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Evaluation of a multidisciplinary care model to improve quality of life in rheumatoid arthritis: a randomised controlled trial. Qual Life Res 2021; 31:1749-1759. [PMID: 34741249 DOI: 10.1007/s11136-021-03029-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Health-Related Quality of Life (HR-QOL) is an important patient-reported domain in patients with rheumatoid arthritis (RA). The uptake of multidisciplinary team (MDT) care in RA is generally low, due to initial high demand for resources. We hypothesised that whilst pharmacological treatments are effective in controlling disease activity, a multipronged intervention in an MDT may have a positive impact on HR-QOL. METHODS This was a single-centre randomized parallel group, single-blind controlled trial of MDT vs. usual care in an established RA clinic. Data were collected through face-to-face questionnaires, medical records review, and joint counts by a blinded assessor at 0, 3 and 6 months. Adult RA patients were randomly assigned in a single visit to a 6-member MDT (rheumatologist, nurse, social worker, physiotherapist, occupational therapist, and podiatrist) or usual care. MDT providers prescribed medications and counselled patients on managing flares, medication adherence, coping, joint protection, exercise, footwear. The primary outcome was minimal clinically important difference (MCID) in HR-QOL (increase in European QOL-5-Dimension-3-Level, EQ-5D-3L by 0.1) at six months. RESULTS 140 patients (86.3% female, 53.4% Chinese, median (IQR) age 56.6 (46.7, 62.4) years); 70 were randomized to each arm. Median (IQR) disease duration was 5.5 (2.4, 11.0) years and disease activity in 28 joints (DAS28) was 2.87 (2.08, 3.66). 123 patients completed the study. Twenty-six (40.6%) MDT vs. 23 (34.3%) usual care patients achieved an MCID in EQ-5D-3L, OR 1.3 (0.6, 2.7). In multivariable logistic regression, baseline EQ-5D-3L was the only predictor of achieving MCID. There was more disease modifying anti-rheumatic drug escalation in MDT (34.4% vs. 19.4%). Patients with high disease activity were more likely to achieve MCID in the MDT arm. CONCLUSIONS A single visit by stable patients with low disease activity to an MDT failed to achieve MCID in the EQ-5D-3L; however, did achieve small but significant improvements in the EQ-5D-3L, DAS28, pain, coping and self-efficacy. To be sustainable, MDT care should be targeted at patients with high disease activity or those with a new diagnosis of RA. TRIAL REGISTRATION The study is registered on ClinicalTrials.gov, identifier: NCT03099668.
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2
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Duarte C, Santos EJF, Ferreira RJO, Kvien TK, Dougados M, de Wit M, da Silva JAP, Gossec L. Validity and reliability of the EULAR instrument RAID.7 as a tool to assess individual domains of impact of disease in rheumatoid arthritis: a cross-sectional study of 671 patients. RMD Open 2021; 7:rmdopen-2020-001539. [PMID: 33547229 PMCID: PMC7871340 DOI: 10.1136/rmdopen-2020-001539] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/17/2021] [Accepted: 01/22/2021] [Indexed: 12/22/2022] Open
Abstract
Objective The rheumatoid arthritis impact of disease (RAID) questionnaire comprises seven patient-important domains of disease impact (pain, function, fatigue, sleep disturbance, emotional well-being, physical well-being, coping). RAID was validated as a pooled-weighted score. Its seven individual items separately could provide a valuable tool in clinical practice to guide interventions targeting the patient’s experience of the disease. The aim was to separately assess the psychometric properties of each of the seven numeric rating scale (NRS) of the RAID (RAID.7). Material and methods Post hoc analyses of data from the cross-sectional RAID study and from the Rainbow study, an open-label 12-week trial of etanercept in patients with RA. Construct validity of each NRS was assessed cross-sectionally in the RAID data set by Spearman’s correlation with the respective external instrument of reference. Using the rainbow data set, we assessed reliability through intraclass correlation coefficient between the screening and the baseline visits and responsiveness (sensitivity to change) by standardised response mean between baseline and 12 weeks. Results A total of 671 patients with RA with features of established disease were analysed, 563 and 108 from RAID and Rainbow, respectively. The NRS correlated moderately to strongly with the respective external instrument of reference (r=0.62–0.81). Reliability ranged from 0.64 (0.51–0.74) (pain) to 0.83 (0.76–0.88) (sleep disturbance) and responsiveness from 0.93 (0.73–1.13) (sleep disturbance) to 1.34 (1.01–1.64) (pain). Conclusion The separate use of the individual NRS of RAID (RAID.7) is valid, feasible, reliable and sensitive to change, representing an opportunity to improve the assessment and treatment of disease impact with minimal questionnaire burden. Trial registration number NCT00768053.
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Affiliation(s)
- Catia Duarte
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal .,iCBR-Coimbra Institute for Clinical and Biomedical Research, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Eduardo José Ferreira Santos
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Ricardo J O Ferreira
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Health Sciences Research Unit Nursing, Higher School of Nursing of Coimbra, Coimbra, Coimbra, Portugal
| | - Tore K Kvien
- Rheumatology Department, Diakonhjemmet Hospital, Oslo, Norway
| | - Maxime Dougados
- Université de Paris, Paris, France.,Rheumatology Department, Hôpital Cochin, AP-HP, Paris, France.,INSERM (U1153): Clinical Epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, France
| | - Maarten de Wit
- Patient Research Partner, EULAR, Amsterdam, The Netherlands
| | - Jose Antonio Pereira da Silva
- Rheumatology Department, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,iCBR-Coimbra Institute for Clinical and Biomedical Research, University of Coimbra Faculty of Medicine, Coimbra, Portugal
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France.,Rheumatology Department, Hopital Universitaire Pitie Salpetriere, AP-HP, Paris, France
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Kim J, Kim J, Han A. Leisure-time physical activity, coping and life satisfaction among Korean individuals with physical disabilities. Health Promot Int 2021; 36:774-783. [PMID: 33063107 DOI: 10.1093/heapro/daaa080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A few studies explored the relationships among leisure-time physical activity (LTPA), coping, and life satisfaction among individuals with physical disabilities. This study aims to investigate how LPTA contributes to coping and life satisfaction among Korean individuals with physical disabilities. Using a purposive sampling strategy, a total of 351 people with physical disabilities participated in this study. The results of this study find that participation in LTPA leads to the development of active coping strategies that contribute to increased life satisfaction. This study suggests that encouraging LTPA participation can be a critical task to healthcare providers working with individuals with physical disabilities.
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Affiliation(s)
- Junhyoung Kim
- Department of Health and Wellness Design, School of Public Health, Indiana University, 1025 E. Seventh Street, Bloomington, IN 47405, USA
| | - Jaehyun Kim
- Department of Recreation and Leisure Studies, State University of New York, College at Brockport, 350 New Campus Drive Brockport, NY 14420, USA
| | - Areum Han
- Research Professor, Korea University Center for Curriculum and Institute of Studies, Korea University, 145 Anam-ro, Seongbuk-gu, Seoul, South Korea
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Ubaka CM, Ibe OG, Amorha KC, Isah A, Okonta MJ. Medication adherence among Nigerian patients with rheumatoid arthritis: a two instruments survey. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objectives
Medication adherence is still a significant problem in chronic diseases management and rheumatoid arthritis (RA) is not an exception. There is very little information regarding the level and influencing factors of medication adherence among Nigerian patients with RA. This study evaluated the level and determinants of medication adherence among patients with RA in a Nigerian referral hospital.
Methods
Using a questionnaire based cross sectional survey, 169 patients with RA were evaluated for their medication adherence using two validated instruments namely; five-item Medication Adherence Report Scale and five-item Compliance Questionnaire for Rheumatology. The two instruments were subjected to descriptive (mean and frequencies) and mean difference (chi-square, t-test, Pearson correlation) analysis, and their reliability (Cronbach alpha) in a Nigerian setting was also established.
Key findings
The level of non-adherence reported in this study was high and ranged from 48.5% for the CQR to 63.9% for the Medication Adherence Report Scale questionnaires respectively. Being of a male gender, of an older age, the higher number of pills taken, better education and the duration of the disease all significantly contributed to higher adherence measures among these RA patients (P <0.05 for all). Both questionnaires used were correlated and reliable for use among patients with rheumatoid arthritis in Nigeria.
Conclusion
Findings from this study show that non adherence to medications among RA patients were high and factors such age, gender, education, pill burden could have been responsible.
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Affiliation(s)
- Chukwuemeka M Ubaka
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ozulonye G Ibe
- Department of Pharmacy, National Orthopedic Hospital, Thinkers Corner, Enugu, Nigeria
| | - Kosisochi C Amorha
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Abdulmuminu Isah
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Mathew J Okonta
- Department of Clinical Pharmacy and Pharmacy Management University of Nigeria, Nsukka, Enugu, Nigeria
- Pharmacy Practice and Pharmaceutical Care Research Group, University of Nigeria, Nsukka, Enugu, Nigeria
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Germain V, Scherlinger M, Barnetche T, Pichon C, Balageas A, Lequen L, Shipley E, Foret J, Dublanc S, Capuron L, Schaeverbeke T. Role of stress in the development of rheumatoid arthritis: a case-control study. Rheumatology (Oxford) 2021; 60:629-637. [PMID: 32533144 DOI: 10.1093/rheumatology/keaa216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/07/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to assess the stressful life events preceding the onset of symptoms in RA. The secondary objectives were to assess how early RA patients perceive stress and cope with stressors. METHODS A case-control study was performed, comparing patients recently diagnosed with RA to age- and gender-matched control subjects recently hospitalized for an unplanned surgical procedure not known to be influenced by stress. The Social Readjustment Rating Scale assessed the cumulative stress induced by stressful life events in the year preceding the onset of symptoms. Coping strategies, stress and anxiety symptoms were evaluated using validated psychological scales. RESULTS Seventy-six subjects were included in each group. The mean Social Readjustment Rating Scale score was twice as high in cases compared with controls [respectively, 167.0 (172.5) vs 83.3 (124.4), P < 0.001]. The association between cumulative stress and RA was statistically significant only in women, with a dose-dependent association between stress and RA. While female patients with RA attributed more often the onset of symptoms to a life event than female controls (70.2 vs 24.5%, P < 0.001), no significant difference was found when comparing male RA patients with male controls (26.9 vs 18.5%, respectively, P = 0.46). Increased perceived stress score (P = 0.04) and coping based on emotions (P = 0.001) were found in cases compared with controls. CONCLUSION Patients with early RA reported more life events in the year preceding the onset of symptoms than controls. Gender specificities were found with a significant association between cumulative stress and RA only in women.
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Affiliation(s)
- Vincent Germain
- Service de Rhumatologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Marc Scherlinger
- Service de Rhumatologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
| | - Thomas Barnetche
- Service de Rhumatologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Clémence Pichon
- Centre Hospitalier de Pau, Service de Rhumatologie, Pau, France
| | | | - Laurence Lequen
- Centre Hospitalier de Pau, Service de Rhumatologie, Pau, France
| | - Emilie Shipley
- Centre Hospitalier de Dax, Service de Rhumatologie, Dax, France
| | - Jennifer Foret
- Centre Hospitalier de Dax, Service de Rhumatologie, Dax, France
| | - Stéphanie Dublanc
- Centre Hospitalier de Libourne, Service de Rhumatologie, Libourne, France
| | - Lucile Capuron
- Université de Bordeaux, Bordeaux, France.,Laboratoire de Nutrition et Neurobiologie Intégrée (NutriNeuro), UMR 1286, INRA, Université de Bordeaux, Bordeaux, France
| | - Thierry Schaeverbeke
- Service de Rhumatologie, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Université de Bordeaux, Bordeaux, France
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Braun J, Krause D, Kiltz U. The efficacy of a nurse-led interventional program to improve the health of patients with axial spondyloarthritis. Rheumatology (Oxford) 2021; 60:487-488. [PMID: 33244586 DOI: 10.1093/rheumatology/keaa639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/03/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jürgen Braun
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Dietmar Krause
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Ruhr University Bochum, Herne, Germany
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Kim J, Han A, Piatt JA, Kim J. Investigating relationships among coping, personal growth, and life satisfaction among individuals with physical disabilities. Health Promot Perspect 2020; 10:401-408. [PMID: 33312936 PMCID: PMC7723005 DOI: 10.34172/hpp.2020.59] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/17/2020] [Indexed: 12/30/2022] Open
Abstract
Background: It is well-documented that active coping strategies can lead to better positive adjustment and psycho-social outcomes among individuals with disabilities and illnesses. However, little information exists related to exploring how coping is related to health benefits such as personal growth and life satisfaction in an international context. Thus, this study examined how the use of coping strategies is associated with personal growth and life satisfaction among individuals with physical disabilities in non-Western settings. Methods: In this cross-sectional study, we employed a nonprobability methodology, purposivesampling, to recruit 351 participants who adults over the age of 18 living with a physicaldisability and currently enrolled in the Korean Disability Association. A hierarchical linearregression analysis was conducted to determine which types of coping strategies predictedpersonal growth and life satisfaction, while controlling for the effects of the demographicvariables (i.e., gender and age). Results: With regard to personal growth, problem-solving coping strategy (β = 0.663, P < 0.001,95% CI [0.51, 0.70]) was the strongest predictor, followed by avoidance coping strategy(β = -0.263, P < 0.001, 95% CI [-0.37, -0.20]). As for life satisfaction, problem-solving copingstrategy (β = 0.268, P < 0.001, 95% CI [0.18, 0.70]) was the strongest predictor, followed bysocial support seeking coping strategy (β = 0.264, P < 0.001, 95% CI [-0.19, 0.10]). Conclusion: Our study suggests that problem-focused and social support coping strategies playimportant roles in improving the personal growth and life satisfaction among Korean individualswith physical disabilities. This study provides implications for health professionals seeking waysto facilitate the personal growth and enhance the life satisfaction of individuals with physicaldisabilities.
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Affiliation(s)
- Junhyoung Kim
- School of Public Health, Indiana University Bloomington, IN, USA
| | - Areum Han
- Center for Curriculum and Institute of Studies, Korea University, Seoul, South Korea
| | | | - Jaehyun Kim
- Department of Recreation, Therapeutic Recreation, and Tourism, State University of New York, College at Brockport, NY, USA
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Frydenberg E. Coping research: Historical background, links with emotion, and new research directions on adaptive processes. AUSTRALIAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1111/ajpy.12051] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Erica Frydenberg
- Education, University of Melbourne, Melbourne, Victoria, Australia,
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9
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Wang T, Zhou Y, Fu J, Chen M, Luo Y. Level of depression, anxiety and stress in patients with intrauterine adhesions in Hunan Province, China: A cross-sectional study. PLoS One 2020; 15:e0229832. [PMID: 32160227 PMCID: PMC7065792 DOI: 10.1371/journal.pone.0229832] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 02/14/2020] [Indexed: 11/24/2022] Open
Abstract
Background The incidence of intrauterine adhesions has been increasing in recent years, seriously affecting women’s health. This study aimed to investigate the psychological status and identify risk factors associated with high psychological distress in patients with intrauterine adhesions. Methods A cross-sectional study was conducted in Hunan Province, China. A total of 258 patients who presented with intrauterine adhesions between February and May 2018 were included. Data were collected by a questionnaire packet that included the Depression Anxiety Stress Scale, the Medical Coping Mode Questionnaire, and demographic and clinical information. Descriptive statistics, t-tests, one-way ANOVA, Pearson’s correlations and multiple linear stepwise regression were employed in this study. Results Among 258 participants, the detection rates of mild depression and moderate to extremely severe depression were 10.1% and 10.5%, respectively; the detection rates of mild anxiety and moderate to extremely severe anxiety were 11.2% and 20.2%, respectively; the detection rates of mild stress and moderate to extremely severe stress were 9.3% and 10.2%, respectively. Avoidance and resignation coping were positively correlated with the overall scores of general distress which represents the total scores of the Depression Anxiety Stress Scale (r = 0.171, 0.475, P < 0.01). Multiple linear stepwise regression results showed that husband-wife relationships and avoidance and resignation coping strategies were the main factors predicting general distress levels. Conclusions Patients with intrauterine adhesions have psychological distress in a certain extent. Target interventions should be taken to improve the mental health level of patients.
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Affiliation(s)
- Ting Wang
- Departmnt of Nursing, The People’s Hospital of Longhua, Shenzhen, China
- Department of Obstetrics and Gynecology, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Yanhui Zhou
- Department of Obstetrics and Gynecology, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Jingxia Fu
- Department of Obstetrics and Gynecology, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Mingzhu Chen
- Department of Obstetrics and Gynecology, Xiangya Nursing School of Central South University, Changsha, Hunan, China
| | - Yang Luo
- Department of Obstetrics and Gynecology, Xiangya Nursing School of Central South University, Changsha, Hunan, China
- * E-mail:
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Castañeda S, Negrón JB, Baquero JL, Carmona L. Facing arthritis: helping patients to handle their disease and concerns. Expert Rev Clin Immunol 2019; 15:903-905. [PMID: 31423861 DOI: 10.1080/1744666x.2019.1656066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Santos Castañeda
- Department of Rheumatology, Hospital de la Princesa, IIS-Princesa , Madrid , Spain.,UAM-ROCHE, EPID-Future, Universidad Autónoma de Madrid (UAM) , Madrid , Spain
| | - José B Negrón
- Research fellow and psychologist, Instituto de Salud Musculoesquelética , Madrid , Spain
| | - José L Baquero
- Director and scientific coordinator of the Spanish Patients' Forum , Madrid , Spain
| | - Loreto Carmona
- Rheumatologist and Director, Instituto de Salud Musculoesquelética , Madrid , Spain
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New insights into the prevalence of depressive symptoms and depression in rheumatoid arthritis - Implications from the prospective multicenter VADERA II study. PLoS One 2019; 14:e0217412. [PMID: 31136632 PMCID: PMC6538160 DOI: 10.1371/journal.pone.0217412] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/10/2019] [Indexed: 12/29/2022] Open
Abstract
Objectives To investigate the prevalence of depressive symptoms in rheumatoid arthritis (RA) patients using two previously validated questionnaires in a large patient sample, and to evaluate depressive symptoms in the context of clinical characteristics (e.g. remission of disease) and patient-reported impact of disease. Methods In this cross-sectional study, the previously validated Patient Health Questionnaire (PHQ-9) and Beck-Depression Inventory II (BDI-II) were used to assess the extent of depressive symptoms in RA patients. Demographic background, RA disease activity score (DAS28), RA impact of disease (RAID) score, comorbidities, anti-rheumatic therapy and antidepressive treatment, were recorded. Cut-off values for depressive symptomatology were PHQ-9 ≥5 or BDI-II ≥14 for mild depressive symptoms or worse and PHQ-9 ≥ 10 or BDI-II ≥ 20 for moderate depressive symptoms or worse. Prevalence of depressive symptomatology was derived by frequency analysis while factors independently associated with depressive symptomatology were investigated by using multiple logistic regression analyses. Ethics committee approval was obtained, and all patients provided written informed consent before participation. Results In 1004 RA-patients (75.1% female, mean±SD age: 61.0±12.9 years, mean disease duration: 12.2±9.9 years, DAS28 (ESR): 2.5±1.2), the prevalence of depressive symptoms was 55.4% (mild or worse) and 22.8% (moderate or worse). Characteristics independently associated with depressive symptomatology were: age <60 years (OR = 1.78), RAID score >2 (OR = 10.54) and presence of chronic pain (OR = 3.25). Of patients classified as having depressive symptoms, only 11.7% were receiving anti-depressive therapy. Conclusions Mild and moderate depressive symptoms were common in RA patients according to validated tools. In routine clinical practice, screening for depression with corresponding follow-up procedures is as relevant as incorporating these results with patient-reported outcomes (e.g. symptom state), because the mere assessment of clinical disease activity does not sufficiently reflect the prevalence of depressive symptoms. Clinical trial registration number This study is registered in the Deutsches Register Klinischer Studien (DRKS00003231) and ClinicalTrials.gov (NCT02485483).
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Prothero L, Sturt J, de Souza S, Lempp H. Intensive management for moderate rheumatoid arthritis: a qualitative study of patients' and practitioners' views. BMC Rheumatol 2019; 3:12. [PMID: 30976751 PMCID: PMC6437952 DOI: 10.1186/s41927-019-0057-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 02/26/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The TITRATE trial seeks to test whether intensive management is valuable in achieving disease remission in moderately active rheumatoid arthritis. Intensive management is a complex intervention consisting of: 1) 12 x monthly appointments, 2) tailored 'treatment support' based on motivational interviewing techniques, 3) optimised medication (including the opportunity for biologics), 4) provision of a Patient Handbook, and 5) shared treatment planning. This study aims to understand: a) patients' and practitioners' views on the feasibility and acceptability of intensive management, and b) patients' and practitioners' experience of receiving/providing intensive management. METHODS A qualitative study, nested within a randomised controlled trial. Participants were patients (n = 15) in the intensive management arm of the trial and rheumatology practitioners (n = 16) providing the intensive management intervention, from 18/42 clinics across England. Data were collected via semi-structured interviews and analysed using thematic analysis and iterative categorization. RESULTS Monthly appointments were largely acceptable to both groups who cited several treatment benefits (e.g. regular review of medication, practitioners built close relationships with patients). Practitioners were 'fairly confident' using the motivational interviewing techniques. Learning to pace was the most commonly reported self-management technique that patients and healthcare professionals worked on together, followed by gaining control over pain and fatigue. Practitioners liked having the option to offer biologics to patients with moderate RA. Most patients found the optimised medication (following monthly joint assessment) helpful and side-effects experienced were resolved. Variation existed in the extent to which patients engaged with the Patient Handbook and shared treatment planning, with those who did engage doing so in the early stages. CONCLUSIONS Feedback from patient participants about the intensive management intervention was positive. They found increased medication helpful. Continuity of care with the same healthcare professional at regular intensive management sessions, and the treatment support provided, were highly rated. Feedback from practitioners indicated that intensive management training is feasible. Evidence from the interviews showed that some practitioners applied motivational interviewing techniques during standard care appointments and they would like the opportunity to address lifestyle issues with patients.
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Affiliation(s)
- Louise Prothero
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, 57 Waterloo Road, London, SE1 8WA UK
| | - Savia de Souza
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
| | - Heidi Lempp
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King’s College London, 10 Cutcombe Road, Denmark Hill, London, SE5 9RJ UK
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Thakur ER, Sansgiry S, Petersen NJ, Stanley M, Kunik ME, Naik AD, Cully JA. Cognitive and Perceptual Factors, Not Disease Severity, Are Linked with Anxiety in COPD: Results from a Cross-Sectional Study. Int J Behav Med 2018; 25:74-84. [PMID: 28779469 DOI: 10.1007/s12529-017-9663-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Guided by the Transactional Model of Stress and Coping, the purpose of this cross-sectional study was to examine clinical factors-demographics, chronic obstructive pulmonary disease (COPD) severity, cognitive/perceptual variables (appraisal and coping)-and their relationship to clinically elevated symptoms of anxiety in a sample of veterans with COPD. METHOD Participants included a sample of veterans with COPD, with or without comorbid congestive heart failure, and clinically significant symptoms of anxiety (n = 172, mean age = 65.3, SD = 8.1), who previously presented to an outpatient VA setting. Participants completed questionnaires examining COPD severity (respiratory impairment and dyspnea- and fatigue-related quality of life); perceptions of a stressor (COPD illness intrusiveness); perceptions of control (locus of health control, mastery over COPD, self-efficacy); coping strategies (adaptive and maladaptive); and anxiety and depressive symptoms. RESULTS Multivariable linear regressions revealed that anxiety was positively associated with more maladaptive coping and locus of control (attributed to other people), above and beyond disease severity, demographics, and depressive symptoms. CONCLUSION These findings suggest that cognitive and perceptual factors are concurrent with anxiety; however, longitudinal investigations are needed to fully understand this relationship. Future research should also focus on identifying optimal assessment and treatment procedures when evaluating and treating patients with COPD and symptoms of anxiety. TRIAL REGISTRATION NCT01149772.
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Affiliation(s)
- Elyse R Thakur
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness, Research and Education Clinical Center, Houston, TX, USA
| | - Shubhada Sansgiry
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA
- VA South Central Mental Illness, Research and Education Clinical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nancy J Petersen
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Melinda Stanley
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness, Research and Education Clinical Center, Houston, TX, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- VA South Central Mental Illness, Research and Education Clinical Center, Houston, TX, USA
| | - Aanand D Naik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey A Cully
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX, 77030, USA.
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- VA South Central Mental Illness, Research and Education Clinical Center, Houston, TX, USA.
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14
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Ferwerda M, van Beugen S, van Middendorp H, Visser H, Vonkeman H, Creemers M, van Riel P, Kievit W, Evers A. Tailored, Therapist-Guided Internet-Based Cognitive Behavioral Therapy Compared to Care as Usual for Patients With Rheumatoid Arthritis: Economic Evaluation of a Randomized Controlled Trial. J Med Internet Res 2018; 20:e260. [PMID: 30309835 PMCID: PMC6231867 DOI: 10.2196/jmir.9997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/16/2018] [Accepted: 05/08/2018] [Indexed: 12/31/2022] Open
Abstract
Background Internet-based cognitive behavioral therapy can aid patients with rheumatoid arthritis with elevated levels of distress to enhance their quality of life. However, implementation is currently lacking and there is little evidence available on the (cost-) effectiveness of different treatment strategies. Objective Cost-benefit ratios are necessary for informing stakeholders and motivating them to implement effective treatment strategies for improving health-related quality of life (HRQoL) of patients with rheumatoid arthritis. A cost-effectiveness study from a societal perspective was conducted alongside a randomized controlled trial on a tailored, therapist-guided internet-based cognitive behavioral therapy (ICBT) intervention for patients with rheumatoid arthritis with elevated levels of distress as an addition to care as usual (CAU). Methods Data were collected at baseline or preintervention, 6 months or postintervention, and every 3 months thereafter during the 1-year follow-up. Effects were measured in terms of quality-adjusted life years (QALYs) and costs from a societal perspective, including health care sector costs (health care use, medication, and intervention costs), patient travel costs for health care use, and costs associated with loss of labor. Results The intervention improved the quality of life compared with only CAU (Δ QALYs=0.059), but at a higher cost (Δ=€4211). However, this increased cost substantially reduced when medication costs were left out of the equation (Δ=€1863). Of all, 93% (930/1000) of the simulated incremental cost-effectiveness ratios were in the north-east quadrant, indicating a high probability that the intervention was effective in improving HRQoL, but at a greater monetary cost for society compared with only CAU. Conclusions A tailored and guided ICBT intervention as an addition to CAU for patients with rheumatoid arthritis with elevated levels of distress was effective in improving quality of life. Consequently, implementation of ICBT into standard health care for patients with rheumatoid arthritis is recommended. However, further studies on cost reductions in this population are warranted. Trial Registration Nederlands Trial Register NTR2100; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2100 (Archived by WebCite at http://www.webcitation.org/724t9pvr2)
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Affiliation(s)
- Maaike Ferwerda
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Sylvia van Beugen
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
| | - Henk Visser
- Department of Rheumatology, Rijnstate Hospital, Arnhem, Netherlands
| | - Harald Vonkeman
- University of Twente, Enschede, Netherlands.,Arthritis Center Twente, Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marjonne Creemers
- Department of Rheumatology, Jeroen Bosch Hospital, Den Bosch, Netherlands
| | - Piet van Riel
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Andrea Evers
- Health, Medical and Neuropsychology Department, Institute of Psychology, Leiden University, Leiden, Netherlands.,Medical Psychology Department, Radboud University Medical Center, Nijmegen, Netherlands
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15
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The Relationship Between Religious Coping and Depression in Iranian Patients with Cancer. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2017. [DOI: 10.5812/ijcm.7810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Flurey CA, Hewlett S, Rodham K, White A, Noddings R, Kirwan JR. "You Obviously Just Have to Put on a Brave Face": A Qualitative Study of the Experiences and Coping Styles of Men With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 69:330-337. [PMID: 27273926 PMCID: PMC5347839 DOI: 10.1002/acr.22951] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 04/04/2016] [Accepted: 05/31/2016] [Indexed: 11/30/2022]
Abstract
Objective To explore the experiences, coping styles, and support preferences of male rheumatoid arthritis (RA) patients. Methods Six focus groups comprised 22 men with RA. Transcripts were analyzed using inductive thematic analysis. Results Three overarching themes describe the experiences, coping styles, and support preferences of men with RA. In “challenges to masculinity,” the men described a “reduction in strength and abilities,” which can lead to loss of independence, “challenges to masculine identity and role,” and “loss of power and control.” Coping by “getting through life with RA” meant dealing with RA by “just getting on with it,” “information seeking,” engaging in “destructive behaviors,” and “withdrawing socially.” Preferred “sources of support” tended not to include friends, as they were perceived to lack understanding or support. For acceptable support the men reported a preference for information‐giving sessions rather than a discussion group, but there was no agreement on whether these should be mixed‐sex or men only, or who should run the sessions. Conclusion Male patients reported a range of coping styles and support preferences to address their experiences of living with RA, many of which may not be shared with women. Further research is needed to investigate whether these findings exist in a larger sample and whether the support preferences of men with RA are broadly different from those of women with RA to decide whether there is a clinical need to design a service for the potentially different needs of men.
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Affiliation(s)
| | | | - Karen Rodham
- Staffordshire University, Stoke‐on‐KentStaffordshireUK
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17
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Dhingra L, Schiller R, Teets R, Nosal S, Rodriguez S, Cruciani G, Barrett M, Ginzburg R, Ahmed E, Wasser T, Chen J, Shuman S, Crump C, Portenoy R. Race and Ethnicity Do Not Clinically Associate with Quality of Life Among Patients with Chronic Severe Pain in a Federally Qualified Health Center. PAIN MEDICINE 2017; 19:1408-1418. [DOI: 10.1093/pm/pnx040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, New York
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Robert Schiller
- The Institute for Family Health, New York, NY
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Raymond Teets
- The Institute for Family Health, New York, NY
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Nosal
- The Institute for Family Health, New York, NY
| | - Sandra Rodriguez
- MJHS Institute for Innovation in Palliative Care, New York, New York
| | - Gabriel Cruciani
- MJHS Institute for Innovation in Palliative Care, New York, New York
| | - Malcolm Barrett
- MJHS Institute for Innovation in Palliative Care, New York, New York
| | - Regina Ginzburg
- The Institute for Family Health, New York, NY
- Department of Clinical Health Professions, St. John’s University, Queens, New York
| | - Ebtesam Ahmed
- MJHS Institute for Innovation in Palliative Care, New York, New York
- Department of Clinical Health Professions, St. John’s University, Queens, New York
| | - Thomas Wasser
- Consult-Stat: Complete Statistical Services, Macungie, Pennsylvania
| | - Jack Chen
- MJHS Institute for Innovation in Palliative Care, New York, New York
| | | | - Casey Crump
- The Institute for Family Health, New York, NY
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Russell Portenoy
- MJHS Institute for Innovation in Palliative Care, New York, New York
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
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18
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Andersson ML, Forslind K, Hafström I. Patients with Early Rheumatoid Arthritis in the 2000s Have Equal Disability and Pain Despite Less Disease Activity Compared with the 1990s: Data from the BARFOT Study over 8 Years. J Rheumatol 2017; 44:723-731. [DOI: 10.3899/jrheum.161235] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/22/2022]
Abstract
Objective.To compare outcomes over the first 8 years in patients with early rheumatoid arthritis (RA) recruited in the 1990s and the 2000s, with a special focus on functional disability and its possible predictors.Methods.Data were acquired from 1938 patients with early RA (American College of Rheumatology 1987 criteria) included in the BARFOT study, who had completed the 8-year followup. The patients were divided into 2 cohorts: cohort 1 (n = 928, 68% women) included from 1992 to 1999 and cohort 2 (n = 1010, 70% women) included from 2000 to 2006. Health Assessment Questionnaire (HAQ), 28-joint Disease Activity Score (DAS28), visual analog scale pain, and radiographs of hands and feet scored by the van der Heijde modified Sharp method were assessed during the 8 years. Longitudinal data analyses were performed using a generalized linear model.Results.Despite more active medical treatment during the 2000s, the courses of HAQ and pain showed no difference between the cohorts during followup, in either women or in men, with significantly higher levels in women compared with men. However, as expected, disease activity decreased more over time in cohort 2 compared with cohort 1, for both sexes, and women in cohort 2 had less radiographic progression compared with cohort 1. HAQ was associated with DAS28, pain, radiological scores, and sex in both cohorts, and in cohort 2 also with age and smoking.Conclusion.Patients included in the 2000s had lower disease activity, but not less activity limitation and pain over 8 years of followup despite more active treatment. Pain, aging, and smoking might explain why patients included in the 2000s still had the same disability levels as those included in the 1990s.
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19
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Kuusalo L, Puolakka K, Kautiainen H, Karjalainen A, Malmi T, Yli-Kerttula T, Leirisalo-Repo M, Rantalaiho V. Patient-reported outcomes as predictors of remission in early rheumatoid arthritis patients treated with tight control treat-to-target approach. Rheumatol Int 2017; 37:825-830. [PMID: 28289873 DOI: 10.1007/s00296-017-3692-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 02/28/2017] [Indexed: 11/29/2022]
Abstract
Identifying prognostic factors for remission in early rheumatoid arthritis (ERA) patients is of key clinical importance. We studied patient-reported outcomes (PROs) as predictors of remission in a clinical trial. We randomized 99 untreated ERA patients to receive remission-targeted treatment with three disease-modifying antirheumatic drugs and prednisolone for 24 months, and infliximab or placebo for the initial 6 months. At baseline, we measured following PROs: eight Short Form 36 questionnaire (SF-36) dimensions, patient's global assessment [PGA, visual analogue scale (VAS)], Health Assessment Questionnaire (HAQ), and pain VAS. We used multivariable-adjusted regression models to identify PROs that independently predicted modified American College of Rheumatology remission at 2 years. Follow-up data at 2 years were available for 93 patients (92%), and 58 patients (62%) were in remission. At baseline, patients who achieved remission had higher radiological score (p = 0.04), lower tender joint count (p = 0.001), lower PGA (p = 0.005) and physician's global assessment (p = 0.019), lower HAQ (p = 0.016), less morning stiffness (p = 0.009), and significantly higher scores in seven out of eight SF-36 dimensions compared with patients who did not. In multivariable models that included all PROs, remission was associated with SF-36 dimensions higher vitality (odds ratio 2.01; 95% confidence interval 1.19-3.39) and better emotional role functioning (odds ratio 1.64; 95% confidence interval 1.01-2.68). PGA, pain VAS, HAQ, and other SF-36 dimensions were not associated with remission. We conclude that self-reported vitality and better emotional role functioning are among the most important PROs for the prediction of remission in ERA.
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Affiliation(s)
- Laura Kuusalo
- Department of Internal Medicine, University of Turku and Turku University Hospital, Kiinanmyllynkatu 4-6, PO BOX 52, 20521, Turku, Finland.
| | - Kari Puolakka
- South-Karelia Central Hospital, Valto Käkelän katu 1, 53130, Lappeenranta, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, P.O. Box 20, 00014, Helsinki, Finland.,Unit of Primary Health Care, Kuopio University Hospital, KYS, P.O. Box 100, 70029, Kuopio, Finland
| | - Anna Karjalainen
- Department of Medicine, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland
| | - Timo Malmi
- Seinäjoki Central Hospital, Hanneksenrinne 7, 60220, Seinäjoki, Finland
| | | | - Marjatta Leirisalo-Repo
- Rheumatology, University of Helsinki and Helsinki University Hospital, HUS, P.O. Box 372, 00029, Helsinki, Finland
| | - Vappu Rantalaiho
- Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, P.O. Box 2000, 33521, Tampere, Finland.,School of Medicine, University of Tampere, 33014, Tampere, Finland
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20
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Walter MJM, Van't Spijker A, Pasma A, Hazes JMW, Luime JJ. Focus group interviews reveal reasons for differences in the perception of disease activity in rheumatoid arthritis. Qual Life Res 2017. [PMID: 27444780 DOI: 10.1007/s11136-016-1369-4)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2023]
Abstract
OBJECTIVE Doctors frequently see patients who have difficulties coping with their disease and rate their disease activity high, despite the fact that according to the doctors, the disease activity is low. This study explored the patients' perspectives on this discordance that may help to understand why for some patients, usual care seems to be insufficient. METHODS In our qualitative study we conducted focus group interviews where questions were used as a guideline. Transcripts were analyzed using inductive thematic analysis. FINDINGS Twenty-nine patients participated in four focus groups. Participants could not put their finger exactly on why doctors estimated that their disease activity was low, while they experienced high levels of disease activity. During the in-depth focus interviews, seven themes emerged that appeared related to high experienced disease activity: (1) perceived stress, (2) balancing activities and rest, (3) medication intake, (4) social stress, (5) relationship with professionals, (6) comorbidity, and (7) physical fitness. CONCLUSION When patients were asked why their view of their disease activity was different from that of their physician, seven themes emerged. The way participants coped with these themes seemed to be the predominant concept. Specific interventions that focus on one or more of the reported themes and on coping may improve not only the quality of life of these patients but also the satisfaction with the patient-doctor relationship for both parties.
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Affiliation(s)
- Margot J M Walter
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Adriaan Van't Spijker
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annelieke Pasma
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Johanna M W Hazes
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus Medical Center, University Medical Center Rotterdam, Postal Box 2040, 3000 CA, Rotterdam, The Netherlands
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21
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Gåfvels C, Hägerström M, Rane K, Wajngot A, Wändell PE. Depression and anxiety after 2 years of follow-up in patients diagnosed with diabetes or rheumatoid arthritis. Health Psychol Open 2016; 3:2055102916678107. [PMID: 28070410 PMCID: PMC5193320 DOI: 10.1177/2055102916678107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
We studied emotional health in patients with diabetes mellitus (n = 89) or rheumatoid arthritis (n = 100) aged 18–65 years, at the time of diagnosis and after 24 months. Predictors for depression or anxiety according to the Hospital Anxiety and Depression scale after 2 years were assessed by logistic regression, with psychosocial factors and coping as dependent factors. There were many similarities between patients with diabetes mellitus or rheumatoid arthritis. Having children at home, low score on the Sense of Coherence scale, and high score on the coping strategy “protest” were important risk factors for depression and anxiety after 2 years.
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Affiliation(s)
- Catharina Gåfvels
- Karolinska University Hospital, Sweden; Karolinska Institutet, Sweden
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22
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Geryk LL, Blalock SJ, DeVellis RF, Jordan JM, Han PKJ, Carpenter DM. Medication-related Self-management Behaviors among Arthritis Patients: Does Attentional Coping Style Matter? Open Rheumatol J 2016; 10:60-70. [PMID: 27843510 PMCID: PMC5080870 DOI: 10.2174/1874312901610010060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 08/30/2016] [Accepted: 08/31/2016] [Indexed: 11/22/2022] Open
Abstract
Objective: The aim of this study was to investigate the relationship between the attentional coping styles (monitoring and blunting) of rheumatoid arthritis (RA) and osteoarthritis (OA) patients and: (a) receipt of medication information; (b) receipt of conflicting medication information; (c) ambiguity aversion; (d) medication-related discussions with doctors and spouse/partners; and (e) medication adherence. Method: A sample of 328 adults with a self-reported diagnosis of arthritis (RA n=159; OA n=149) completed an Internet-based survey. Coping style was assessed using the validated short version of the Miller Behavioral Style Scale. Measures related to aspects of medication information receipt and discussion and validated measures of ambiguity aversion and medication adherence (Vasculitis Self-Management Survey) were collected. Pearson correlation coefficients, ANOVA, independent samples t-tests and multiple regression models were used to assess associations between coping style and the other variables of interest. Results: Arthritis patients in our sample were more likely to be high monitors (50%) than high blunters (36%). Among RA patients, increased information-receipt was significantly associated with decreased monitoring (b = -1.06, p = .001). Among OA patients, increased information-receipt was significantly associated with increased blunting (b = .60, p = .02). Conclusion: In our sample of patients with arthritis, attentional coping style is not in accordance with the characteristic patterns outlined in the acute and chronic disease coping literature.
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Affiliation(s)
- Lorie L Geryk
- University of North Carolina, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA
| | - Susan J Blalock
- University of North Carolina, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA
| | - Robert F DeVellis
- University of North Carolina, Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, USA
| | - Paul K J Han
- Maine Medical Center, Center for Outcomes Research and Evaluation, Portland, ME, USA
| | - Delesha M Carpenter
- University of North Carolina, UNC Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, NC, USA
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23
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Dures E, Fraser I, Almeida C, Peterson A, Caesley J, Pollock J, Ambler N, Morris M, Hewlett S. Patients' Perspectives on the Psychological Impact of Inflammatory Arthritis and Meeting the Associated Support Needs: Open-Ended Responses in a Multi-Centre Survey. Musculoskeletal Care 2016; 15:175-185. [PMID: 27605495 DOI: 10.1002/msc.1159] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Psychological support for inflammatory arthritis is recommended in rheumatology treatment guidelines. Previous research found that high numbers of patients would access such support but that provision is often inconsistent and inadequate. The present study explored patients' perspectives on the nature of the psychological impact of inflammatory arthritis and how to meet the associated support needs. METHODS A cross-sectional survey was conducted, using questionnaires which included three open-ended questions about helpful and unhelpful psychological support. The questionnaires were administered to 1,080 patients at six regional rheumatology units across England, and 1,200 members of a national patient charity. RESULTS A total of 1,210 (53%) patients completed the questionnaire, with 779 (64%) responding to the open-ended questions: 80% female; mean age 59 years (12.6); disease duration <5 years (40%), 5-10 years (20%), >10 years (40%). Data were analysed using a hybrid content analysis. Four categories emerged: challenges of an altered life course (negative emotions, isolation and loneliness, a dysfunctional body, loss, strained relationships, and fears for the future); poor communication (feeling unheard, clinicians' reluctance to address psychological issues, a lack of help to manage pain and fatigue, and struggling to ask for help); understood by others (sharing with people who have arthritis, supportive family and friends, whole team support, and understanding from clinicians); and acquiring strategies (ways of coping). CONCLUSIONS Psychological distress was commonplace, and often attributed to fatigue and pain. In addition to peers and family, patients looked to the rheumatology team for validation and support. Further research will address the skills training needs of rheumatology teams to meet patients' psychological support requirements.
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Affiliation(s)
- Emma Dures
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Isobel Fraser
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Celia Almeida
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Alice Peterson
- Academic Rheumatology, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Judy Caesley
- Academic Rheumatology, University Hospitals Bristol NHS Trust, Bristol, UK
| | - Jon Pollock
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | | | - Marianne Morris
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - Sarah Hewlett
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
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24
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Jia X, Jackson T. Pain beliefs and problems in functioning among people with arthritis: a meta-analytic review. J Behav Med 2016; 39:735-56. [DOI: 10.1007/s10865-016-9777-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/30/2016] [Indexed: 02/07/2023]
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25
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Chew E, Griva K, Cheung PP. Evaluation of coping strategies in established rheumatoid arthritis patients: emergence of concealment in an Asian cohort. Int J Rheum Dis 2016; 19:1069-1077. [PMID: 27457885 DOI: 10.1111/1756-185x.12932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To evaluate coping strategies of Asian RA patients and their associations with health-related quality of life (HRQoL). METHODS A cross-sectional sample of patients with established RA was evaluated using measures of coping (Coping in Rheumatoid Arthritis Questionnaire [C-RAQ]; appraisal of coping effectiveness and helplessness), HRQoL (Mental and Physical Components [MCS/PCS] of the Short Form 12v2; Rheumatoid Arthritis Impact of Disease score [RAID]) and clinical/laboratory assessments. Principal component analysis was conducted to identify coping strategies. Multiple linear regression analyses were performed to evaluate the associations between coping strategies and HRQoL outcomes. RESULTS The study sample comprised 101 patients, 81% female, 72.3% Chinese, mean age 54.2 ± 12.6 years. Five coping strategies were identified: Active problem solving (E = 5.36), Distancing (E = 2.30), Concealment (E = 1.89), Cognitive reframing (E = 1.55) and Emotional expression (E = 1.26). Concealment was consistently associated with PCS (rs = -0.23, P = 0.049), MCS (rs = -0.24, P = 0.04) and RAID (rs = 0.39, P < 0.001), and was significant in the multivariate model to explain lower disease-specific HRQoL (RAID) even after adjusting for disease activity, coping effectiveness and helplessness (β = 0.20, P = 0.04). Emotional expression was associated with poorer physical HRQoL (PCS), after adjusting for disease severity, body mass index, coping effectiveness, helplessness and Concealment (β = -0.39, P < 0.001). Perceived coping-related helplessness was significant in multivariate correlates for PCS (β = -0.25, P = 0.036), MCS (β = -0.29, P = 0.02) and RAID (β = 0.53, P < 0.001), after adjusting for covariates. CONCLUSION Concealment and Emotional expression are associated with lower disease-specific HRQoL and physical HRQoL respectively, with the former coping strategy likely to be culture-specific. Interventions should tailor psychosocial support needs to address not only coping strategies, but patients' perception of their coping.
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Affiliation(s)
- Elizabeth Chew
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Konstadina Griva
- Department of Psychology, National University of Singapore, Singapore, Singapore
| | - Peter P Cheung
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Rheumatology, National University Hospital, Singapore, Singapore
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Focus group interviews reveal reasons for differences in the perception of disease activity in rheumatoid arthritis. Qual Life Res 2016; 26:291-298. [PMID: 27444780 PMCID: PMC5288407 DOI: 10.1007/s11136-016-1369-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/24/2022]
Abstract
Objective Doctors frequently see patients who have difficulties coping with their disease and rate their disease activity high, despite the fact that according to the doctors, the disease activity is low. This study explored the patients’ perspectives on this discordance that may help to understand why for some patients, usual care seems to be insufficient. Methods In our qualitative study we conducted focus group interviews where questions were used as a guideline. Transcripts were analyzed using inductive thematic analysis. Findings Twenty-nine patients participated in four focus groups. Participants could not put their finger exactly on why doctors estimated that their disease activity was low, while they experienced high levels of disease activity. During the in-depth focus interviews, seven themes emerged that appeared related to high experienced disease activity: (1) perceived stress, (2) balancing activities and rest, (3) medication intake, (4) social stress, (5) relationship with professionals, (6) comorbidity, and (7) physical fitness. Conclusion When patients were asked why their view of their disease activity was different from that of their physician, seven themes emerged. The way participants coped with these themes seemed to be the predominant concept. Specific interventions that focus on one or more of the reported themes and on coping may improve not only the quality of life of these patients but also the satisfaction with the patient–doctor relationship for both parties.
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Affective disturbance in rheumatoid arthritis: psychological and disease-related pathways. Nat Rev Rheumatol 2016; 12:532-42. [PMID: 27411910 DOI: 10.1038/nrrheum.2016.112] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In addition to recurrent pain, fatigue, and increased rates of physical disability, individuals with rheumatoid arthritis (RA) have an increased prevalence of some mental health disorders, particularly those involving affective or mood disturbances. This narrative Review provides an overview of mental health comorbidities in RA, and discusses how these comorbidities interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioural responses that could exacerbate the physical and psychological difficulties associated with RA. This article describes how the social context of individuals with RA affects both their coping strategies and their psychological responses to the disease, and can also impair responses to treatment through disruption of patient-physician relationships and treatment adherence. Evidence from the literature on chronic pain suggests that the resulting alterations in neural pathways of reward processing could yield new insights into the connections between disease processes in RA and psychological distress. Finally, the role of psychological interventions in the effective and comprehensive treatment of RA is discussed.
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Flurey CA, Hewlett S, Rodham K, White A, Noddings R, Kirwan J. Men, rheumatoid arthritis, psychosocial impact and self-management: A narrative review. J Health Psychol 2016; 21:2168-82. [PMID: 25759375 DOI: 10.1177/1359105315572452] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Rheumatoid arthritis is a chronic disease affecting fewer men than women. We systematically reviewed the literature on impact and self-management of rheumatoid arthritis in men. A total of 28 papers were included and grouped into two categories: psychosocial impact of rheumatoid arthritis, and coping and self-management. This review finds gender differences relating to quality of life, work, distress, self-management, coping and support. We conclude that there is a dearth of literature focussing on rheumatoid arthritis in men only, and mixed gender studies include insufficient men to draw strong conclusions about men. Thus, further research is needed to understand the support needs of men with rheumatoid arthritis in depth.
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Poh LW, He HG, Chan WCS, Lee CSC, Lahiri M, Mak A, Cheung PP. Experiences of Patients With Rheumatoid Arthritis: A Qualitative Study. Clin Nurs Res 2016; 26:373-393. [PMID: 26862118 DOI: 10.1177/1054773816629897] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that greatly impacts one's physical and psychosocial well-being. The purpose of this study was to explore the experiences and support needs of adult patients living with RA. A descriptive qualitative study was conducted, and 16 adults with RA were interviewed from October 2013 to January 2014. The transcribed data were analyzed using thematic analysis. Five themes were identified: altered physical capacity and well-being, psychological and emotional challenges, changes in social life, coping strategies, and support received and further support needs. This study provided insights into the experiences and support needs of patients with RA in Singapore. Physical and psychosocial challenges experienced by patients affected their daily and social activities. Patients' needs for variety of support should be addressed.
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Affiliation(s)
| | - Hong-Gu He
- 2 National University of Singapore, Singapore; National University Health System, Singapore
| | | | - Ching Siang Cindy Lee
- 2 National University of Singapore, Singapore; National University Health System, Singapore
| | - Manjari Lahiri
- 4 National University Hospital, Singapore; National University Health System, Singapore
| | - Anselm Mak
- 4 National University Hospital, Singapore; National University Health System, Singapore
| | - Peter P Cheung
- 4 National University Hospital, Singapore; National University Health System, Singapore
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Tälli S, Etcheto A, Fautrel B, Balanescu A, Braun J, Cañete JD, de Vlam K, de Wit M, Heiberg T, Helliwell P, Kalyoncu U, Kiltz U, Maccarone M, Niedermayer D, Otsa K, Scrivo R, Smolen JS, Stamm T, Veale DJ, Kvien TK, Gossec L. Patient global assessment in psoriatic arthritis - what does it mean? An analysis of 223 patients from the Psoriatic arthritis impact of disease (PsAID) study. Joint Bone Spine 2015; 83:335-40. [PMID: 26677994 DOI: 10.1016/j.jbspin.2015.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/30/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Patient global assessment is a key outcome measure in psoriatic arthritis. To explore the meaning of patient global assessment in psoriatic arthritis by examining associations to domains of health assessed by the Psoriatic arthritis impact of disease score. METHODS Post-hoc analysis of a multicentre cross-sectional study of patients with psoriatic arthritis. Data collection included patient global assessment, specific joint and skin global patient assessments, Psoriatic arthritis impact of disease questions covering physical (including joints and skin), psychological and social impact, and other comparator outcomes. Univariate analyses (Pearson correlation) and multivariate linear regression were performed to explain patient global assessment and the specific joint and skin global patient assessments. RESULTS Among 223 patients (mean age: 51.0 [standard deviation, ±13.3] years; mean disease duration: 9.9 [±10.1] years; mean swollen joint count: 4.1 [±5.1]; 84.3% with current psoriasis [mainly of less than 5% body surface area]), 50.2% were females. Mean patient global assessment was 4.8 (±2.7), mean joint and skin patient assessments were respectively 5.6 (±2.5) and 4.1 (±3.0). Intraclass correlation between patient global assessment and joint or skin patient assessment was respectively 0.71 (95% confidence interval, 0.64-0.77) and 0.52 (95% confidence interval, 0.42-0.60). In multivariate analyses, patient global assessment was explained (R(2) of model: 0.754) by coping (β = 0.287); pain (β = 0.240); work and/or leisure activities (β = 0.141); and anxiety (β = 0.109). CONCLUSIONS Patient global assessment in psoriatic arthritis was explained mainly by physical, but also psychological aspects of the disease.
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Affiliation(s)
- Sandra Tälli
- Sorbonne universités, UPMC université Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; AP-HP, Pitié-Salpêtrière hospital, department of rheumatology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Adrien Etcheto
- Paris Descartes university, department of rheumatology, Cochin hospital and epidemiology, 75014 Paris, France; Biostatistics unit, Sorbonne Paris Cité research center, Inserm U1153, 75004 Paris, France
| | - Bruno Fautrel
- Sorbonne universités, UPMC université Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; AP-HP, Pitié-Salpêtrière hospital, department of rheumatology, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Andra Balanescu
- Research center of rheumatic diseases, Sf. Maria hospital, university of medicine and pharmacy Carol Davila, 011172 Bucharest, Romania
| | - Jurgen Braun
- Rheumazentrum Ruhrgebiet, 44649 Herne, Germany; Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Juan D Cañete
- Arthritis unit, department of rheumatology, hospital Clínic and IDIBAPS, 08036 Barcelona, Spain
| | - Kurt de Vlam
- Department of rheumatology, university hospitals Leuven, 1348 Leuven, Belgium
| | - Maarten de Wit
- People with Arthritis/Rheumatism in Europe (PARE), 8000 Zurich, Switzerland
| | - Turid Heiberg
- Faculty of health and social studies, Oestfold university college, NO-1757 Halden, regional research support Oslo, university hospital Postbox 4956 Nydalen, NO-0424 Oslo, Norway
| | - Philip Helliwell
- Institute of rheumatic and musculoskeletal medicine, university of Leeds, LS2 9JT Leeds, United Kindom
| | - Umut Kalyoncu
- University faculty of medicine, division of rheumatology, 06560 Ankara, Turkey
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, 44649 Herne, Germany; Ruhr-Universität Bochum, 44801 Bochum, Germany
| | - Mara Maccarone
- Associazione per la Difesa degli Psoriasici (ADIPSO) - Pan European Psoriasis Patients' Organization Forum (PE.Pso.POF), 00193 Rome, Italy
| | - Dora Niedermayer
- 3rd rheumatology department, National institute of rheumatology and physiotherapy, 1051 Budapest, Hungary
| | - Kati Otsa
- East-Tallinn central hospital, rheumatology department, 10001 Tallinn, Estonia
| | - Rossana Scrivo
- Dipartimento di medicina interna e specialità mediche, reumatologia, Sapienza università di Roma, 00185 Rome, Italy
| | - Josef S Smolen
- Division of rheumatology, department of medicine 3, medical university of Vienna, 2nd department of medicine, Hietzing hospital, 1130 Vienna, Austria
| | - Tanja Stamm
- Division of rheumatology, department of medicine 3, medical university of Vienna, 2nd department of medicine, Hietzing hospital, 1130 Vienna, Austria; University of applied sciences FH Campus Wien, department of health, division of health assisting engineering, 1140 Vienna, Austria
| | - Douglas J Veale
- Dublin academic medical centre, Saint-Vincent's university hospital, Elm Park, Dublin 4, Ireland
| | - Tore K Kvien
- Department of rheumatology, Diakonhjemmet hospital, 0370 Oslo, Norway
| | - Laure Gossec
- Sorbonne universités, UPMC université Paris 06, institut Pierre-Louis d'épidémiologie et de santé publique, 75013 Paris, France; AP-HP, Pitié-Salpêtrière hospital, department of rheumatology, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Emotional Distress Associated with Surgical Treatment and its Relationship with Coping Profiles Among Chronically ill Older Patients. CURRENT PSYCHOLOGY 2015. [DOI: 10.1007/s12144-015-9398-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gruszczyńska E, Knoll N. Meaning-focused coping, pain, and affect: a diary study of hospitalized women with rheumatoid arthritis. Qual Life Res 2015; 24:2873-83. [PMID: 26048347 PMCID: PMC4615666 DOI: 10.1007/s11136-015-1031-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE The aim of the study was to investigate the relationship between affective state, pain, and coping in hospitalized women with rheumatoid arthritis, including both between- and within-person perspectives. METHODS Participants were 95 female patients between 24 and 82 years of age (M = 50.91; SD = 13.80). For three consecutive days, they rated each night their state affect (positive and negative), pain level, and coping strategies (emotion-, problem- and meaning-focused ones). Relations among variables were tested with a multilevel approach with time included as a covariate. RESULTS Within-person meaning-focused coping suppressed the negative pain effect on emotional state, but only for positive affect (Sobel's z = 2.07, p = .04). Moderators of the pain-affect relationship were between-person differences in pain level (B = -.23, SE = .08, t = -2.884, p = .004) and in meaning-focused coping (B = -.63, SE = .20, t = -2.097, p = .04). Specifically, suppression was significant only for patients who reported lower than sample average pain levels and for patients who reported lower than sample average use of meaning-focused strategies. CONCLUSIONS Findings indicated that meaning-focused coping can be a crucial strategy for keeping daily positive affect in the face of chronic pain and how this effect is modified by interindividual differences. Even if restricted to the specific context, it may inform an intervention for hospitalized women with rheumatoid arthritis.
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Affiliation(s)
- Ewa Gruszczyńska
- Health Psychology Department, University of Social Sciences and Humanities, Chodakowska 19/31, 03-815, Warsaw, Poland.
| | - Nina Knoll
- Division of Health Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany.
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Gender differences in the impact of mental disorders and chronic physical conditions on health-related quality of life among non-demented primary care elderly patients. Qual Life Res 2015; 25:1461-74. [DOI: 10.1007/s11136-015-1182-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 12/21/2022]
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Aimer P, Stamp L, Stebbings S, Valentino N, Cameron V, Treharne GJ. Identifying barriers to smoking cessation in rheumatoid arthritis. Arthritis Care Res (Hoboken) 2015; 67:607-15. [PMID: 25370172 DOI: 10.1002/acr.22503] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/09/2014] [Accepted: 10/21/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to investigate disease-related issues that make smoking cessation challenging for patients with rheumatoid arthritis (RA). There is currently a lack of research on tailoring smoking cessation interventions for RA patients. Qualitative exploration is a necessary first step in planning targeted interventions. METHODS A qualitative mixed-methods study was undertaken. Participants attended either a focus group or an individual interview and completed a set of standardized questionnaires. The sample consisted of 36 RA patients: 24 current smokers and 12 ex-smokers. The transcripts were analyzed thematically using a critical realist approach to inductively identify themes. RESULTS Five key barriers to smoking cessation that are faced by RA patients were identified. First, participants were unaware of the relationship between smoking and RA and therefore did not perceive this as a reason to quit. Second, smoking was used as a distraction from pain. Third, participants found it difficult to exercise and therefore were unable to use exercise as an alternative distraction. Fourth, smoking was used as a coping mechanism for the frustrations of living with RA. Fifth, participants felt unsupported and isolated from other RA patients. CONCLUSION Disease-related issues may hinder smoking cessation for RA patients. Through an understanding of patients' perspectives there is an opportunity to plan an effective targeted intervention that may increase the chance of smoking cessation in RA patients where smoking may adversely influence disease progression and comorbidities.
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Affiliation(s)
- Pip Aimer
- University of Otago, Christchurch, New Zealand
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Aimer P, Stamp LK, Stebbings S, Cameron V, Kirby S, Croft S, Treharne GJ. Developing a Tailored Smoking Cessation Intervention for Rheumatoid Arthritis Patients. Musculoskeletal Care 2015; 14:2-14. [PMID: 25982887 DOI: 10.1002/msc.1106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Smoking is associated with an increased risk of comorbidities in rheumatoid arthritis (RA) and may reduce the efficacy of anti-rheumatic therapies. Smoking cessation is therefore an important goal in RA. Our previous qualitative research identified five RA-related barriers to smoking cessation: lack of support; limited knowledge of the relationship between smoking and RA; uncontrolled pain; inability to exercise; and using smoking as a coping strategy. The aim of this article is to describe the process of developing a smoking cessation intervention for RA patients based on these themes. METHODS A comprehensive review of the literature on smoking cessation was undertaken. A tailored smoking cessation programme was designed to address each RA-specific barrier. A meeting was convened with key staff of Arthritis New Zealand to develop a consensus on feasible design to deliver a smoking cessation programme based on existing best practice and smoking cessation resources, and tailored within existing Arthritis New Zealand service delivery frameworks. RESULTS A three-month intervention was designed to be delivered by trained arthritis educators, with the following key components: nicotine replacement therapy for eight weeks; a telephone or face-to-face interview with each patient to determine their individual specific RA-related barriers to smoking cessation; and individualized education and support activities which addressed these barriers. The intervention also included three follow-up telephone calls; a support website; and 12 weekly smoking cessation advice emails. CONCLUSIONS A RA-specific smoking cessation invention was developed, matching support to specific issues within each patient's experience. A pilot study is in progress to evaluate the programme's efficacy. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Pip Aimer
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Lisa K Stamp
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Simon Stebbings
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Vicky Cameron
- Department of Medicine, University of Otago, Christchurch, New Zealand
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Peláez-Ballestas I, Boonen A, Vázquez-Mellado J, Reyes-Lagunes I, Hernández-Garduño A, Goycochea MV, Bernard-Medina AG, Rodríguez-Amado J, Casasola-Vargas J, Garza-Elizondo MA, Aceves FJ, Shumski C, Burgos-Vargas R. Coping strategies for health and daily-life stressors in patients with rheumatoid arthritis, ankylosing spondylitis, and gout: STROBE-compliant article. Medicine (Baltimore) 2015; 94:e600. [PMID: 25761177 PMCID: PMC4602460 DOI: 10.1097/md.0000000000000600] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 02/05/2015] [Accepted: 02/06/2015] [Indexed: 11/26/2022] Open
Abstract
This article aims to identify the strategies for coping with health and daily-life stressors of Mexican patients with chronic rheumatic disease. We analyzed the baseline data of a cohort of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), and gout. Their strategies for coping were identified with a validated questionnaire. Comparisons between health and daily-life stressors and between the 3 clinical conditions were made. With regression analyses, we determined the contribution of individual, socioeconomic, educational, and health-related quality-of-life variables to health status and coping strategy. We identified several predominant coping strategies in response to daily-life and health stressors in 261 patients with RA, 226 with AS, and 206 with gout. Evasive and reappraisal strategies were predominant when patients cope with health stressors; emotional/negative and evasive strategies predominated when coping with daily-life stressors. There was a significant association between the evasive pattern and the low short-form health survey (SF-36) scores and health stressors across the 3 diseases. Besides some differences between diagnoses, the most important finding was the predominance of the evasive strategy and its association with low SF-36 score and high level of pain in patients with gout. Patients with rheumatic diseases cope in different ways when confronted with health and daily-life stressors. The strategy of coping differs across diagnoses; emotional/negative and evasive strategies are associated with poor health-related quality of life. The identification of the coping strategies could result in the design of psychosocial interventions to improve self-management.
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Affiliation(s)
- Ingris Peláez-Ballestas
- From the Department of Rheumatology (IP-B, JV-M, JC-V, RB-V), Hospital General de México "Eduardo Liceaga," Mexico City, Mexico; Maastricht University Medical Center (AB), The Netherlands; Postgraduate Department of Psychology (I-RL), Universidad Nacional Autónoma de México, Mexico City; Department of Pediatrics (A-HG), Hospital Universitario "José Eleuterio Gonzalez", Monterrey, Nuevo Leon; Clinical Epidemiology Unit (MVG), Hospital Gabriel Mancera Regional 1, IMSS, Mexico City; Department of Rheumatology (AGB-M), Hospital Civil de Guadalajara, Guadalajara, Jalisco; Department of Rheumatology (JR-A, MAG-E), Hospital Universitario "José Eleuterio Gonzalez," Monterrey, Nuevo Leon; Hospital General de zona 46 (FJA), IMSS and Unidad de Investigación Crônico-Degenerativas, Guadalajara, Jalisco; and Department of Rheumatology (CS), Hospital Central, PEMEX, Mexico City, Mexico
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Dür M, Coenen M, Stoffer MA, Fialka-Moser V, Kautzky-Willer A, Kjeken I, Drăgoi RG, Mattsson M, Boström C, Smolen J, Stamm TA. Do patient-reported outcome measures cover personal factors important to people with rheumatoid arthritis? A mixed methods design using the International Classification of Functioning, Disability and Health as frame of reference. Health Qual Life Outcomes 2015; 13:27. [PMID: 25879438 PMCID: PMC4379722 DOI: 10.1186/s12955-015-0214-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 01/24/2015] [Indexed: 02/08/2023] Open
Abstract
Background Personal factors (PFs) are internal factors that determine functioning and the individuals’ experience of disability. Their coverage by patient-reported outcome measures (PROMs) has not been examined in rheumatoid arthritis (RA) so far. The aims of this study were to identify PFs important in the life stories of people with RA and to determine their coverage by PROMs used in RA. Methods The qualitative data of people with RA was explored to identify PFs. Additionally a systematic literature search was conducted to find PROMs used in RA. PROMs items were linked to the components, domains and categories of the International Classification of Functioning, Disability and Health (ICF) to determine the coverage of important PFs by PROMs. Results Twelve PFs were found to be important in the life stories of people with RA. The PFs coping and reflecting about one’s life in an optimistic way were covered most frequently, each by 14 of the 42 explored PROMs, while job satisfaction was not covered at all. The London Coping with Rheumatoid Arthritis Questionnaire, General Self-Efficacy Scale, Arthritis Self-Efficacy Scale, Rheumatoid Arthritis Self-Efficacy Questionnaire and Revised Ways of Coping Inventory covered most PFs. Nineteen PROMs did not cover any of the PFs. Conclusion Several PFs were identified as important in the life stories of people with RA, but only 55% of the PROMS covered some of these PFs. When evaluating PFs important to people with RA, health professionals should be alert on which PROMs can be used to assess which PFs.
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Affiliation(s)
- Mona Dür
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,IMC University of Applied Sciences Krems, Department of Health Sciences, Occupational Therapy, Piaristengasse 1, 3500, Krems, Austria.
| | - Michaela Coenen
- Ludwig-Maximilians-University, Department of Medical Informatics, Biometry and Epidemiology, Research Unit for Bio Psychosocial Health, Marchioninistraße 17, 81377, Munich, Germany.
| | - Michaela Alexandra Stoffer
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Veronika Fialka-Moser
- Medical University of Vienna, Department of Physical Medicine and Rehabilitation, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Alexandra Kautzky-Willer
- Medical University of Vienna, Department of Internal Medicine III, Division of Diabetology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ingvild Kjeken
- Diakonhjemmet Hospital, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Postbox 23 Vinderen, 0319, Oslo, Norway.
| | - Răzvan Gabriel Drăgoi
- "Victor Babeş" University of Medicine and Pharmacy, Department of Rehabilitation, Physical Medicine and Rheumatology, Piata Eftimie Murgu 2, Timişoara, 300041, Timis, Romania.
| | - Malin Mattsson
- Luleå University of Technology, Department of Health Sciences, SE-971 87, Luleå, Sweden. .,Sunderby Hospital, Department of Physiotherapy, SE-971 80, Luleå, Sweden.
| | - Carina Boström
- Karolinska Institutet, Department of Neurobiology, Care sciences and Society, Division of Physiotherapy, Alfred Nobels Allé 23, 141 83 Huddinge, Stockholm, Sweden.
| | - Josef Smolen
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Tanja Alexandra Stamm
- Medical University of Vienna, Department of Internal Medicine III, Division of Rheumatology, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Fachhochschule Campus Wien, University of Applied Sciences, Department of Health, Favoritenstraße 226, 1100, Vienna, Austria.
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Poh L, He HG, Lee C, Cheung P, Chan WC. An integrative review of experiences of patients with rheumatoid arthritis. Int Nurs Rev 2015; 62:231-47. [DOI: 10.1111/inr.12166] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L.W. Poh
- Division of Nursing; Khoo Teck Puat Hospital; Singapore
| | - H.-G. He
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - C.S.C. Lee
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - P.P. Cheung
- Division of Rheumatology; National University Hospital; Singapore
| | - W.-C.S. Chan
- School of Nursing and Midwifery; Faculty of Health and Medicine; The University of Newcastle; Newcastle Australia
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Yakupov EZ, Yakupova SP, Muslimova EA. The multivector nature of relief of acute and chronic pain and necessity of using pain coping strategies. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:98-103. [DOI: 10.17116/jnevro201511511298-103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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An examination of expectations for rheumatoid arthritis disability in Germany: comparison with Canadian data. Semin Arthritis Rheum 2014; 44:e4. [PMID: 24816196 DOI: 10.1016/j.semarthrit.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 04/07/2014] [Indexed: 11/21/2022]
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Gandhi S, Jedel S, Hood MM, Mutlu E, Swanson G, Keshavarzian A. The relationship between coping, health competence and patient participation among patients with inactive inflammatory bowel disease. J Crohns Colitis 2014; 8:401-8. [PMID: 24230968 DOI: 10.1016/j.crohns.2013.10.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/14/2013] [Accepted: 10/15/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Coping is an integral part of adjustment for patients with Inflammatory Bowel Disease but has not been well described in the literature. This study explored the relationship between coping, perceived health competence, patient preference for involvement in their treatment, depression and quality of life, particularly among patients with inactive disease (in remission). METHODS Subjects (n=70) with active and inactive IBD completed questionnaires, including the Inflammatory Bowel Disease Quality of Life Questionnaire, Beck Depression Inventory, Perceived Health Competence Scale and the Coping Inventory for Stressful Situations. The Harvey Bradshaw Index measured disease activity. RESULTS Patients with inactive IBD demonstrated significantly more interest in participating in their treatment (p<.05), more perceived health competence (p=.001), less depressive symptoms (p<.001), more task oriented coping (p=.02), and better quality of life than those with active disease. Only Task Oriented Coping was significantly negatively associated with the number of flares among inactive patients (p<.001). Patient preference for participation in treatment was inversely associated with Avoidance (p=.005), Distraction (p=.008), and Social Diversion (p=.008) coping among inactive patients. CONCLUSION Among patients in remission, those who expressed a greater interest in treatment participation were also less likely to practice maladaptive coping. Our data demonstrate that a more active coping style may be associated with improved health outcome. Compared to patients with active disease, patients in remission are more likely to employ task oriented coping, demonstrate a higher interest in treatment participation, report greater perceived control of their health, and exhibit less depression symptoms. Our findings may increase awareness of the importance of identifying coping strategies for IBD patients, including those in remission.
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Affiliation(s)
- Seema Gandhi
- Department of Internal Medicine (Division of Digestive Disease and Nutrition), Rush University Medical Center, Chicago, IL, United States
| | - S Jedel
- Department of Internal Medicine (Division of Digestive Disease and Nutrition), Rush University Medical Center, Chicago, IL, United States.
| | - M M Hood
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - E Mutlu
- Department of Internal Medicine (Division of Digestive Disease and Nutrition), Rush University Medical Center, Chicago, IL, United States
| | - G Swanson
- Department of Internal Medicine (Division of Digestive Disease and Nutrition), Rush University Medical Center, Chicago, IL, United States
| | - A Keshavarzian
- Department of Internal Medicine (Division of Digestive Disease and Nutrition), Rush University Medical Center, Chicago, IL, United States
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Herman A, Taylor S, Noll J. Coping strategies and support networks for Sjögren's syndrome patients. Oral Maxillofac Surg Clin North Am 2013; 26:111-5. [PMID: 24287199 DOI: 10.1016/j.coms.2013.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sjögren's syndrome is a chronic systemic autoimmune disease that can affect any organ system in the body. The most common symptoms are dryness of the mouth and eyes resulting from chronic inflammation and a progressive loss of secretory function. As with most individuals managing a chronic condition, patients with Sjögren's are on a multipronged path to disease and symptom management. Various coping strategies are presented in this article and the advantages and disadvantages discussed. Additionally, how a support group functions and practical guidance for the initiation of a Sjögren's support group are discussed.
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Affiliation(s)
- Andrea Herman
- Department of Oral Medicine, Carolinas Center for Oral Health, 1601 Abbey Place, Suite 220, Charlotte, NC 28209, USA.
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Daker-White G, Donovan J, Campbell R. Redefined by illness: meta-ethnography of qualitative studies on the experience of rheumatoid arthritis. Disabil Rehabil 2013; 36:1061-71. [PMID: 24001261 DOI: 10.3109/09638288.2013.829531] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To synthesize published qualitative studies concerning the lived experience of rheumatoid arthritis (RA). To compare the conceptual features of qualitative studies covering two different time periods. METHODS In 2002, 24 items published 1975-2001 were identified in comprehensive literature searches and assessed by multiple reviewers. In 2010, the first author found 28 articles published 2002-2009 in a simple search of the Medline database and synthesized them alone. Articles were synthesized using meta-ethnography. RESULTS Both syntheses found that the main symptoms of RA are variable and unpredictable. However, in the first synthesis a sociological model dominated where RA was seen as an assault on self-identity with devastating social consequences. The main concepts were biographical disruption, role incompetence and the dread of dependency on others. In the second synthesis, the findings produced a model for health care practitioners tied to perceptions of control and incorporating a career-adaptation model of the experience of RA. CONCLUSIONS We recommend that future synthesizers and primary qualitative health researchers focus more on non-hospital based populations and non-English language articles or study participants. The implications for rehabilitation follow from reflecting the findings of the synthesis against existing psychological models of coping and adaptation in RA. Implications for Rehabilitation Coping and adaptation are biographical processes, although the relative importance of active "disease mastery" versus more passive "getting used to it" is unclear. The uncertainty and fluctuating nature of symptoms and disease course presents existential challenges for people with RA in relation to maintaining physical functioning and social roles. Within a social model of disability, these findings point to potential intervention sites in society and relationships that would benefit people living with RA.
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Affiliation(s)
- Gavin Daker-White
- Centre for Primary Care, Institute of Population Health, University of Manchester , Manchester , UK and
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Iglesias-Rey M, Barreiro-de Acosta M, Caamaño-Isorna F, Rodríguez IV, González AL, Lindkvist B, Domínguez-Muñoz E. How do psychological variables influence coping strategies in inflammatory bowel disease? J Crohns Colitis 2013; 7:e219-26. [PMID: 23083699 DOI: 10.1016/j.crohns.2012.09.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 08/28/2012] [Accepted: 09/18/2012] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adjusting to chronic disease is a complex process and one that, in the case of inflammatory bowel disease (IBD), has received very little attention. The objectives of this study were to identify coping strategies used by patients with IBD and to explore how these strategies are related to psychological characteristics. METHODS A transversal study was designed in which 875 patients with IBD were prospectively enrolled. Independent variables were evaluated using a sociodemographic questionnaire and a clinical questionnaire-the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS); dependent variables were evaluated using the COPE Inventory (Coping Orientation to Problems Experienced), a multidimensional scale for evaluating general coping styles. Multiple linear regression was used to identify the variables associated with the type of coping used. RESULTS The participation rate was 91.3%. The most common coping strategy was emotion-focused coping (X=2.64; 95% CI=2.61-2.69), with no differences in relation to type of disease. The highest scores for anxiety were associated with emotion-focused coping (β=0.164, p=0.001) whereas, for depression, the highest scores were associated with escape-avoidance (β=0.108, p=0.044). No correlation was found between stress levels and type of coping. CONCLUSIONS Patients with IBD have a tendency to focus on emotions in their coping process, and this process appears to be related not only to sociodemographic characteristics or features of the disease itself but also to psychological factors-anxiety and depression, primarily.
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Englbrecht M, Kruckow M, Araujo E, Rech J, Schett G. The interaction of physical function and emotional well-being in rheumatoid arthritis--what is the impact on disease activity and coping? Semin Arthritis Rheum 2013; 42:482-91. [PMID: 23369659 DOI: 10.1016/j.semarthrit.2012.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 09/11/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the impact of the interaction of physical function and emotional well-being on disease-related parameters and coping with rheumatoid arthritis. METHODS A cross-sectional survey among 177 RA patients included demographic and disease-related variables as well as the following patient-reported outcome measures: Health Assessment Questionnaire-Disability Index (HAQ-DI) (physical function), Mental Component Summary Scale of the SF-36 (MCSS) for emotional well-being, Rheumatoid Arthritis Disease Activity Index (RADAI), and Coping with Rheumatoid Arthritis Questionnaire (C-RAQ). Based on HAQ-DI and MCSS, six categories representing various levels of physical and emotional impairment were formed. Multivariate analysis of variance and a subsequent discriminant analysis were used to evaluate whether demographic and disease-related variables and coping strategies differed between these categories. RESULTS Patients with moderate to high impairment of physical function and emotional well-being reported significantly higher disease activity and a more frequent use of distancing and active problem solving coping strategies than patients with low-level impairment (p<0.001-0.043). Furthermore, these patients reported experiencing significantly higher levels of helplessness (p<0.001-0.032). Results from the discriminant analysis highlighted a combination of disease activity and helplessness to differentiate best between patients with either low or high impairment of physical function and emotional well-being (p<0.001). CONCLUSION Aside from perceived disease activity, helplessness, and distancing as well as active problem solving allowed for a good discrimination between the different levels of impairment of physical function and emotional well-being. Encouraging and educating patients on how to cognitively reframe their current situation might play a key role in reducing the level of helplessness resulting from impairments of physical function and emotional well-being.
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Affiliation(s)
- Matthias Englbrecht
- Department of Internal Medicine 3 and Institute of Clinical Immunology, University of Erlangen-Nuremberg, Erlangen, Germany.
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Abstract
Pierre-Auguste Renoir was one of the most influential painters in art history, but few people know that he suffered from debilitating rheumatoid arthritis. Despite his arthritis, he was able to maintain an incredible level of precision and efficiency with his painting. More importantly, he remained positive and did not let his condition affect his passion for painting or take away from the beauty that he saw in the world around him. Renoir applied a wide variety of coping mechanisms and used his ingenuity to come up with different ways to continue painting even as his arthritis weakened him. Renoir's long battle with rheumatoid arthritis serves as an inspiration to patients who experience the pain and limited mobility associated with this disease, encouraging them to persevere and to develop coping mechanisms that prevent the effects of their impairment from disabling them.
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Affiliation(s)
- Evan Kowalski
- Section of Plastic Surgery, The University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340 USA
| | - Kevin C. Chung
- Section of Plastic Surgery, The University of Michigan Medical School, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-5340 USA
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Murphy SL, Kratz AL, Williams DA, Geisser ME. The Association between Symptoms, Pain Coping Strategies, and Physical Activity Among People with Symptomatic Knee and Hip Osteoarthritis. Front Psychol 2012; 3:326. [PMID: 22969747 PMCID: PMC3432514 DOI: 10.3389/fpsyg.2012.00326] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 08/15/2012] [Indexed: 11/29/2022] Open
Abstract
Effective use of coping strategies by people with chronic pain conditions is associated with better functioning and adjustment to chronic disease. Although the effects of coping on pain have been well studied, less is known about how specific coping strategies relate to actual physical activity patterns in daily life. The purpose of this study was to evaluate how different coping strategies relate to symptoms and physical activity patterns in a sample of adults with knee and hip osteoarthritis (OA; N = 44). Physical activity was assessed by wrist-worn accelerometry; coping strategy use was assessed by the Chronic Pain Coping Inventory. We hypothesized that the use of coping strategies that reflect approach behaviors (e.g., Task Persistence), would be associated with higher average levels of physical activity, whereas avoidance coping behaviors (e.g., Resting, Asking for Assistance, Guarding) and Pacing would be associated with lower average levels of physical activity. We also evaluated whether coping strategies moderated the association between momentary symptoms (pain and fatigue) and activity. We hypothesized that higher levels of approach coping would be associated with a weaker association between symptoms and activity compared to lower levels of this type of coping. Multilevel modeling was used to analyze the momentary association between coping and physical activity. We found that higher body mass index, fatigue, and the use of Guarding were significantly related to lower activity levels, whereas Asking for Assistance was significantly related to higher activity levels. Only Resting moderated the association between pain and activity. Guarding, Resting, Task Persistence, and Pacing moderated the association between fatigue and activity. This study provides an initial understanding of how people with OA cope with symptoms as they engage in daily life activities using ecological momentary assessment and objective physical activity measurement.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan Ann Arbor, MI, USA
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