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Landgren E, Mogard E, Bremander A, Lindqvist E, Nylander M, Larsson I. Belonging, happiness, freedom and empowerment-a qualitative study of patients' understanding of health in early rheumatoid arthritis. BMC Rheumatol 2024; 8:29. [PMID: 38937849 PMCID: PMC11212251 DOI: 10.1186/s41927-024-00399-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/12/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory joint disease, that influences patients' health in different ways, including physical, social, emotional, and psychological aspects. The goal of rheumatology care is to achieve optimal health and personalised care and therefore, it is essential to understand what health means for patients in the early course of RA. The aim of this study was to describe the understanding of health among patients with early RA. METHODS The study had a descriptive qualitative design with a phenomenographic approach. Phenomenography is used to analyse, describe, and understand various ways people understand or experience a phenomenon, in this study, patients' understandings of health. Individual semi-structured interviews were conducted with 31 patients (22 women and nine men, aged (38-80) with early RA, defined as a disease duration of < 1 year, and disease-modifying anti-rheumatic drugs (DMARDs) for 3-7 months. The phenomenographic analysis was conducted in 7 steps, and the outcome space presents the variation in understanding and the interrelation among categories. In accordance with the European Alliance of Associations for Rheumatology's (EULAR) recommendations, a patient research partner participated in all phases of the study. RESULTS The analysis revealed four main descriptive categories: 'Health as belonging' was described as experiencing a sense of coherence. 'Health as happiness' was understood as feeling joy in everyday life. 'Health as freedom' was understood as feeling independent. 'Health as empowerment' was understood as feeling capable. Essential health aspects in early RA are comprised of a sense of coherence, joy, independence, and the capability to manage everyday life. CONCLUSIONS This study revealed that patients' perception of health in early RA encompasses various facets, including a sense of belonging, happiness, freedom, and empowerment. It highlighted that health is multifaceted and personal, emphasizing the importance of acknowledging this diversity in providing person-centred care. The findings can guide healthcare professionals to deepen patients' participation in treatment goals, which may lead to better treatment adherence and health outcomes.
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Affiliation(s)
- Ellen Landgren
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden.
- Department of Rheumatology, Skåne University Hospital, Lund, SE-221 85, Sweden.
- Spenshult Research and Development Centre, Halmstad, Sweden.
| | - Elisabeth Mogard
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Ann Bremander
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sonderborg, Denmark
| | - Elisabet Lindqvist
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Rheumatology, Skåne University Hospital, Lund, SE-221 85, Sweden
| | - Maria Nylander
- Spenshult Research and Development Centre, Halmstad, Sweden
- Swedish Rheumatism Association, Stockholm, Sweden
| | - Ingrid Larsson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Blum NS, Esbensen BA, Østergaard M, Bremander A, Hendricks O, Lindgren LH, Andersen L, Jensen KV, Primdahl J. Patients' experience of a novel interdisciplinary nurse-led self-management intervention (INSELMA)-a qualitative evaluation. BMC Rheumatol 2024; 8:10. [PMID: 38429851 PMCID: PMC10905856 DOI: 10.1186/s41927-024-00379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/09/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Despite continuous improvements in anti-rheumatic pharmacological treatment, people with chronic inflammatory arthritis still report substantial disease impact. Based on the framework for complex interventions, we thus developed INSELMA, a novel nurse-coordinated multidisciplinary self-management intervention for patients with rheumatoid arthritis, psoriatic arthritis or axial spondyloarthritis. Based on individual biopsychosocial assessments, a rheumatology nurse facilitated goal setting and coordinated interdisciplinary support. The aim of this study was to explore the patients' experience of participating in the six-months INSELMA intervention. METHODS Individual semi-structured interviews were conducted with 15 of the participants after their final follow-up. Thematic analysis was applied. RESULTS The analysis derived four overall themes. (1) A new opportunity at the right time. The participants' disease impacted all areas of daily life. Participation in INSELMA was experienced as an opportunity to improve symptoms and together reduce long-held challenges they had fought alone, until now. (2) The importance of person-centred goals. The participants found it meaningful to work with their individual goals, which encompassed physical, psychological, and social factors. Having time between consultations to work with goals at home was important. (3) Empathy, partnership and a little nudging from health professionals are essential. The empathic nurses' continuous support and coaching helped participants become aware of their own resources. The participants highlighted having access to support from a physiotherapist and occupational therapist with rheumatology experience as important. (4) I got more than I could have hoped for. Most of the participants experienced decreased symptom load and improvement in physical strength, mobility, sleep, and mood as well as increased energy, knowledge, and self-management ability. The participants expressed new hope for the future with an improved ability to manage their symptoms and work towards new goals. CONCLUSION The participants found the INSELMA intervention meaningful and feasible. They experienced decreased disease impact and increased activity levels, facilitated by empathy and self-management support from health professionals.
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Affiliation(s)
- Nadine Schäffer Blum
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark.
| | - Bente Appel Esbensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ann Bremander
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Section of Rheumatology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Spenshult Research and Development Centre, Halmstad, Sweden
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Oliver Hendricks
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Luise Holberg Lindgren
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
| | - Lena Andersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Patient research partner, Nyborg, Denmark
| | - Kim Vilbaek Jensen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Rigshospitalet, Glostrup, Denmark
- Patient research partner, Helsingør, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- University Hospital of Southern Denmark, Aabenraa, Denmark
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Westland H, Kuiper S, van den Bovenkamp C, Blaas E, Jaarsma T. How do patients with rheumatoid arthritis perceive their self-care and self-care support? A mixed-method study. J Adv Nurs 2024. [PMID: 38366696 DOI: 10.1111/jan.16103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
AIM To explore self-care and needs and preferences towards tailored self-care support of patients with rheumatoid arthritis at the outpatient clinic. DESIGN A sequential explanatory mixed method design. METHODS The Self-Care of Chronic Illness Inventory questionnaire, two focus groups and six semi-structured interviews were conducted between November 2021 and April 2023. Questionnaires of 107 patients were descriptively analysed. Subsequently, 11 patients and 2 healthcare professionals participated in the focus groups and 6 patients in the interviews, which were thematically analysed. RESULTS Quantitative and qualitative data corresponded and showed that patients perform various self-care activities at an adequate level and have strategies to exert control and reduce symptoms. One key theme emerged: 'Not only being the person with rheumatoid arthritis' (RA) as patients primarily aim to get on with their lives. Nine subthemes covered self-care activities for maintaining health including staying physically active, finding the right medication and dose and adapting their diet. Patients differed in how they self-monitored their symptoms. Recognizing symptoms and finding strategies to manage symptoms included the process of body listening in which patient seek and try different strategies to find what works for them and incorporate routines. Patients experienced positive effects of a warm or cold environment. Patients felt the need for practical and emotional support from others and preferred having credible information. CONCLUSION Patients perform adequate self-care including a diversity of self-care activities to get on with their lives and have strategies to reduce and control the symptoms and impact of RA. IMPLICATIONS Tailoring self-care support to patients' individual needs and preferences is necessary to help patients cope with the erratic nature of the disease and maintain their quality of life. Healthcare providers need to provide practical and emotional support and use credible information to allow patients to make self-care decisions to manage their lives. REPORTING METHODS Quantitative finding are reported according to the STROBE guidelines and qualitative finding are reported according to the COREQ guidelines. WHAT DOES THIS PAPER ADD Patients perform various self-care activities at an adequate level and have strategies to exert control and reduce symptoms. Patients primarily aim to continue their lives and not being seen as the person with rheumatoid arthritis. Healthcare professionals need to provide practical and emotional support and use credible information to inform patients' self-care decision-making. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Heleen Westland
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stefan Kuiper
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cheryl van den Bovenkamp
- KGW Nursing Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Etienne Blaas
- Division Internal Medicine and Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tiny Jaarsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Bergström M, Larsson Ranada Å, Sverker A, Thyberg I, Björk M. A dyadic exploration of support in everyday life of persons with RA and their significant others. Scand J Occup Ther 2023; 30:616-627. [PMID: 34846249 DOI: 10.1080/11038128.2021.2007997] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/22/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Support from significant others is important for participation in everyday life for persons with rheumatoid arthritis (RA). Meanwhile, significant others also experience limitations. AIMS To explore how support is expressed by persons with RA and significant others, and how support relates to participation in everyday life of persons with RA. MATERIAL AND METHODS Sixteen persons with RA and their significant others participated in individual semi-structured interviews. The material was analyzed using dyadic analysis. RESULTS Persons with RA and significant others reported that RA and support had become natural parts of everyday life, especially emotional support. The reciprocal dynamics of support were also expressed as imperative. Also, support from people outside of the dyads and well-functioning communication facilitated everyday life. CONCLUSIONS Significant others and the support they give are prominent factors and facilitators in everyday life of persons with RA. Concurrently, the support persons with RA provide is important, along with support from outside of the dyads. SIGNIFICANCE The results indicate that the interaction between persons with RA and the social environment is central to gain insight into how support should be provided for optimal participation in everyday life. Significant others can preferably be more involved in the rehabilitation process.
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Affiliation(s)
- Maria Bergström
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Åsa Larsson Ranada
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Annette Sverker
- Department of Activity and Health and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Thyberg
- Department of Rheumatology in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mathilda Björk
- Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Lindgren LH, Thomsen T, de Thurah A, Aadahl M, Hetland ML, Kristensen SD, Esbensen BA. Newly diagnosed with inflammatory arthritis (NISMA)-development of a complex self-management intervention. BMC Health Serv Res 2023; 23:123. [PMID: 36750937 PMCID: PMC9902823 DOI: 10.1186/s12913-022-09007-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/23/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Patients newly diagnosed with inflammatory arthritis (IA) request regular consultations and support from health professionals to manage physiological, emotional, and social challenges. Evidence suggests that providing a tailored multi-component self-management program may benefit disease management. However, there is a lack of evidence of effective interventions with multiple components targeting the needs of this group. Therefore, the aim of this study was to develop a self-management intervention targeting newly diagnosed patients with IA, following the Medical Research Council (MRC) framework for developing complex interventions. METHODS The development of the complex self-management intervention covered three steps. First, the evidence base was identified through literature reviews, in which we described a preliminary nurse-led intervention. Secondly, we chose Social Cognitive Theory as the underlying theory along with Acceptance and Commitment Theory to support our communication strategy. Thirdly, the preliminary intervention was discussed and further developed in workshops to ensure that the intervention was in accordance with patients' needs and feasible in clinical practice. RESULTS The developed intervention comprises a 9-month nurse-led intervention (four individual and two group sessions). A physiotherapist and an occupational therapist will attend the group sessions along with the nurse. All sessions should target IA-specific self-management with a particular focus on medical, role, and emotional management. CONCLUSION Through the workshops, we involved all levels of the organization to optimize the intervention, but also to create ownership and commitment, and to identify barriers and shortcomings of the preliminary intervention. As a result, from the existing evidence, we believe that we have identified effective mechanisms to increase self-management in people newly diagnosed with IA. Further, we believe that the involvement of various stakeholders has contributed significantly to developing a relevant and feasible intervention. The intervention is a nurse-led complex self-management intervention embedded in a multidisciplinary team (named NISMA). The intervention is currently being tested in a feasibility study.
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Affiliation(s)
- L. H. Lindgren
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark
| | - T. Thomsen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.512917.9Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - A. de Thurah
- grid.154185.c0000 0004 0512 597XDepartment of Rheumatology, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M. Aadahl
- grid.512917.9Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M. L. Hetland
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - B. A. Esbensen
- grid.475435.4Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 17, 2600 Glostrup, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Khoo T, Jones B, Chin A, Terrett A, Voshaar M, Hoogland W, March L, Beaton D, Gazel U, Shea B, Tugwell P, Flurey CA, Proudman S. Defining independence: A scoping review by the OMERACT patient perspective of remission in rheumatoid arthritis group. Semin Arthritis Rheum 2023; 58:152152. [PMID: 36543070 DOI: 10.1016/j.semarthrit.2022.152152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022]
Abstract
AIMS The Outcome Measures in Rheumatology Trials (OMERACT) Remission in Rheumatoid Arthritis (RA) patient perspective working group has previously found that patients prioritised independence, pain, and fatigue as key domains of remission in RA. However, there is currently no clear definition of independence. Consequently, this scoping review aimed to explore how independence is represented in the RA literature. METHODS A comprehensive search of the EMBASE, Medline, and PsycInfo databases was performed for publications that used independence or autonomy as a disease activity measure, description of disease in remission or treatment outcome. Papers were included if they involved adult participants and were written in English, with no restrictions on study design or publication year. Two reviewers (TK and AC, AT or BJ) independently screened the abstracts. A thematic approach was applied to derive common definitions and descriptions of independence. RESULTS 660 articles were identified, of which 58 (25 qualitative, 28 quantitative, one mixed, and four reviews) met the inclusion criteria. 86% of total participants were female. Ten publications referenced remission. Independence took many forms; in addition to physical and functional capability, it was described in relation to work, social activities, autonomy in healthcare, and household activities. Four common themes describing independence were identified: 1. A return to a state before arthritis. 2. Being physically and functionally able. 3. A sense of freedom without needing to rely on others. 4. Having control over the organisation of one's life. CONCLUSION Although independence is frequently mentioned in the RA literature, it has various meanings, lacks a consistent definition, and is a concept rarely applied to remission. It is multi-factorial, exceeding functional ability alone, and contextualised within sociodemographic and disease factors. This scoping review provides common descriptions of independence to inform future qualitative work towards the development of an outcome measure of independence for the assessment of RA in remission.
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Affiliation(s)
- Thomas Khoo
- Rheumatology Unit, Flinders Medical Centre, South Australia, Australia.
| | - Bethan Jones
- Faculty of Health and Applied Sciences, University of the West of England, United Kingdom
| | - Athena Chin
- Rheumatology Unit, Flinders Medical Centre, South Australia, Australia
| | - Alice Terrett
- Rheumatology Unit, Royal Adelaide Hospital, South Australia, Australia
| | - Marieke Voshaar
- Department of Pharmacy and Department of Research & Innovation, Sint Maartenskliniek and Department of Pharmacy, Radboud University Medical Centre, Nijmegen, The Netherlands; OMERACT Patient Research Partner, the Netherlands
| | | | - Lyn March
- Sydney Medical School, Institute of Bone and Joint Research, and Department of Rheumatology, Royal North Shore Hospital, St Leonards, Australia
| | - Dorcas Beaton
- Insititute of Work and Health, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Ummugulsum Gazel
- Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa, Canada
| | - Beverley Shea
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa, Canada
| | - Caroline-A Flurey
- Faculty of Health and Applied Sciences, University of the West of England, United Kingdom
| | - Susanna Proudman
- Rheumatology Unit, Royal Adelaide Hospital, South Australia, Australia; Discipline of Medicine, University of Adelaide, South Australia, Australia
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"My Pain Is Unbearable…I Cannot Recognize Myself!" Emotions, Cognitions, and Behaviors of People Living With Musculoskeletal Disorders: An Umbrella Review. J Orthop Sports Phys Ther 2022; 52:243-A102. [PMID: 35536247 DOI: 10.2519/jospt.2022.10707] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To summarize (1) the emotions, cognitions, and behaviors of people who are living with musculoskeletal disorders related to symptoms and (2) the interactions of emotions, cognitions, and behaviors with the person's environment (family, social, and work roles). DESIGN An umbrella review of qualitative research syntheses and meta-summaries (metasynthesis, meta-ethnographies, meta-aggregation, meta-summary). LITERATURE SEARCH We searched CINAHL, EMBASE, PsycARTICLES, PsycEXTRA, PsycINFO, PubMed, and PubPsych from database inception to January 2021. We also searched gray literature via Open Grey and Google Scholar. STUDY SELECTION CRITERIA We included qualitative evidence syntheses evaluating adults with musculoskeletal disorders, based on the multidimensional diagnostic criteria for acute and chronic pain. Emotions, cognitions, and behaviors were the phenomenon of interest. DATA SYNTHESIS We developed 3 categories of themes ([1] emotions, [2] cognitions, and [3] behaviors) for each objective. We selected the 3 most common emotions, cognitions, and behaviors that appear as themes in our narrative synthesis. RESULTS We included 20 qualitative evidence syntheses that retrieved 284 original qualitative studies. Despair, distress, and fear were the main emotions reported by people living with musculoskeletal disorders. The alterations of the self and how people described their symptoms, what caused them, and how the symptoms impacted their lives were the most common cognitions. Cognitive strategies (ie, acceptance) and perceptions about social support emerged. People often used passive behaviors (eg, social isolation or hiding symptoms) to cope with the challenges that arose related to musculoskeletal symptoms. However, some people actively faced their symptoms, planning their activities or practicing them despite their symptoms. CONCLUSION Clinicians who support people living with musculoskeletal disorders should consider (1) assessing other emotions than pain-related fear (eg, despair and distress), (2) observing their cognitive responses (ie, acceptance), and (3) evaluating what type of behaviors people use (eg, active or passive). J Orthop Sports Phys Ther 2022;52(5):243-261. doi:10.2519/jospt.2022.10707.
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Larsson I, Bremander A, Andersson M. Patient Empowerment and Associations with Disease Activity and Pain-Related and Lifestyle Factors in Patients With Rheumatoid Arthritis. ACR Open Rheumatol 2021; 3:842-849. [PMID: 34523815 PMCID: PMC8672186 DOI: 10.1002/acr2.11341] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/16/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Empowerment is important to patients with rheumatoid arthritis (RA) because most care is in the form of self-management. The aim was to study levels of empowerment and associated variables in patients with RA and to investigate longitudinal clinical data in patients with low and high empowerment. METHODS A postal survey was sent in 2017 to patients with RA from the BARFOT (Better Anti-Rheumatic Pharmacotherapy) cohort that included questions about disease activity, pain-related factors, lifestyle habits, and contained the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23). The 844 patients who answered the SWE-RES-23 made up the cohort of the present study. Differences in level of empowerment between groups (low, moderate, and high empowerment) were analyzed with ANOVA. Logistic regression analysis was used to study variables associated with low empowerment. Thirdly, we performed comparisons in longitudinal data (15 years) of disease activity, pain, and physical function between the three empowerment groups (low, moderate, and high empowerment). RESULTS Patients with low empowerment (n = 282) were significantly older, more often women, and reported worse pain-related factors and physical function and lower moderate and vigorous physical activity compared with those with high empowerment (n = 270). An analysis of longitudinal data found that patients with low empowerment had worse pain and physical function at all time points. CONCLUSION Patients with low empowerment have more pain-related symptoms, poorer physical function, and are less physically active. To promote patient empowerment in rehabilitation interventions it is important to identify and support self-management.
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Affiliation(s)
- Ingrid Larsson
- Spenshult Research and Development Centre and Halmstad University, Halmstad, Sweden, and Lund UniversityLundSweden
| | - Ann Bremander
- Spenshult Research and Development Center, Halmstad, Sweden, and Lund University, Lund, Sweden, and University of Southern Denmark, Odense, Denmark, and Danish Hospital for Rheumatic Diseases, University Hospital of Southern DenmarkSønderborgDenmark
| | - Maria Andersson
- Spenshult Research and Development Centre, Halmstad, Sweden, and Lund UniversityLundSweden
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