, p = 0.03, aged 30 years or older; OR = 1.23, p < 0.01, HIV knowledge, dose of NAMWEZA participation; OR = 1.01, p < 0.001, and high self-efficacy for condom use; OR = 1.4, p < 0.001. Stigma demonstrated a significant but negative association with communication for condom use; OR = 1.01, p < 0.01.Qualitative data reflected perceived possession of more individual skills and ability to address some personal/cultural obstacles to communicating about HIV prevention including those observed in the quantitative data. NAMWEZA improved communication about HIV prevention among PLH with their at-risk-NMs. The approach is a promising complement to media campaigns in similar populations. Future research and program evaluation efforts should explore how communities perceive and communicate about protecting others from HIV.
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Affiliation(s)
- Hellen Siril
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Public Health Evaluations and Quality Improvement, Management and Development for Health, Dar es Salaam, Tanzania
| | - Anna Kaale
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Anna Minja
- Department of Healthy Options, Africa Academy for Public Health (AAPH), Dar es Salaam, Tanzania
| | - Japheth Kilewo
- Department of Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ferdinand Mugusi
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jim Todd
- London School of Hygiene and Tropical Medicine, London, UK
| | - Sylvia Kaaya
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary C Smith Fawzi
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Kongsted A, Ris I, Kjaer P, Vach W, Morsø L, Hartvigsen J. GLA:D ® Back: implementation of group-based patient education integrated with exercises to support self-management of back pain - protocol for a hybrid effectiveness-implementation study. BMC Musculoskelet Disord 2019; 20:85. [PMID: 30777049 PMCID: PMC6380042 DOI: 10.1186/s12891-019-2443-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 01/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Reassuring patient education and exercise therapy are widely recommended interventions for back pain in clinical guidelines. However, many patients are offered non-guideline endorsed options, and strategies for effective implementation of guideline-based care have not yet been developed. This protocol outlines the evaluation of a strategy for nationwide implementation of standardised patient education and exercise therapy for people with persistent or recurrent back pain in a hybrid implementation-effectiveness design. The strategy and the evaluation were planned using the framework of the Behaviour Change Wheel. METHODS The main activity of the implementation strategy is a two-days course for physiotherapists and chiropractors in delivering patient education and exercise therapy that is aimed at supporting patient self-management. This comes with ready-to-use patient education materials and exercise programs. The clinical intervention is a group-based program consisting of two sessions of patient education and 8 weeks of supervised exercises. The program uses a cognitive-behavioural approach and the aim of the exercise component is to restore the patient's ability and confidence to move freely. The implementation process is evaluated in a dynamic process monitoring the penetration, adoption and fidelity of the clinical intervention. The clinical intervention and potential effect mechanisms will be evaluated at the patient-level using measures of knowledge, skills, beliefs, performance, self-efficacy and success in self-management. The education of clinicians will be evaluated via clinician-level outcomes, including the Pain Attitudes and Beliefs Scale, the Practitioner Confidence Scale, and the Determinants of Implementation Behaviour Questionnaire. Effects at a national level will be investigated via data from national registries of health care utilisation and sick-leave. DISCUSSION This implementation-effectiveness study is designed to evaluate the process of implementing an evidence-based intervention for back pain. It will inform the development of strategies for implementing evidence-based care for musculoskeletal pain conditions, it will enhance the understanding of mechanisms for developing patient self-management skills, and it will demonstrate the outcomes that are achievable in everyday clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT03570463 . Registered 27 June 2018.
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Affiliation(s)
- Alice Kongsted
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Applied Health Science, University College Lillebaelt, Odense, Denmark
| | - Werner Vach
- The Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Lars Morsø
- Centre for Quality, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Kjaer P, Kongsted A, Ris I, Abbott A, Rasmussen CDN, Roos EM, Skou ST, Andersen TE, Hartvigsen J. GLA:D ® Back group-based patient education integrated with exercises to support self-management of back pain - development, theories and scientific evidence. BMC Musculoskelet Disord 2018; 19:418. [PMID: 30497440 PMCID: PMC6267880 DOI: 10.1186/s12891-018-2334-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/31/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Clinical guidelines recommend that people with back pain be given information and education about their back pain, advice to remain active and at work, and exercises to improve mobility and physical activity. Guidelines, however, rarely describe how this is best delivered. The aim of this paper is to present the development, theories, and underlying evidence for 'GLA:D Back' - a group education and exercise program that translates guideline recommendations into a clinician-delivered program for the promotion of self-management in people with persistent/recurrent back pain. METHODS GLA:D Back, which included a rationale and objectives for the program, theory and evidence for the interventions, and program materials, was developed using an iterative process. The content of patient education and exercise programs tested in randomised trials was extracted and a multidisciplinary team of expert researchers and clinicians prioritised common elements hypothesised to improve back pain beliefs and management skills. The program was tested on eight people with persistent back pain in a university clinic and 152 patients from nine primary care physiotherapy and chiropractic clinics. Following feedback from the clinicians and patients involved, the working version of the program was created. RESULTS Educational components included pain mechanisms, pain modulation, active coping strategies, imaging, physical activity, and exercise that emphasised a balance between the sum of demands and the individual's capacity. These were operationalised in PowerPoint presentations with supporting text to aid clinicians in delivering two one-hour patient education lectures. The exercise program included 16 supervised one-hour sessions over 8 weeks, each comprising a warm-up section and eight types of exercises for general flexibility and strengthening of six different muscle groups at four levels of difficulty. The aims of the exercises were to improve overall back fitness and, at the same time, encourage patients to explore variations in movement by incorporating education content into the exercise sessions. CONCLUSION From current best evidence about prognostic factors in back pain and effective treatments for back pain, research and clinical experts developed a ready-to-use structured program - GLA:D® Back - to support self-management for people with persistent/recurrent back pain.
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Affiliation(s)
- Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Applied Health Services, University College Lillebaelt, Niels Bohrs Alle 1, 5230 Odense M, Denmark
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
| | - Inge Ris
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Allan Abbott
- Department of Medical and Health Sciences, Division of Physiotherapy, Faculty of Health Sciences, Sandbäcksgatan 7/3, University Hospital Campus, Linköping University, 581 83 Linköping, Sweden
| | | | - Ewa M. Roos
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, 4200 Slagelse, Denmark
| | - Tonny Elmose Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230 Odense M, Denmark
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Martinez-Calderon J, Meeus M, Struyf F, Luque-Suarez A. The role of self-efficacy in pain intensity, function, psychological factors, health behaviors, and quality of life in people with rheumatoid arthritis: A systematic review. Physiother Theory Pract 2018; 36:21-37. [PMID: 29873569 DOI: 10.1080/09593985.2018.1482512] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: The aim of this study was to systematically review and critically appraise the role of self-efficacy in pain intensity, function, psychological factors, health behaviors, and quality of life in people with rheumatoid arthritis, based on the analyses of longitudinal studies. Methods: An electronic search of PubMed, AMED, CINAHL, PsycINFO, and PubPsych was carried out from inception to July 2017. Study selection was based on longitudinal studies which have explored the role of self-efficacy in rheumatoid arthritis. The Newcastle-Ottawa Scale adapted version was used to evaluate the risk of bias, whereas the Grading of Recommendations Assessment, Development and Evaluation evaluated the quality of the evidence per outcome. Results: A total of 11 articles met the inclusion criteria. Our results suggest an association between higher self-efficacy and greater goal achievement, positive affect, acceptance of illness, problem-solving coping, physical function, physical activity participation, and quality of life. Inversely, there was also an association between higher self-efficacy and lower pain intensity, depressive symptoms, and anxiety. Conclusions: The findings of this systematic review suggest that self-efficacy might have a positive effect on the prognosis of this condition, although further longitudinal studies are needed.
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Affiliation(s)
| | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Rehabilitation Sciences and Physiotherapy Department, Ghent University, Ghent, Belgium
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium
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de Thurah A, Esbensen BA, Roelsgaard IK, Frandsen TF, Primdahl J. Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis. RMD Open 2017; 3:e000481. [PMID: 28879053 PMCID: PMC5574437 DOI: 10.1136/rmdopen-2017-000481] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/28/2017] [Accepted: 07/04/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To compare the efficacy of embedded nurse-led versus conventional physician-led follow-up on disease activity in patients with rheumatoid arthritis (RA). METHODS In a systematic literature search, we identified randomised controlled trials (RCTs) reporting on the efficacy of nurse-led follow-up on disease control in patients with RA compared with physician-led follow-up. Primary outcome was disease activity indicated by Disease Activity Score (DAS)-28. Secondary outcomes were: patient satisfaction, physical disability, fatigue, self-efficacy and quality of life. Outcomes were assessed after 1-year and 2 year follow-ups. RESULTS Seven studies representing five RCTs, including a total of 723 participants, were included. All but one study included stable patients in low disease activity or remission at baseline. No difference in DAS-28 was found after 1 year (mean difference (MD) -0.07 (95% CI -0.23 to 0.09)). After 2 years, a statistically significant difference was seen in favour of nurse-led follow-up (MD -0.28 (95% CI -0.53 to -0.04)). However, the difference did not reach a clinically relevant level. No difference was found in patient satisfaction after 1 year (standard mean difference (SMD) -0.17 (95 % CI -1.0 to 0.67), whereas a statistical significant difference in favour of nurse-led follow-up was seen after 2 years (SMD: 0.6 (95% CI -0.00 to 1.20)). CONCLUSION After 1 year no difference in disease activity, indicated by DAS-28, were found between embedded nurse-led follow-up compared with conventional physician-led follow-up, in RA patients with low disease activity or remission.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ida Kristiane Roelsgaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - Tove Faber Frandsen
- Department of Design and Communication, University of Southern Denmark, Kolding, Denmark
| | - Jette Primdahl
- King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark.,Hospital of Southern Jutland, Aabenraa, Denmark.,Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
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Hewlett S, Nicklin J, Bode C, Carmona L, Dures E, Engelbrecht M, Hagel S, Kirwan J, Molto A, Redondo M, Gossec L. Translating patient reported outcome measures: methodological issues explored using cognitive interviewing with three rheumatoid arthritis measures in six European languages. Rheumatology (Oxford) 2016; 55:1009-16. [PMID: 26912585 DOI: 10.1093/rheumatology/kew011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Cross-cultural translation of patient-reported outcome measures (PROMs) is a lengthy process, often performed professionally. Cognitive interviewing assesses patient comprehension of PROMs. The objective was to evaluate the usefulness of cognitive interviewing to assess translations and compare professional (full) with non-professional (simplified) translation processes. METHODS A full protocol used for the Bristol RA Fatigue Multi-dimensional Questionnaire and Numerical Rating Scale (BRAF-MDQ, BRAF-NRS) was compared with a simplified protocol used for the RA Impact of Disease scale (RAID). RA patients in the UK, France, the Netherlands, Germany, Spain and Sweden completed the PROMs during cognitive interviewing (BRAFs in the UK were omitted as these were performed during development). Transcripts were deductively analysed for understanding, information retrieval, judgement and response options. Usefulness of cognitive interviewing was assessed by the nature of problems identified, and translation processes by percentage of consistently problematic items (⩾40% patients per country with similar concerns). RESULTS Sixty patients participated (72% women). For the BRAFs (full protocol) one problematic item was identified (of 23 items × 5 languages, 1/115 = 0.9%). For the RAID (simplified protocol) two problematic items were identified (of 7 items × 6 languages, 2/42 = 4.8%), of which one was revised (Dutch). Coping questions were problematic in both PROMs. CONCLUSION Conceptual and cultural challenges though rare were important, as identified by formal evaluation, demonstrating that cognitive interviewing is crucial in PROM translations. Proportionately fewer problematic items were found for the full than for the simplified translation procedure, suggesting that while both are acceptable, professional PROM translation might be preferable. Coping may be a particularly challenging notion cross-culturally.
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Affiliation(s)
- Sarah Hewlett
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Joanna Nicklin
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Chistina Bode
- Department of Psychology, Health & Technology, University of Twente, Enschede, The Netherlands
| | | | - Emma Dures
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Matthias Engelbrecht
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Germany
| | - Sofia Hagel
- Department of Clinical Sciences, Section of Rheumatology, Lund University and Skane University Hospital, Lund, Sweden
| | - John Kirwan
- Academic Rheumatology, University of Bristol, Bristol, UK
| | - Anna Molto
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS) Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
| | - Marta Redondo
- School of Psychology, Universidad Camilo José Cela, Madrid, Spain
| | - Laure Gossec
- Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d'Epidémiologie et de Santé Publique, GRC-UPMC 08 (EEMOIS) Department of Rheumatology, AP-HP, Pitié Salpêtrière Hospital, Paris, France
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11
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Garratt AM, Løchting I, Smedslund G, Hagen KB. Measurement properties of instruments assessing self-efficacy in patients with rheumatic diseases. Rheumatology (Oxford) 2013; 53:1161-71. [PMID: 24249031 DOI: 10.1093/rheumatology/ket374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The measurement properties of instruments assessing self-efficacy (SE) in patients with rheumatic diseases were reviewed. The consensus-based standards for the selection of health measurement instruments (COSMIN) checklist was applied following systematic searches of seven electronic databases from 1989 to December 2011. Fifteen articles met the inclusion criteria that included the arthritis SE scales (ASES), generalized SE scale (GSES), joint protection SE scale (JP-SES), Marcus & Resnick SE exercise behaviour (SEEB) instruments, and RA SE scale (RASE). The ASES and RASE have undergone more than one evaluation. There was little formal evaluation of content validity for the instruments. Evidence for the RASE suggests that it is not unidimensional. The JP-SES and SEEB were evaluated using modern psychometric methods. The instruments require further evaluation before application. The quality of the evidence for the ASES and RASE is generally poor. The generic focus of the GSES limits its relevance. The JP-SES and SEEB have only undergone one evaluation and that relating to the latter was narrow in scope. Future studies should address these methodological weaknesses.
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Affiliation(s)
- Andrew M Garratt
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ida Løchting
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Smedslund
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kåre B Hagen
- National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.National Resource Centre for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Norwegian Knowledge Centre for the Health Services, Communication and Research Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital and Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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12
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Primdahl J, Sørensen J, Horn HC, Petersen R, Hørslev-Petersen K. Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity--patient outcomes from a 2-year, randomised controlled trial. Ann Rheum Dis 2013; 73:357-64. [PMID: 23385306 DOI: 10.1136/annrheumdis-2012-202695] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare patient outcomes of three regimes of follow-up care for rheumatoid arthritis (RA) outpatients with low disease activity. METHODS RA outpatients (n=287) with Disease Activity Score (DAS28-CRP)<3.2 and Health Assessment Questionnaire<2.5 from two Danish rheumatology clinics were randomised to 2-year follow-up by either: (1) planned rheumatologist consultations, (2) shared care without planned consultations or (3) planned nursing consultations. The primary outcome was change in disease activity. DAS28-CRP, Health Assessment Questionnaire, visual analogue scale (VAS)-pain, fatigue, global health, confidence and satisfaction, quality-of-life by the Short Form 12 and self-efficacy measured by the RA Self-Efficacy questionnaire and the Arthritis Self-Efficacy Scale, were recorded annually and safety measures were recorded. x-Rays of hands and feet were taken at baseline and at 2-year follow-up. Mixed effect models were used to explore differences between the three groups over time. RESULTS At 2-year follow-up, the group allocated to nursing consultations had lower disease activity than the group that underwent rheumatologist consultations (DAS28-CRP -0.3, p=0.049). The nursing group increased their self-efficacy (Arthritis Self-Efficacy Scale 18.8, p=0.001), confidence (10.7, p=0.001) and satisfaction (10.8, p<0.001) compared with the rheumatologist group. The shared care group reported a transient lower satisfaction compared with the rheumatologist group after 1 year (-8.8, p=0.004). No statistically significant differences were seen in other outcome variables. CONCLUSIONS It is safe to implement shared care and nursing consultations as alternatives to rheumatologist consultations for RA outpatients with low disease activity without deterioration in disease control. Nursing consultations can enhance patients' self-efficacy, confidence and satisfaction.
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Affiliation(s)
- Jette Primdahl
- Institute for Regional Health Research, University of Southern Denmark, , Odense Denmark
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13
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Lee HY, Hale CA, Hemingway B, Woolridge MW. Tai Chi exercise and auricular acupressure for people with rheumatoid arthritis: an evaluation study. J Clin Nurs 2012; 21:2812-22. [PMID: 22830622 DOI: 10.1111/j.1365-2702.2011.04058.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES (i) To assess the effectiveness of Tai Chi exercise in people with rheumatoid arthritis (RA). (ii) To ascertain if Tai Chi and auricular acupressure have a potentiation effect in controlling pain. (iii) To evaluate the acceptability and enjoyment of the classes. BACKGROUND Tai Chi has been suggested as a suitable exercise for people with arthritis and specific programmes have been developed. Auricular acupressure is a therapeutic method by which points on the ear are stimulated to treat various disorders. DESIGN A pragmatic non-randomised before/after study to compare the effects of the interventions. METHODS People with RA (n=21) were recruited and allocated into two groups. Both groups followed a Tai Chi exercise programme, twice a week for 12 weeks, but one group (n=14) had, in addition, the auricular acupressure. Physical symptoms and function, pain, quality of life and self-efficacy were measured in both groups before and after the programme. Acceptability and enjoyment were assessed at the end. RESULTS At 12 weeks, both groups had achieved statistically significant improvements in balance, grip strength, pinch strength, 50 foot walk time self reported joint pain, swollen joint count, tender joint count and in self efficacy in relation to pain control. All participants stated that they enjoyed the classes. There was no evidence to suggest that the auricular acupressure enhanced the effects of the Tai Chi intervention. CONCLUSION The classes appeared to be mentally as well as physically helpful to participants. RELEVANCE TO CLINICAL PRACTICE People with a chronic debilitating disease such as RA should be encouraged to undertake gentle strengthening exercise such as Tai Chi because of its potential for physical and psychological improvements.
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Affiliation(s)
- Hea-Young Lee
- Nursing Policy Research Institute, Korean Nurse Association, Seoul, Korea
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14
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Brady TJ. Measures of self-efficacy: Arthritis Self-Efficacy Scale (ASES), Arthritis Self-Efficacy Scale-8 Item (ASES-8), Children's Arthritis Self-Efficacy Scale (CASE), Chronic Disease Self-Efficacy Scale (CDSES), Parent's Arthritis Self-Efficacy Scale (PASE), and Rheumatoid Arthritis Self-Efficacy Scale (RASE). Arthritis Care Res (Hoboken) 2012; 63 Suppl 11:S473-85. [PMID: 22588769 DOI: 10.1002/acr.20567] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Teresa J Brady
- Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
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15
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Primdahl J, Wagner L, Holst R, Hørslev-Petersen K. The impact on self-efficacy of different types of follow-up care and disease status in patients with rheumatoid arthritis--a randomized trial. PATIENT EDUCATION AND COUNSELING 2012; 88:121-128. [PMID: 22386009 DOI: 10.1016/j.pec.2012.01.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 01/27/2012] [Accepted: 01/28/2012] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To explore the impact from different types of outpatient care, demographic and disease related variables on self-efficacy beliefs (SE) in patients with established rheumatoid arthritis (RA) after completing an educational program. METHODS 287 adult RA outpatients with low disease activity and moderate physical disability from two Danish rheumatology clinics were randomized for follow-up care. (1) planned rheumatologist's consultations, (2) a shared care model without planned consultations, (3) planned nursing consultations. The participants' SE were assessed by the Danish versions of the rheumatoid arthritis self-efficacy questionnaire (RASE) and the arthritis self-efficacy scale (ASES). Data were collected at baseline, 3 months and one-year follow up and were explored in random intercept models. RESULTS Following an educational programme the nursing group increased or stabilized their SE during the first year compared to the medical and the shared care group. SE in the shared care group did not differ significantly from the medical group. No difference between the groups was seen in disease activity at any time. CONCLUSION Nursing consultations provide opportunities for maintenance of the patients' SE after patient education. PRACTICE IMPLICATIONS Implementation of nursing consultations as part of follow-up care in patients with stable RA is recommended.
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Affiliation(s)
- Jette Primdahl
- Institute for Regional Health Research, University of Southern Denmark, Odense C, Denmark.
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16
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Primdahl J, Wagner L, Hørslev-Petersen K. Self-efficacy as an outcome measure and its association with physical disease-related variables in persons with rheumatoid arthritis: a literature review. Musculoskeletal Care 2011; 9:125-40. [PMID: 21661092 DOI: 10.1002/msc.210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies have demonstrated a positive impact of patient education on self-efficacy in persons with rheumatoid arthritis (RA). However, the relationship between self-efficacy, physical disease-related variables and educational interventions has not yet been reviewed. AIM The aims of this study, in relation to persons with RA, were: 1) to provide an overview of the existing research into the association between self-efficacy and physical disease-related variables and, with this knowledge, 2) to provide an overview of the existing research on the effect of different types of educational interventions on self-efficacy. METHOD A systematic literature search was performed using eight databases, based on the terms 'rheumatoid arthritis' AND 'self-efficacy'. In total, 74 studies reporting associations between self-efficacy and physical disease-related variables and using self-efficacy as an outcome measure in educational interventions were included. RESULTS The scores obtained by the most commonly used questionnaire, the Arthritis Self-Efficacy Scale (ASES), was highly associated with physical disability, pain, fatigue and disease duration. If educational activities had a positive impact on self-efficacy, disease-related variables usually improved as well. Evidence is scarce as to whether disease-related variables affect patients' self-efficacy or vice versa and whether individual consultations can affect patients' self-efficacy. CONCLUSION The scores attained by the ASES is highly associated with physical disease-related variables. This relationship requires further research using a specific study design to restrict bias when evaluating the impact of interventions on self-efficacy in persons with RA. Research is needed on whether individual consultations can affect patients' self-efficacy. Disease-related variables do not affect the Rheumatoid Arthritis Self-Efficacy (RASE) questionnaire but this needs further exploration.
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Affiliation(s)
- J Primdahl
- Institute of Regional Health Services Research, University of Southern Denmark, Odense C, Denmark and King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark.
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17
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Primdahl J, Wagner L, Hørslev-Petersen K. Being an outpatient with rheumatoid arthritis--a focus group study on patients' self-efficacy and experiences from participation in a short course and one of three different outpatient settings. Scand J Caring Sci 2010; 25:394-403. [PMID: 21175732 DOI: 10.1111/j.1471-6712.2010.00854.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND A Danish study compared three different outpatient settings for persons with rheumatoid arthritis (RA). All participants completed a short course before random allocation to one of three groups. A third of the patients continued with planned medical consultations. A third was allocated to a shared care setting with no planned consultations. The final third was allocated for planned nursing consultations every 3 months. Little knowledge exists of patients' experiences at different outpatient settings. AIMS (1) To explore the patients' experiences of participation in the course and one of the three different outpatient settings and (2) to explore whether some of these experiences can explain possible changes in self-efficacy beliefs. METHOD In total six focus group interviews were carried out with 33 participants from the three settings. The interviews and the analysis were inspired by phenomenological philosophy. RESULTS On the short course the participants felt understood, gained new insights and some changed behaviours after attendance. Important themes in experiences from the three outpatient settings were: (1) continuity and relationships with health professionals, (2) a need for others to take control, and (3) contact with health professionals. SPECIFIC FINDINGS: The nursing consultations were experienced as less factual and less authoritarian than the medical consultations. The participants in the shared care setting had a lack of confidence in the GP's competence to manage their RA. However, they felt responsible for taking action in case of a flare up. The study provided opportunities to enhance the participants' self-efficacy beliefs. CONCLUSION When planning follow-up care, the focus needs to be on continuity, the interpersonal relationship and easy access to health professionals with thorough knowledge of RA. A short course and consultations with nurses and hospital doctors can enhance patients' self-efficacy and thereby strengthen their confidence to assess and manage their own disease.
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Affiliation(s)
- Jette Primdahl
- King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark.
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