Effect of valued activity disability, social comparisons, and satisfaction with ability on depressive symptoms in rheumatoid arthritis

Longitudinal mediation effects of activity meaning on the association between activity performance and quality of life among older adults with disabilities

BACKGROUND

Physical limitations may hinder older adults with physical disabilities' capability to perform various activities, which can affect their quality of life (QOL). Accomplishing meaningful activities may mitigate the impact of limited activity performance on their QOL. This longitudinal study aims to investigate how activity meaning mediates the relationship between activity performance and QOL among older adults with disabilities.

METHODS

Data for this longitudinal study was collected from 813 community-dwelling older adults aged 60 and above who had physical disabilities, over a two year interval. Path analysis was used to examine the cross-sectional and longitudinal mediation effects from activity performance, through activity meaning, to QOL.

RESULTS

At the same wave, high IADL performance or social activity performance, and high QOL was indirectly associated through high IADL meaning or social meaning. As for longitudinal association, high T1 IADL performance was associated with better T2 QOL through high T1 and T2 IADL meaning. Similarly, high T1 social activity performance also contributed to T2 QOL through high T1 and T2 social activity meaning. Additionally, social activity performance exhibited higher influence on QOL than that of IADL.

CONCLUSIONS

Both IADL and social activities have distinct impacts on the QOL of older adults with disabilities. To improve the current and future QOL of older adults with disabilities, professionals must prioritize their involvement in the most meaningful activities while being sensitive to and supportive of their preferences and valued lifestyles.

Is the presence of home entrance steps associated with community participation of people with mobility impairments?

BACKGROUND

Little is known about how home entrances are related to community participation for people with mobility impairments.

OBJECTIVE

This investigation explored how the need to navigate steps at the entrance of a home affects the community participation levels of people with mobility impairments.

METHODS

This survey study used pre-measure data collected from three different samples. Participants were adults living independently in the community aged 18-94 years old who self-reported having a mobility impairment. Measures included the Brief Community Engagement Questionnaire to examine potential differential effects on the number of non-discretionary trips people make into the community (e.g., getting groceries, medications) versus the number of discretionary activities (e.g., socializing outside the home) people reported over seven days.

RESULTS

People with mobility impairments were less likely to report a stepped entrance than people without MI, but when the entrance they use the most had steps they reported significantly higher exertion to use the entrance. The presence of steps had no effect on non-discretionary trips (p = .74), but was associated with 49% (p < .01) fewer discretionary activities reported by people with mobility impairment relative to those without MI.

CONCLUSION

Steps at the home entrance of people with mobility impairment may be an important mediating factor in their level of participation. When researchers and practitioners evaluate interventions that aim to increase community participation of people with mobility impairment, they should control for the presence of steps at their home entrance.

Momentary Associations of Osteoarthritis Pain and Affect: Depression as Moderator

OBJECTIVE

This research examined main and moderating effects of global depressive symptoms upon in-the-moment associations of pain and affect among individuals with knee osteoarthritis (OA). Effects of depression on short-term change in pain and affect were also examined.

METHOD

Older adults with physician-confirmed OA (N=325) completed a baseline interview tapping global depressive symptoms, followed by an experience sampling protocol that captured momentary pain and affect 4 times daily for 7 days. Multilevel models controlling demographics and health conditions examined main and moderating effects of depression on momentary associations of pain with positive (PA) and negative affect (NA). Similar methods addressed short-term change in pain and affect. Auxiliary analyses explored broad associations of depressive symptoms with person-level averages and variability in pain and affect.

RESULTS

Global depression predicted current pain, PA, and NA as well as change in pain and affect over a 3-8 hour period. Further, both in the moment and over short periods, the association of pain and NA was stronger among persons higher in depressive symptoms. No moderating effect for the PA-pain association was found. Depressive symptoms were also associated with variability in pain and affect, particularly NA.

DISCUSSION

Results confirm previous work on the relation of chronic pain with both global depressive symptoms and short-term affect. This research further demonstrates a unique moderating role of depression on the association of momentary pain with NA, and suggests that the causal path may be stronger from pain to affect than vice versa.

The Valued Life Activities Scale (VLAs): linguistic validation, cultural adaptation and psychometric testing in people with rheumatic and musculoskeletal diseases in the UK

Background

The Valued Life Activities Scale (VLAs) measures difficulty in daily activities and social participation. With various versions involving a different number of items, we have linguistically and culturally adopted the full VLAs (33-items) and psychometrically tested it in adults with rheumatic and musculoskeletal diseases in the United Kingdom.

Methods

Participants with Rheumatoid Arthritis, Ankylosing Spondylitis, Chronic Pain/ Fibromyalgia, Chronic Hand/ Upper Limb Conditions, Osteoarthritis, Systemic Lupus, Systemic Sclerosis and Primary Sjogren’s Syndrome were recruited from out-patient clinics in National Health Service Hospitals, General Practice and patient organisations in the UK. Phase1 involved linguistic and cultural adaptation: forward translation to British English; synthesis; expert panel review and cognitive debriefing interviews. In Phase2 participants completed postal questionnaires to assess internal construct validity using (i) Confirmatory Factor Analysis (CFA) (ii) Mokken scaling and (iii) Rasch model.

Results

Responders (n = 1544) had mean age of 59 years (SD13.3) and 77.2% women. A CFA failed to support a total score from the 33-items (Chi Square 3552:df 464: p < 0.0001). Mokken scaling indicated a strong non-parametric association between items. Fit to the Rasch model indicated that the VLAs was characterised by multidimensionality and item misfit, which may have been influenced by clusters of residual item correlations. An item banking approach resolved a 25-item calibrated set whose application could accommodate the ‘does not apply to me’ response option.

Conclusions

The UK version of the VLAs failed to satisfy classical and modern psychometric standards for complete item sets. However, as the scale is not usually applied in complete format, an item bank approach calibrated 25 items with fit to the Rasch model. Suitable Computer Adaptive Testing (CAT) software could implement the item set, giving patients the choice of whether an item applies to them, or not.

Profiles of Women With Fibromyalgia and Social Comparison Processes

Background

Due to uncertainty regarding chronic pain in Fibromyalgia (FM) patients, there has been a growing interest in social comparison and its influence on emotional responses.

Aims

to analyze profiles in FM patients according to pain perception, social comparison strategies and anxiety and depression.

Methods

The sample consisted of 131 FM outpatients (Mean age: 50.15, SD = 11.1). Two scales were used: the Social Comparison Illness Scale and the Hospital Anxiety and Depression Scale.

Results

Two profiles were found by cluster analysis (K-means method): one (66%) with a higher level of pain perception, anxiety and depression and greater use of upward contrast and downward identification social comparison; and another (34%) with lower levels of pain perception, anxiety and depression and greater use of upward identification and downward contrast.

Conclusion

These profiles underline the interest in social comparison strategies and their role in FM.

Identification and Treatment Optimization of Comorbid Depression in Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) suffer from high rates of depression but depression often remains undiagnosed and untreated among RA patients. Because of its high prevalence and its profound impact on functional disability and health-related quality of life, prompt recognition and management of comorbid depression is urgently needed in patients with RA. Rheumatologists face the challenge of addressing depression in their clinical interactions with patients. The purpose of this paper is to present the prevalence of comorbid depression in RA, to delineate the consequences of depression among RA patients, to discuss the barriers to the identification of depression among RA patients, and to outline a set of recommendations to identify and treat comorbid depression that could be implemented within the rheumatology clinic setting. A comprehensive approach to the management of both physical and mental health needs of RA patients can aid in improving patient overall quality of life. New clinical protocols should be developed to include routine depression screening as part of the rheumatology visit. Patient education to address misconceptions, knowledge gaps, and destigmatize depression is also recommended. More counseling resources, including emotional support groups, are necessary to provide treatment for those suffering from depression. Such interventions could help mitigate disability, improve quality of life, patient function, and overall satisfaction.

Social and Temporal Comparisons as Moderators of Psychological Resources Associations With Wellbeing

Abstract. The current study investigated the associations of psychological resources, social comparisons, and temporal comparisons with general wellbeing. The sample included 142 community participants (47.9% men; age range 23–83 years), who compared themselves with others, and with their younger selves, on eight dimensions (e.g., physical health, resilience). They also completed questionnaires assessing psychological resources of mastery and self-esteem, and three components of subjective wellbeing: life satisfaction and negative and positive affect. The main results showed that high levels of psychological resources contributed to wellbeing, with self-enhancing social and temporal comparisons moderating the effects of resources on certain wellbeing components. Specifically, under low levels of mastery or self-esteem self-enhancing social or temporal comparisons were related to either higher life satisfaction or positive affect. The results highlight the role of resources and comparisons in promoting people’s wellbeing, and suggest that self-enhancing comparisons function as cognitive coping mechanisms when psychological resources are low.

Social participation in early and established rheumatoid arthritis patients

PURPOSE

The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients.

METHOD

Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere-Terpstra test.

RESULTS

Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group.

CONCLUSIONS

The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.

IMPLICATIONS FOR REHABILITATION

Supporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life. Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation.

Measuring self-esteem after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Self-esteem item bank and short form

OBJECTIVE

To describe the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Self-esteem item bank.

DESIGN

Using a mixed-methods design, we developed and tested a self-esteem item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory-(IRT) based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision.

SETTING

We tested a pool of 30 items at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters/Bronx Department of Veterans Affairs hospital.

PARTICIPANTS

A total of 717 individuals with SCI completed the self-esteem items.

RESULTS

A unidimensional model was observed (CFI=0.946; RMSEA=0.087) and measurement precision was good (theta range between -2.7 and 0.7). Eleven items were flagged for DIF; however, effect sizes were negligible with little practical impact on score estimates. The final calibrated item bank resulted in 23 retained items.

CONCLUSION

This study indicates that the SCI-QOL Self-esteem item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.

Temporal associations between the different domains of rheumatoid arthritis disease activity and the onset of patient-reported depressive symptoms

BACKGROUND

Depression is a frequently occurring comorbid condition in patients with rheumatoid arthritis (RA), and research into the temporal relationships regarding its onset has mainly focused on functional status. The study aim was to examine temporal associations of the diverse measures of RA disease activity with incident self-reports of depressive symptoms.

METHODS

RA patients from the Consortium of Rheumatology Researchers of North America (CORRONA) registry were utilized. Cox regression was used to assess the lagged time-varying association of RA disease activity with the incident onset of depressive symptoms as measured using a single-item depression question. Predictor variables included joint counts, global assessments, pain, function, serum biomarkers, and composite disease activity. Hazard ratios (HRs) comparing categorical quintiles were estimated with 95 % confidence intervals.

RESULTS

Every metric of disease activity, except inflammatory markers, were significantly associated with the self-reported onset of depressive symptoms. Adjusted HRs comparing fifth quintiles to first quintiles were the following: CDAI = 2.3 [2.1-2.7]; pain = 2.3 [2.0-2.6]; SJC = 1.4 [1.4-1.6]. When examining successive self-reports (two consecutive), the magnitude of the associations greatly increased: CDAI = 3.6 [2.5-5.0].

CONCLUSIONS

The data suggest depressive symptom onset in RA patients is related to measures reported by the patient: pain, functional status, and global disease activity; and measures reported by providers, rather than biological markers. The magnitude of the associations, however, were greater for the patient-reported measures when compared to physician assessments, implying that patients' experience of their disease activity may be a precipitating factor of depression onset.

Pain and functional impairment as mediators of the link between medical symptoms and depression in type 2 diabetes

BACKGROUND

Among people with diabetes, depression is more common and is associated with greater morbidity and mortality. A better understanding of mechanisms underlying the link between poor health and depression is needed. Pain and functional impairment may account for the effect of poor health on depression in diabetes.

PURPOSE

The purpose of the study was to examine whether pain and functional impairment mediate the association between diabetes-related medical symptoms and depression in type 2 diabetes.

METHOD

Adults diagnosed with type 2 diabetes (N = 77) completed the following measures: Patient Health Questionnaire (PHQ), Diabetes Symptom Checklist (DSC), and Medical Outcomes Study 12-item Short-Form Health Survey (SF-12). Body mass index (BMI) was computed using height and weight data from medical records. Mediation and linear regression analyses were conducted.

RESULTS

Pain and functional impairment made significant, independent contributions to depression. Functional impairment mediated the link between diabetes-related medical symptoms and depression. Pain mediated the association between higher BMI and depression.

CONCLUSION

Pain and functional impairment appear to play important, independent roles in depression in type 2 diabetes. Mediation analyses suggest the following: 1. diabetes-related medical problems increase functional impairment, which in turn leads to greater depression; and 2. the burden of carrying greater body mass (higher BMI) increases pain, which leads to increased depression.

Adjusting to recent onset of rheumatoid arthritis: a qualitative study

The purpose of this study was to examine men’s and women’s experiences living with rheumatoid arthritis (RA). Using semi-structured, in-depth telephone interviews, nine women and seven men who were recently diagnosed with RA (disease duration < four years) were interviewed about their experiences adjusting to RA. Line-by-line coding using thematic analysis was used to identify themes. Findings from the qualitative analysis revealed six categories emerging from the data: 1. degree of severity of the impact of the disease, 2. appraisal about what the illness means to me, 3. availability of social support, 4. perception of self-efficacious behaviours, 5. use of coping strategies, and 6. RA’s effect on valued life activities. A number of participants described positive thinking about managing their RA; whereas others described negative thinking. Individuals’ appraisals and perceptions about their illness coupled with how their illness affected their ability to fulfill their role responsibilities were important in their adjustment to RA. Social support was also identified as key in learning to live with RA. For individuals with RA, the impact of the disease on their ability to maintain normal life is important, and as such it is vital that healthcare professionals have a better understanding of the perceptions and experiences that individuals have living with RA.

Living with arthritis: using self-management of valued activities to promote health

In this article, we explore how adults with arthritis use self-care strategies in their valued leisure activities, and variations in use based on their access to environmental resources. We conducted six focus groups (N = 34) with adults aged 55 and older with a diagnosis of arthritis. Adults living in residential communities were recruited, with 31% of the sample residing in subsidized housing. Focus group transcripts were analyzed using content analysis based on themes of selective optimization with compensation. We found some differences in strategy use between the resource-rich and resource-poor participants. Adults highlighted the value of their leisure activities and the importance of leisure in maintaining their health and well-being. Our findings point to the need to incorporate leisure education into interventions and programs targeting adults with arthritis.

Effect of Body Mass Index on Affect at Intensities Spanning the Ventilatory Threshold

The aim of this study was to compare acute affective responses at exercise intensities based on the ventilatory threshold between normal weight, overweight, and obese women. 66 sedentary women (22 in each Body Mass Index group) performed a maximal graded treadmill test to measure their maximal oxygen uptake and ventilatory thresholds. Affective valence was compared at intensities spanning the ventilatory threshold (below, at, and above threshold). Affective valence below ventilatory threshold did not differ among the Body Mass Index groups. The obese group had a lower affective response at ventilatory threshold and above ventilatory threshold than the normal weight and overweight groups; the latter two groups did not differ. The obese group had a lower affective response than the normal and overweight groups, which corresponds to a less pleasant experience. Exercise prescriptions for obese subjects targeting intensities below ventilatory threshold can provide a more pleasant experience and may facilitate exercise adherence.

A critical review of the literature on social and leisure activity and wellbeing in later life

An engaged lifestyle is seen as an important component of successful ageing. Many older adults with high participation in social and leisure activities report positive wellbeing, a fact that fuelled the original activity theory and that continues to influence researchers, theorists and practitioners. This study's purpose is to review the conceptualisation and measurement of activity among older adults and the associations reported in the gerontological literature between specific dimensions of activity and wellbeing. We searched published studies that focused on social and leisure activity and wellbeing, and found 42 studies in 44 articles published between 1995 and 2009. They reported from one to 13 activity domains, the majority reporting two or three, such as informal, formal and solitary, or productive versus leisure. Domains associated with subjective wellbeing, health or survival included social, leisure, productive, physical, intellectual, service and solitary activities. Informal social activity has accumulated the most evidence of an influence on wellbeing. Individual descriptors such as gender or physical functioning sometimes moderate these associations, while contextual variables such as choice, meaning or perceived quality play intervening roles. Differences in definitions and measurement make it difficult to draw inferences about this body of evidence on the associations between activity and wellbeing. Activity theory serves as shorthand for these associations, but gerontology must better integrate developmental and psychological constructs into a refined, comprehensive activity theory.

Strength and vulnerability integration: a model of emotional well-being across adulthood

The following article presents the theoretical model of strength and vulnerability integration (SAVI) to explain factors that influence emotion regulation and emotional well-being across adulthood. The model posits that trajectories of adult development are marked by age-related enhancement in the use of strategies that serve to avoid or limit exposure to negative stimuli but by age-related vulnerabilities in situations that elicit high levels of sustained emotional arousal. When older adults avoid or reduce exposure to emotional distress, they often respond better than younger adults; when they experience high levels of sustained emotional arousal, however, age-related advantages in emotional well-being are attenuated, and older adults are hypothesized to have greater difficulties returning to homeostasis. SAVI provides a testable model to understand the literature on emotion and aging and to predict trajectories of emotional experience across the adult life span.

Enabling a survey of primary care to measure the health care experiences of adults with disabilities

PURPOSE

To enable an existing survey on primary care so that it can be used to assess the healthcare experiences reported by adults living with disabilities, and to evaluate its properties.

METHODS

Mixed-methods study. We first identified content areas for measurement as compared to the items in the existing instrument and then developed new candidate items. Cognitive testing was conducted in English and Spanish. After revisions to the primary care instrument based on the cognitive testing results, the draft-enabled instrument was field-tested by mail with telephone follow-up, in English and Spanish.

RESULTS

Consumer focus groups and a technical expert panel identified eight content areas in primary care that are particularly important to maximise function and well-being of people of with disabilities. Cognitive testing also revealed serious problems with several items in the existing survey when answered by or about people with disabilities. Field testing yielded 1086 surveys, of which 40% were completed by a proxy respondent. Learning disabilities were reported by 38% of respondents. Item non-response for revised and new questions was less than 4%.

CONCLUSIONS

It is feasible to enable a survey of primary care and its administration. Survey administration instructions should be modified to accommodate proxy respondents. The screener item to identify people with mobility impairments on walking a distance should be replaced with walking for 6 min. Adding questions from the American Community Survey about functional ability will allow survey sponsors to identify respondents with various limitations, and to compare their experiences to those of people with no limitations. Careful development and testing of the items with input from interested parties throughout the design and testing stages yielded a survey with good psychometric properties and content validity in multiple languages. Health delivery systems can use the survey data to identify clinical processes needing improvement to provide high quality care for people with disabilities.

Satisfaction with current health status in patients with a history of acute coronary syndrome

OBJECTIVE

To describe satisfaction with current health status in patients with a recent history of an acute coronary syndrome (ACS) event and to determine the association between satisfaction and patient-specific variables.

RESEARCH DESIGN AND METHODS

Patients from an ACS registry who were discharged from a university affiliated hospital over a 3-year period were mailed the study questionnaire.

MAIN OUTCOMES MEASURES

Data included demographics, cardiac-specific measures, and general health status (SF-8 PCS, MCS and the EQ-5D VAS) and health status preference weight (EQ-5D Health Index). Satisfaction with current health status was assessed by a single question derived for this study with a 5-point Likert scale from 'not satisfied at all' to 'highly satisfied.' ANOVA determined the association between levels of satisfaction and health status scores. A multivariate linear regression model determined the association of patient, disease, and treatment variables with satisfaction. Independent variables were determined to be significant if the p-value in the model was <0.05.

RESULTS

Respondents (490, 40.3% response rate) averaged 65.2 +/- 11.3 years of age; 71% male; 92% Caucasian; 64% with MI history; and 17% had their most recent cardiac event within 6 months. 63% of respondents were either mostly satisfied or highly satisfied with there current health status. Based on level of satisfaction, the mean PCS ranged from 36.9 +/- 8.9 to 63.0 +/- 6.2; mean MCS from 38.3 +/- 13.1 to 55.7 +/- 5.7; mean EQ-5D VAS from 37.0 +/- 21.7 to 90.8 +/- 20.7, and mean EQ-5D Health Index from 0.38 +/- 0.3 to 0.93 +/- 0.14, all ANOVA models p < 0.001. Statistically significant independent variables in the multivariate linear regression model included the number of symptoms, DASI cardiac function score, perceived severity of disease, and age. Satisfaction with current health state was associated with older age, fewer symptoms, better DASI cardiac function scores, and lower perceived severity of illness.

CONCLUSION

Health-related quality of life, or health status, and satisfaction with health status have a direct, positive association. Greater burden of illness and younger age were significantly associated with dissatisfaction with health status. Extrapolation of results is limited to determining association but not causation due to the cross sectional study design.

Social comparisons and well-being following widowhood and divorce

A sample of 196 participants (mean age 45.94 years, 54% women) completed inventories assessing upward and downward positive and negative social comparisons and general well-being. Widows and widowers were higher on upward negative comparisons than divorced or married persons while being lower on well-being measures of life satisfaction and psychosocial adjustment. The divorced were higher than the widowed or married people on upward or downward positive social comparisons. Upward negative social comparisons were associated with lower levels of well-being measures whereas upward positive social comparisons showed an opposite tendency. Upward negative comparisons were found to mediate the effects of widowhood on well-being. It is concluded that cognitive adaptation contributes to the well-being of widowed and divorced persons.

Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation

Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.

Valued life activity disability played a significant role in self-rated health among adults with chronic health conditions

OBJECTIVE

Because self-rated health (SRH) is strongly associated with health outcomes, it is important to identify factors that individuals take into account when they assess their health. We examined the role of valued life activities (VLAs), the wide range of activities deemed to be important to individuals, in SRH assessments.

STUDY DESIGN AND SETTING

Data were from three cohort studies of individuals with different chronic conditions--rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and chronic obstructive pulmonary disease (COPD). Each cohort's data were collected through structured telephone interviews. Logistic regression analyses identified factors associated with ratings of fair/poor SRH. All analyses included sociodemographic characteristics, general and disease-specific health-related factors, and general measures of physical functioning.

RESULTS

Substantial portions of each group rated their health as fair/poor (RA 37%, SLE 47%, COPD 40%). In each group, VLA disability was strongly associated with fair/poor health (RA: OR=4.44 [1.86,10.62]; SLE: OR=3.60 [2.10,6.16]; COPD: OR=2.76 [1.30,5.85]), even after accounting for covariates.

CONCLUSION

VLA disability appears to play a substantial role in individual perceptions of health, over and above other measures of health status, disease symptoms, and general physical functioning.

Enhancing quality of life in older adults: a comparison of muscular strength and power training

Background

Although progressive resistance strength training (ST) has been found to improve various measures of physical functioning in older adults, the benefit to quality of life is unclear. Additionally, recent evidence suggests that high velocity power training (PT) may be more beneficial for physical functioning than ST, but it is not known whether this type of training impacts quality of life. The purpose of this study was to compare changes in multiple measures of quality of life resulting from ST vs. PT in older adults. A no exercise group was also included as control comparison condition.

Methods

Forty-five older adults (M age = 74.8 years; SD = 5.7) were randomly assigned to either a) PT, b) ST, or c) control group (no exercise). Measures of self-efficacy (SE), satisfaction with physical function (SPF), and the Satisfaction with Life Scale (SWL) were assessed at baseline and following training. The resistance training conditions met 3 times per week for 12 weeks at an intensity of 70% 1 repetition maximum.

Results

A series of ANCOVA's comparing between group differences in change and controlling for baseline values revealed significant group differences in all three measures: SE (F_(2,31) = 9.77; p < .001); SPF (F_(2,32) = 3.36; p = .047); SWL (F_(2,31) = 4.76; p = .016). Follow up analyses indicated that the PT group reported significantly more change in SE, SPF, and SWL than the control group whereas the ST group reported greater change than the control group only in SE.

Conclusion

These pilot data indicate that high velocity power training may influence multiple levels of quality of life over and above the benefits gained through traditional strength training.

Physical activity in prefrail older adults: confidence and satisfaction related to physical function

We examined the hypothesis that physical activity will have favorable effects on measures of self-efficacy for a 400-m walk and satisfaction with physical functioning in older adults 70+ years of age who have deficits in mobility. We randomized a total of 412 adults aged 70-89 years at elevated risk for mobility disability to either a physical activity or a successful aging educational control intervention for 12 months. Participants in the physical activity intervention had more favorable changes in both outcomes as a result of treatment than those in the successful aging intervention. Gender, age, and scores on a short physical performance battery did not moderate these effects. Physical activity is an effective means of intervening on self-efficacy and satisfaction with physical function in older adults with impaired lower extremity functioning. This is an important finding in light of the importance of these process variables in behavior change and quality of life.

Psychological well-being across 1 year with rheumatoid arthritis: coping resources as buffers of perceived stress

OBJECTIVES

Using the transactional model of stress and coping, the present study investigated whether specific coping resources act as buffers of the relationship between perceived stress and psychological well-being among rheumatoid arthritis (RA) patients.

DESIGN

A longitudinal observational study was carried out with assessments at baseline, 6 months and 1 year.

METHODS

Measures of perceived stress, coping resources (optimism/pessimism, social support and explicit active coping strategies) and psychological well-being (anxiety, depression and life satisfaction) were completed by 134 RA patients. Demographics, RA duration, pain, fatigue, functional disability, antidepressant use and physical comorbidities were recorded and statistically controlled for.

RESULTS

Perceived stress had the strongest relationship with psychological well-being at baseline, and affected anxiety after 6 months. Optimism and pessimism predicted psychological well-being across 1 year. Active behavioural coping buffered an association of stress with depression at baseline, while baseline active cognitive coping buffered the effect of baseline stress on life satisfaction after 6 months.

CONCLUSIONS

Patients with RA under greater perceived stress who do not use active coping strategies appear to be at risk of psychological comorbidity and may therefore benefit from interventions teaching specific active coping strategies. Larger observational studies and interventions are required to confirm and extend these findings.

Necessary and Discretionary Activities in Knee Osteoarthritis: Do They Mediate the Pain–Depression Relationship?

OBJECTIVE

This study examined direct vs indirect associations of pain and physical function with depression in 369 older adults with osteoarthritis (OA) of the knee. A key focus was the distinction of functional disability in necessary tasks (basic and instrumental activities of daily living) from discretionary, leisure activities.

DESIGN

A naturalistic longitudinal study examined effects of demographic variables, indicators of arthritis status, general health, pain, and several measures of functional disability upon depressive symptoms at baseline and 1 year later.

SETTING AND PATIENTS

Participants with diagnosed knee OA were recruited from rheumatological and general geriatric outpatient clinics, as well as public service announcements.

OUTCOME MEASURE

Depressive symptoms, measured with the Center for Epidemiologic Studies Depression scale.

RESULTS

At baseline, the relationships of depression with functional disability and activity limitation were wholly mediated by pain. In contrast, activity participation was independently linked with depression, even controlling health and demographic variables. A 1-year follow-up revealed that depressive symptoms increased with increasing health problems, and with reduction in activity participation over time. Having and retaining favorite pastimes were also associated with reduced depressive symptomatology at baseline and follow-up, respectively.

CONCLUSIONS

These data highlight the disease-specific nature of paths among depression, pain, and disability, and the importance of considering discretionary as well as necessary activities in evaluating effects of pain upon quality of life.

Understanding the relationship between obesity and positive and negative affect: the role of psychosocial mechanisms

We examined the relationship between body mass index (BMI) and positive and negative affect, and evaluated whether this relationship is mediated (or suppressed) by physical health, intrusiveness of weight on physical functioning, and distressing interpersonal interactions. Analyses were based on a national sample of more than 3,000 adults ages 25 to 74. Class II (BMI 35-39.9) and Class III (BMI> or =40) obesity were associated with more frequent negative affect and less frequent positive affect, even after demographic and socioeconomic status characteristics were controlled. After the purported pathway variables were controlled, however, obese I persons reported significantly more frequent positive affect, while overweight, obese I, and obese II persons reported significantly less frequent negative affect, compared to normal weight persons. These patterns did not differ significantly by race or gender. Our findings suggest that excessive body weight is not necessarily distressing, yet the physical and interpersonal strains associated with obesity may impair one's mood. We discuss the implications for policy and practice.

Experiences of mothers living with inflammatory arthritis

OBJECTIVE

To describe the impact of chronic, inflammatory arthritis on parenting and to develop a conceptual framework for subsequent study of mothering.

METHODS

A qualitative, grounded theory design guided data collection and analysis. In-depth interviews were conducted with a purposive sample of 12 women with either rheumatoid arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, or systemic lupus erythematosus who were mothers of at least 1 child living at home. Transcripts were analyzed using a systematic approach of coding and forming concepts and key categories to construct an explanatory framework. Peer checking and member checking enhanced analytical rigor.

RESULTS

Analysis of participants' experiences resulted in 4 interrelated categories describing the impact of arthritis on their role as mothers: participation in mothering tasks, best described as "sometimes I can, sometimes I can't"; different types and levels of support from others; the influence of the mother's arthritis on the family; and the challenge of balancing energy and fatigue. Individuals' arthritis story, life stage, their children's developmental stage, and daily routine described the context in which mothers experienced elements of each of the 4 main categories.

CONCLUSION

Inflammatory arthritis has a dramatic impact on the experience of motherhood, with both positive and negative influences. The perspectives shared by study participants may inform practice regarding problem identification and adaptive strategies, and the explanatory model generated from the data proposes hypotheses for further study.

Serious psychological distress in U.S. adults with arthritis

BACKGROUND

Arthritis and mental health disorders are leading causes of disability commonly seen by health care providers. Several studies demonstrate a higher prevalence of anxiety and depression in persons with arthritis versus those without arthritis.

OBJECTIVES

Determine the national prevalence of serious psychological distress (SPD) and frequent anxiety or depression (FAD) in adults with arthritis, and in adults with arthritis, identify risk factors associated with SPD.

METHODS

Cross-sectional data from the 2002 National Health Interview Survey, an in-person household interview survey, were used to estimate the prevalence of SPD and FAD in adults with (n=6,829) and without (n=20,676) arthritis. In adults with arthritis, the association between SPD and sociodemographic, clinical, and functional factors was evaluated using multivariable logistic regression.

RESULTS

The prevalence of SPD and FAD in adults with arthritis is significantly higher than in adults without arthritis (5.6% vs 1.8% and 26.2% vs 10.7%, P<.001, respectively). In adults with arthritis, SPD was significantly associated with younger age, lower socioeconomic status, divorce/separation, recurrent pain, physical inactivity, having functional or social limitations, and having comorbid medical conditions. Adults aged 18 to 44 years were 6.5 times more likely to report SPD than those 65 years or older, and adults with recurrent pain were 3 times more likely to report SPD than those without recurrent pain.

CONCLUSIONS

Serious psychological distress and FAD affect persons with arthritis and should be addressed in their treatment. Younger adults with arthritis, and those with recurrent pain or either functional or social limitations, may be at higher risk for SPD.

Health psychology: psychological adjustment to chronic disease

Chronic diseases carry important psychological and social consequences that demand significant psychological adjustment. The literature is providing increasingly nuanced conceptualizations of adjustment, demonstrating that the experience of chronic disease necessitates adaptation in multiple life domains. Heterogeneity in adjustment is apparent between individuals and across the course of the disease trajectory. Focusing on cancer, cardiovascular disease, and rheumatic diseases, we review longitudinal investigations of distal (socioeconomic variables, culture/ethnicity, and gender-related processes) and proximal (interpersonal relationships, personality attributes, cognitive appraisals, and coping processes) risk and protective factors for adjustment across time. We observe that the past decade has seen a surge in research that is longitudinal in design, involves adequately characterized samples of sufficient size, and includes statistical control for initial values on dependent variables. A progressively convincing characterization of risk and protective factors for favorable adjustment to chronic illness has emerged. We identify critical issues for future research.

Marital closeness, functional disability, and adjustment in late life

Socioemotional selectivity theory (SST) posits that emotionally close relationships are increasingly valued as people perceive constraints on time. Based on SST, this study of 1,532 older married persons hypothesized that emotional dimensions of marriage would more strongly predict adjustment at higher levels of functional disability. High levels of marital closeness were negatively associated with depression and anxiety and positively associated with self-esteem. Consistent with predictions derived from SST, marital closeness moderated the negative psychological effects of high levels of functional disability on depression, anxiety, and self-esteem. Results are discussed in the context of SST and traditional stress-buffering models of social support.

Understanding functioning, disability, and health in rheumatoid arthritis: the basis for rehabilitation care

PURPOSE OF REVIEW

To examine the recent literature on rheumatoid arthritis in relation to functioning and disability, highlighting it from the perspective of the biopsychosocial model of functioning, disability, and health of the World Health Organization. This review focuses on longitudinal studies because they clarify associations found in cross-sectional studies and are useful in shedding light on the mechanisms that explain functioning and disability.

RECENT FINDINGS

The studies that contribute best to understanding of functioning and disability in patients with rheumatoid arthritis are studies that (1) incorporate a comprehensive model to integrate different variables of interest, (2) use a longitudinal design to examine the potential casual relationships among the variables, and (3) use hierarchical regression analyses or path analysis to study the relation among variables.

SUMMARY

It is time to rethink and redefine what should be measured when addressing functioning and disability of patients with rheumatoid arthritis. The use of a universally agreed framework and classification, such as the International Classification of Functioning, Disability and Health, a universally agreed-on comprehensive list of variables potentially relevant to functioning and disability in rheumatoid arthritis, and a greater focus on functioning-oriented versus disability-oriented perspectives constitute a solid foundation for such a rethinking process.

Perceived difficulty, importance, and satisfaction with physical function in COPD patients

BACKGROUND

Research suggests that patients' satisfaction with their physical functioning (SPF) is a critical component of HRQL. This study was designed to examine the extent to which perceptions of physical function and the value placed on physical function are related to satisfaction ratings. The sample consisted of older adults suffering from a progressively debilitating disease, chronic obstructive pulmonary disease (COPD).

METHODS

During baseline assessments, COPD patients participating in a randomized controlled physical activity trial completed measures of SPF, perceived difficulty, and perceived importance.

RESULTS

An ANCOVA controlling for age and gender indicated that perceived difficulty, perceived importance, and their interaction accounted for 43% of the variance in SPF. Additionally, participants were most satisfied with important tasks that they performed with little difficulty. Participants were least satisfied with important tasks that they perceived as highly difficult.

CONCLUSION

The results of the present study indicate that not being able to perform valued tasks produces discontent that is reflected in lower rating of satisfaction with physical functioning. Clearly, the significance of loss in function to individual patients is related to the importance of the functional activities that may be compromised. These data have implications for the scope of patient assessment in clinical care and for the conceptual basis of future research in the area of physical functioning.