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Coady A, Godard R, Holtzman S. Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain. J Health Psychol 2024; 29:52-64. [PMID: 37565664 PMCID: PMC10757395 DOI: 10.1177/13591053231191919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
Pain invalidation (e.g., having pain discounted) is a risk factor for depression among people with chronic pain, but the mechanisms remain unclear. Shame is a common, yet understudied, aspect of the pain experience. This study investigated whether pain-related shame helps explain the relationship between pain discounting and heightened depressive symptoms. The secondary aim was to examine whether social support can protect against the harmful effects of discounting. Patients with chronic pain (N = 305) were recruited from outpatient pain clinics. Participants completed an online cross-sectional survey and data were analyzed using moderated mediation analysis. Greater discounting was associated with greater depressive symptoms, and pain-related shame significantly mediated this relationship. Perceived social support attenuated the relationship between discounting and depressive symptoms. Greater attention towards pain-related shame as a treatment target is needed. Individual- and system-level interventions are required to address pain invalidation and bolster support for this population.
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Gavilán-Carrera B, Geenen R, Hughes C, Barbosa L, Visser M, McVeigh J, Ferreira RJO, Boschloo L, Estévez-López F. NET-RMDs study: networks of fatigue and pain in rheumatic and musculoskeletal diseases - protocol for an international cross-sectional study. BMJ Open 2022; 12:e061099. [PMID: 36379658 PMCID: PMC9668028 DOI: 10.1136/bmjopen-2022-061099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Fatigue and pain are the main symptoms of rheumatic and musculoskeletal diseases (RMDs). Healthcare professionals have a primary role in helping patients to manage both these symptoms, which are part of a complex network of co-occurring factors including sleep problems, psychological distress, social support, body weight, diet, inactive lifestyle and disease activity. The patterns of relationships (networks) between these factors and these symptoms, fatigue and pain, are largely unknown. The current proposal aims to reveal them using network estimation techniques. We will also consider differences in networks for subgroups of people with (1) different RMDs and (2) different clusters (profiles) of biopsychosocial factors. METHODS AND ANALYSIS Adults with at least one RMD will be recruited to this online cross-sectional observational project. To provide a complete overview, a large sample size from different countries will be included. A brief online survey, using 0-10 numeric rating scales will measure, for the past month, levels of fatigue and pain as well as scores on seven biopsychosocial factors. These factors were derived from literature and identified by interviews with patients, health professionals and rheumatologists. Using this input, the steering committee of the project decided the factors to be measured giving priority to those that can be modified in self-management support in community health centres worldwide. Network estimation techniques are used to detect the complex patterns of relationships between these biopsychosocial factors, fatigue and pain; and how these differ for subgroups of people with different RMDs and profiles. ETHICS AND DISSEMINATION Ethical approval of national Institutional Review Boards was obtained. The online survey includes an information letter and informed consent form. The findings will be disseminated via conferences and publications in peer-reviewed scientific journals, while public media channels will be used to inform people with RMDs and other interested parties.
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Affiliation(s)
- Blanca Gavilán-Carrera
- PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Andalucía, Spain
- Departamento de Medicina Interna, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Ciara Hughes
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Belfast, UK
| | - Lourdes Barbosa
- Department of Rheumatology, Hospital Garcia de Orta EPE, Almada, Setúbal, Portugal
| | - Marianne Visser
- EULAR PARE Patient Research Partners, Amsterdam, The Netherlands
| | | | - Ricardo J O Ferreira
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Higher School of Nursing of Lisbon, Lisbon, Portugal
| | - Lynn Boschloo
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Fernando Estévez-López
- Department of Social and Behavioral Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Ghavidel-Parsa B, Khosousi MJ, Tohidi S, Bidari A, Soltani S, Zayeni H, Montazeri A. Validity and reliability of the Persian version of illness invalidation inventory (3*I) among patients with non-inflammatory rheumatic painful disorders. BMC Rheumatol 2022; 6:23. [PMID: 35501881 PMCID: PMC9063106 DOI: 10.1186/s41927-022-00256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Invalidation Illness Inventory (3*I) is an instrument that assesses invalidation (including discounting and lack of understanding dimensions) experienced by patients with rheumatic disorders. This study aimed to translate and validate the 3*I in Iran. METHODS Following translation of the 3*I into the Iranian language (Persian), a cross-sectional study was conducted. A consecutive sample of females with chronic non-inflammatory rheumatic painful diseases completed the questionnaire. Patients also completed the Revised Symptom Impact Questionnaire (SIQR) and the Short Form Health Survey-12 (SF-12). To examine convergent validity, the correlation between the 3*I, the SIQR, and the SF-12 was assessed. The reliability of the 3*I was examined by internal consistency (the Cronbach's alpha coefficient) and intraclass correlation coefficient (ICC). RESULTS In all 196 patients participated in the study. The mean (SD) age of patients was 45.62 ± 10.70 years. Several significant correlations between the Invalidation Illness Inventory (discounting/lack of understanding) with the symptom impact (SIQR) and the short form health survey (SF-12) were observed lending support to the convergent validity of the 3*I. The Cronbach's alpha coefficients were acceptable for most dimensions and sources, ranging from 0.52 to 0.88. Most ICC values for the dimensions of 3*I were above 0.75. CONCLUSIONS The findings indicated that the Persian version of Illness Invalidation Inventory (3*I) is a valid instrument for invalidation assessment in patients with chronic pain. Given the high frequency of perceived invalidation among patients with rheumatic painful disorders, serious attention is needed to the issue in clinical and research settings.
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Affiliation(s)
- Banafsheh Ghavidel-Parsa
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Mohammad-Javad Khosousi
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Sepehr Tohidi
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran
| | - Saman Soltani
- Student Research Committee, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Habib Zayeni
- Rheumatology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ali Montazeri
- Health Metrics Research Centre, Institute for Health Sciences Research, ACECR, Tehran, Iran. .,Faculty of Humanity Sciences, University of Science and Culture, Tehran, Iran.
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Stigma perceived by patients with functional somatic syndromes and its effect on health outcomes - A systematic review. J Psychosom Res 2022; 154:110715. [PMID: 35016138 DOI: 10.1016/j.jpsychores.2021.110715] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Patients with functional somatic syndromes (FSS) experience stigma which arguably affects their health. AIM To determine the presence of perceived stigma and its effects on physical and mental health in patients with FSS compared to patients with comparable explained conditions. METHODS A comprehensive search of PubMed, Embase, PsycINFO, CINAHL and Cochrane Library was performed to select studies focusing on stigma perceived by patients with irritable bowel syndrome (IBS), fibromyalgia (FM) or chronic fatigue syndrome (CFS), comparing these patients to patients with comparable but explained conditions. RESULTS We identified 1931 studies after duplicate removal. After screening we included eight studies: one study about all three FSS, one about IBS, five about FM and one about CFS. We found that patients with IBS did not consistently experience higher levels of stigma than those with a comparable explained condition. Patients with CFS and FM experienced higher levels of stigma compared to patients with comparable explained conditions. All studies showed a correlation between stigma and negative health outcomes. DISCUSSION Patients with FSS experience stigma and negative health outcomes. However, experiencing stigma is not restricted to patients with FSS, as many patients with explained health conditions also experience stigma. Whether stigma has more negative health consequences in patients with FSS compared to patients with explained health conditions remains unclear and should be assessed in future research.
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The Impact of a Peer Social Support Network from the Perspective of Women with Fibromyalgia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312801. [PMID: 34886527 PMCID: PMC8657284 DOI: 10.3390/ijerph182312801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 12/22/2022]
Abstract
Background: Fibromyalgia is a chronic and complex disease whose management by patients requires a high level of commitment. Patient empowerment therefore represents an important milestone in chronic disease treatment and control. We explored the impact of a peer social support network from the perspective of women with fibromyalgia. Methods: A generic qualitative design was proposed for the study, for which women who had been diagnosed with fibromyalgia were purposefully selected. Six semi-structured interviews were conducted, and the collected data were thematically analysed. Results: Three key themes emerged regarding the peer social support network: (1) empowerment (facilitating acceptance of the diagnosis and acting as a source of information); (2) effects on well-being and quality of life (attenuated the stigma, improved physical well-being, provided emotional support and was a socialization medium); and (3), valuable aspects (transmitted feelings of being understood and listened to and increased personal feelings of satisfaction). Conclusions: A peer social support network for women with fibromyalgia exerts positive effects on their physical, mental, and social well-being and empowers them to better manage their disease. Healthcare for women with fibromyalgia should include strategies that connect them through peer social support networks.
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Agala CB, Fried BJ, Thomas JC, Reynolds HW, Lich KH, Whetten K, Zimmer C, Morrissey JP. Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study. BMC Public Health 2020; 20:567. [PMID: 32345253 PMCID: PMC7189687 DOI: 10.1186/s12889-020-08585-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 03/25/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy is critical to the achievement of the third target of the UNAIDS Fast-Track Initiative goals of 2020-2030. Reliable, valid and accurate measurement of adherence are important for correct assessment of adherence and in predicting the efficacy of ART. The Simplified Medication Adherence Questionnaire is a six-item scale which assesses the perception of persons living with HIV about their adherence to ART. Despite recent widespread use, its measurement properties have yet to be carefully documented beyond the original study in Spain. The objective of this paper was to conduct internal consistency reliability, concurrent validity and measurement invariance tests for the SMAQ. METHODS HIV-positive women who were receiving ART services from 51 service providers in two sub-cities of Addis Ababa, Ethiopia completed the SMAQ in a HIV treatment referral network study between 2011 and 2012. Two cross-sections of 402 and 524 female patients of reproductive age, respectively, from the two sub-cities were randomly selected and interviewed at baseline and follow-up. We used Cronbach's coefficient alpha (α) to assess internal consistency reliability, Pearson product-moment correlation (r) to assess concurrent validity and multiple-group confirmatory factor analysis to analyze factorial structure and measurement invariance of the SMAQ. RESULTS All participants were female with a mean age of 33; median: 34 years; range 18-45 years. Cronbach's alphas for the six items of the SMAQ were 0.66, 0.68, 0.75 and 0.75 for T1 control, T1 intervention, T2 control, and T2 intervention groups, respectively. Pearson correlation coefficients were 0.78, 0.49, 0.52, 0.48, 0.76 and 0.80 for items 1 to 6, respectively, between T1 compared to T2. We found invariance for factor loadings, observed item intercepts and factor variances, also known as strong measurement invariance, when we compared latent adherence levels between and across patient-groups. CONCLUSIONS Our results show that the six-item SMAQ scale has adequate reliability and validity indices for this sample, in addition to being invariant across comparison groups. The findings of this study strengthen the evidence in support of the increasing use of SMAQ by interventionists and researchers to examine, pool and compare adherence scores across groups and time periods.
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Affiliation(s)
- Chris B. Agala
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Bruce J. Fried
- Health Policy & Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina United States of America
| | - James C. Thomas
- MEASURE Evaluation and Epidemiology Department, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Heidi W. Reynolds
- MEASURE Evaluation, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Kristen Hassmiller Lich
- Health Policy & Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina United States of America
| | - Kathryn Whetten
- Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina United States of America
| | - Catherine Zimmer
- Odum Institute for Research in Social Science, University of North Carolina, Chapel Hill, North Carolina United States of America
| | - Joseph P. Morrissey
- Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina United States of America
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Galvez-Sánchez CM, Reyes del Paso GA. Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives. J Clin Med 2020; 9:E1219. [PMID: 32340369 PMCID: PMC7230253 DOI: 10.3390/jcm9041219] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 04/11/2020] [Accepted: 04/13/2020] [Indexed: 12/21/2022] Open
Abstract
Fibromyalgia syndrome (FMS) is a chronic illness characterized by widespread pain and other clinical and emotional symptoms. The lack of objective markers of the illness has been a persistent problem in FMS research, clinical management, and social recognition of the disease. A critical historical revision of diagnostic criteria for FMS, especially those formulated by the American College of Rheumatology (ACR), was performed. This narrative review has been structured as follows: Introduction; historical background of FMS, including studies proposing and revising the diagnostic criteria; the process of development of the ACR FMS diagnostic criteria (1990 and 2010 versions); revisions of the 2010 ACR FMS diagnostic criteria; the development of scales based on the 2010 and 2011 criteria, which could help with diagnosis and evaluation of the clinical severity of the disease, such as the Polysymptomatic Distress Scale and the FMS Survey Questionnaire; relationships of prevalence and sex ratio with the different diagnostic criteria; validity and diagnostic accuracy of the ACR FMS criteria; the issues of differential diagnosis and comorbidity; the strength and main limitations of the ACR FMS criteria; new perspectives regarding FMS diagnosis; and the impact of the novel findings in the diagnosis of FMS. It is concluded that despite the official 2010 FMS diagnostic criteria and the diagnostic proposal of 2011 and 2016, complaints from health professionals and patients continue.
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Validating Invalidation: Examining the Construct Validity of the Illness Invalidation Inventory Among Individuals With Chronic Low Back Pain. Clin J Pain 2020; 36:344-351. [PMID: 32068539 DOI: 10.1097/ajp.0000000000000817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Illness Invalidation Inventory (3*I) was designed to assess individuals' perceived invalidation regarding chronic pain experiences. However, no study has yet investigated the psychometric properties of the 3*I among individuals with chronic low back pain (CLBP). Given the personal and societal impact of CLBP and the potential for invalidation associated with this condition, the current study sought to examine the psychometric properties of the 3*I among individuals with CLBP. MATERIALS AND METHODS Community-dwelling adults with CLBP living in the Southwestern United States (N=134) completed the 3*I. In line with previous literature, current analyses focused on the 3*I "family members" subscale. Exploratory and confirmatory factor analysis was performed on participant responses. Hierarchical linear regression analyses examined the relationship between the identified factors and participant self-reported pain severity, disability, and depression. RESULTS Exploratory factor analysis conducted on the 3*I "family members" subscale found 2 factors with high internal consistency (α>0.70) that cumulatively accounted for 49.04% of the variance in scores. Consistent with previous findings, factor loadings suggested that these factors correspond to "discounting" and "lack of understanding." Subsequent confirmatory factor analysis found that this 2-factor model demonstrated a good fit with the data. Greater perceived discounting by family members was associated with greater pain severity, disability, and depression. DISCUSSION The 2-factor model of the 3*I "family members" subscale identified in the current study reflects previous findings and extends the psychometric validity of the 3*I to a US multiethnic sample of individuals with CLBP.
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Pulido-Martos M, Luque-Reca O, Segura-Jiménez V, Álvarez-Gallardo IC, Soriano-Maldonado A, Acosta-Manzano P, Gavilán-Carrera B, McVeigh JG, Geenen R, Delgado-Fernández M, Estévez-López F. Physical and psychological paths toward less severe fibromyalgia: A structural equation model. Ann Phys Rehabil Med 2019; 63:46-52. [PMID: 31386910 DOI: 10.1016/j.rehab.2019.06.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/12/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Previous research suggested isolated associations of physical and psychological factors with fibromyalgia severity. Integration of physical and psychological, experienced and observed, modifiable factors associated with fibromyalgia severity in a single model will reveal therapeutic paths toward less severity of disease. We aimed to examine an encompassing model of determinants of fibromyalgia severity. METHODS This observational, population-based cross-sectional study included 569 people with fibromyalgia. An integrative model of fibromyalgia severity was tested by using structural equation modelling. This model included 8 factors: resilience, catastrophizing, active lifestyle, declarative memory, subjective fitness, objective fitness, psychological distress, and physical fatigue. RESULTS Two core paths were associated with reduced fibromyalgia severity: 1) a psychological path connecting high resilience and low catastrophizing with low distress and 2) a physical path, connecting a more active lifestyle (directly and via high objective and subjective physical fitness) with low fatigue. Additional interconnecting paths especially suggested a connection from the psychological to physical path. Our model explained 83% of the fibromyalgia severity. CONCLUSIONS The present model integrated the complexity of mutually influencing factors of fibromyalgia severity, which may help to better understand the disease. It emphasised the importance of: 1) physical factors and psychological factors and their interconnections, 2) patients' experiences and clinical measurements, and 3) positive and negative signs such as physical fitness and distress. Future longitudinal and experimental research should aim at testing the causal direction of the associations in the model as well as the clinical implications suggested by the model. For instance, to reduce fatigue, exercise should enhance not only objective fitness but also fitness-related perceptions. Reducing distress and fatigue seems crucial for lowering fibromyalgia severity.
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Affiliation(s)
- Manuel Pulido-Martos
- Department of Psychology, Faculty of Humanities and Education Sciences, University of Jaén, Jaén, Spain
| | - Octavio Luque-Reca
- Facultad de Educación y Psicología, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - Víctor Segura-Jiménez
- Department of Physical Education, Faculty of Education Sciences, University of Cádiz, Cádiz, Spain
| | | | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain; SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Pedro Acosta-Manzano
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Blanca Gavilán-Carrera
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Joseph G McVeigh
- Physiotherapy, School of Clinical Therapies, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Rinie Geenen
- Department of Psychology, Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Fernando Estévez-López
- Department of Psychology, Child and Adolescent Psychiatry/Psychology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Leon L, Redondo M, Fernández-Nebro A, Gómez S, Loza E, Montoro M, Garcia-Vicuña R, Galindo M. Expert recommendations on the psychological needs of patients with rheumatoid arthritis. Rheumatol Int 2018; 38:2167-2182. [PMID: 29808295 DOI: 10.1007/s00296-018-4057-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/17/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To establish feasible and practical recommendations for the management of the psychological needs of patients with rheumatoid arthritis (RA) from the moment of diagnosis through the course of the disease. METHODS A nominal group meeting was held with an RA expert team including rheumatologists and psychologists, at which a guided discussion addressed the most important psychological and emotional needs in RA. Based on the comments collected, and a literature review, a matrix document of recommendations for telematics discussion was prepared, as well as a Delphi survey to test agreement with these recommendations. Agreement was defined if at least 80% of participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grading of recommendations was established following the Oxford criteria, and the degree of agreement through the Delphi. RESULTS Thirteen recommendations were established, addressing several key processes: (1) identification of psychological problems and needs in patients with RA, and a guideline for their management in daily practice; (2) communication with patients; (3) referral criteria to mental health professionals. CONCLUSIONS These recommendations are intended to help health care professionals openly address the psychological aspects of patients in daily practice to follow and treat them properly.
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Affiliation(s)
- Leticia Leon
- Rheumatology Unit, IDISSC, San Carlos Clinical Hospital, Madrid, Spain.,Faculty of Heath Sciences, Camilo José Cela University, Madrid, Spain
| | - Marta Redondo
- Faculty of Heath Sciences, Camilo José Cela University, Madrid, Spain
| | - Antonio Fernández-Nebro
- Rheumatology Clinical Management Unit, Biomedical Research Institute in Malaga (IBIMA), Regional University Hospital in Malaga, University of Malaga, Malaga, Spain
| | - Susana Gómez
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | | | - María Montoro
- Pfizer Medical Department, Alcobendas, Madrid, Spain
| | | | - María Galindo
- Rheumatology Service, 12 de Octubre University Hospital, Av. Cordoba, s/n, 28041, Madrid, Spain.
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Cameron N, Kool M, Estévez-López F, López-Chicheri I, Geenen R. The potential buffering role of self-efficacy and pain acceptance against invalidation in rheumatic diseases. Rheumatol Int 2017; 38:283-291. [PMID: 29086068 PMCID: PMC5773646 DOI: 10.1007/s00296-017-3859-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/19/2017] [Indexed: 01/13/2023]
Abstract
A substantial amount of people with a rheumatic disease perceive invalidation consisting of lack of understanding and discounting (negative social responses). To get insight into the potential buffering role of self-efficacy and pain acceptance against invalidation, this cross-sectional study examined associations between these variables. Spanish speaking people (N = 1153, 91% female, mean age 45 ± 11 years) with one or multiple rheumatic diseases completed online the Illness Invalidation Inventory, the Chronic Pain Acceptance Questionnaire, and the Chronic Disease Self-Efficacy Scale. Higher self-efficacy (t = − 4.80, p = < 0.001) and pain acceptance (t = − 7.99, p = < 0.001) were additively associated with discounting. Higher self-efficacy (t = − 5.41, p = < 0.001) and pain acceptance (t = − 5.71, p = < 0.001) were also additively associated with lack of understanding. The combined occurrence of high self-efficacy and high acceptance was associated most clearly with lower lack of understanding (interaction: t = − 2.12, p = 0.034). The findings suggest the usefulness of examining whether interventions aimed at increasing self-efficacy and pain acceptance can help people with rheumatic diseases for whom invalidation is a considerable burden.
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Affiliation(s)
- Nigel Cameron
- Department of Psychology, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands
| | - Marianne Kool
- Association of Dutch Burn Centres, Beverwijk, The Netherlands
| | - Fernando Estévez-López
- Department of Psychology, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands.,Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | | | - Rinie Geenen
- Department of Psychology, Utrecht University, Heidelberglaan 1, 3584CS, Utrecht, The Netherlands.
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Santiago MG, Marques A, Kool M, Geenen R, da Silva JAP. Invalidation in Patients with Rheumatic Diseases: Clinical and Psychological Framework. J Rheumatol 2017; 44:512-518. [DOI: 10.3899/jrheum.160559] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 12/19/2022]
Abstract
Objective.The term “invalidation” refers to the patients’ perception that their medical condition is not recognized by the social environment. Invalidation can be a major issue in patients’ lives, adding a significant burden to symptoms and limitations while increasing the risk of physical and psychological disability. In this study in patients with rheumatic diseases, we investigated the relationship between invalidation and sociodemographic, clinical, psychological, and personality characteristics.Methods.This international cross-sectional study included 562 adults with rheumatoid arthritis (n = 124), spondyloarthritis (n = 85), systemic lupus erythematosus (n = 112), or fibromyalgia (FM; n = 241). Assessed were the family and health professionals subscales of the Illness Invalidation Inventory (3*I), happiness (Subjective Happiness Scale), personality (Ten-Item Personality Inventory), pain, and loneliness (numerical rating scales). Univariate and multivariate analyses were used to test different models.Results.Invalidation occurred in all rheumatic diseases, but patients with FM reported the most invalidation. Including all correlated variables in the multivariate model, pain remained as a determinant of invalidation by health professionals, but not by family. Regarding psychological variables, loneliness remained as a determinant of invalidation by family, but not by health professionals. FM and low levels of happiness, agreeableness, and conscientiousness were associated with invalidation while taking account of other variables.Conclusion.Invalidation occurs in all rheumatic diseases and patients with FM experience the most invalidation. Psychological factors (happiness, agreeableness, and conscientiousness), loneliness, and pain intensity are associated with invalidation, irrespective of the rheumatic disease and may deserve dedicated interventions.
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Trost Z, Van Ryckeghem D, Scott W, Guck A, Vervoort T. The Effect of Perceived Injustice on Appraisals of Physical Activity: An Examination of the Mediating Role of Attention Bias to Pain in a Chronic Low Back Pain Sample. THE JOURNAL OF PAIN 2016; 17:1207-1216. [DOI: 10.1016/j.jpain.2016.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 07/18/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
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Estévez-López F, Pulido-Martos M, Armitage CJ, Wearden A, Álvarez-Gallardo IC, Arrayás-Grajera MJ, Girela-Rejón MJ, Carbonell-Baeza A, Aparicio VA, Geenen R, Delgado-Fernández M, Segura-Jiménez V. Factor structure of the Positive and Negative Affect Schedule (PANAS) in adult women with fibromyalgia from Southern Spain: the al-Ándalus project. PeerJ 2016; 4:e1822. [PMID: 27047704 PMCID: PMC4817417 DOI: 10.7717/peerj.1822] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 02/26/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Fibromyalgia is a syndrome characterized by the presence of widespread chronic pain. People with fibromyalgia report lower levels of Positive Affect and higher levels of Negative Affect than non-fibromyalgia peers. The Positive and Negative Affect Schedule (PANAS)-a widely used questionnaire to assess two core domains of affect; namely 'Positive Affect' and 'Negative Affect' -has a controversial factor structure varying across studies. The internal structure of a measurement instrument has an impact on the meaning and validity of its score. Therefore, the aim of the present study was to assess the structural construct validity of the PANAS in adult women with fibromyalgia. METHODS This population-based cross-sectional study included 442 adult women with fibromyalgia (age: 51.3 ± 7.4 years old) from Andalusia (Southern Spain). Confirmatory factor analyses were conducted to test the factor structure of the PANAS. RESULTS A structure with two correlated factors (Positive Affect and Negative Affect) obtained the best fit; S-B χ(2) = 288.49, df = 155, p < .001; RMSEA = .04; 90% CI of RMSEA = (.036, .052); the best fit SRMR = .05; CFI = .96; CAIC = -810.66, respectively. CONCLUSIONS The present study demonstrates that both Positive Affect and Negative Affect are core dimensions of affect in adult women with fibromyalgia. A structure with two correlated factors of the PANAS emerged from our sample of women with fibromyalgia from Andalusia (Southern Spain). In this model, the amount of variance shared by Positive Affect and Negative Affect was small. Therefore, our findings support to use and interpret the Positive Affect and Negative Affect subscales of the PANAS as separate factors that are associated but distinctive as well.
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Affiliation(s)
- Fernando Estévez-López
- Department of Physical Education and Sport,
Faculty of Sport Sciences, University of Granada,
Granada, Spain
- Department of Psychology, Faculty of Social
and Behavioural Sciences, Utrecht University,
Utrecht, The Netherlands
| | - Manuel Pulido-Martos
- Department of Psychology, Faculty of
Humanities and Education Sciences, University of Jaén,
Jaén, Spain
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology,
School of Psychological Sciences, Manchester Academic Health Science Centre,
University of Manchester, Manchester,
United Kingdom
| | - Alison Wearden
- Manchester Centre for Health Psychology,
School of Psychological Sciences, Manchester Academic Health Science Centre,
University of Manchester, Manchester,
United Kingdom
| | | | - Manuel Javier Arrayás-Grajera
- Department of Physical Education, Music and
Fine Arts, Faculty of Education Sciences, University of Huelva,
Huelva, Spain
| | - María J. Girela-Rejón
- Department of Physical Education and Sport,
Faculty of Sport Sciences, University of Granada,
Granada, Spain
| | - Ana Carbonell-Baeza
- Department of Physical Education, Faculty
of Education Sciences, University of Cádiz,
Cádiz, Spain
| | - Virginia A. Aparicio
- Department of Physiology and Institute of
Nutrition and Food Technology, Faculty of Pharmacy, University of
Granada, Granada,
Spain
- Department of Public and Occupational
Health, EMGO+ Institute for Health and Care Research, VU University Medical
Care, Amsterdam, The
Netherlands
| | - Rinie Geenen
- Department of Psychology, Faculty of Social
and Behavioural Sciences, Utrecht University,
Utrecht, The Netherlands
| | - Manuel Delgado-Fernández
- Department of Physical Education and Sport,
Faculty of Sport Sciences, University of Granada,
Granada, Spain
| | - Víctor Segura-Jiménez
- Department of Physical Education and Sport,
Faculty of Sport Sciences, University of Granada,
Granada, Spain
- Department of Physical Education, Faculty
of Education Sciences, University of Cádiz,
Cádiz, Spain
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15
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van Middendorp H, Kool MB, van Beugen S, Denollet J, Lumley MA, Geenen R. Prevalence and relevance of Type D personality in fibromyalgia. Gen Hosp Psychiatry 2016; 39:66-72. [PMID: 26804772 DOI: 10.1016/j.genhosppsych.2015.11.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/30/2015] [Accepted: 11/16/2015] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Distressed (Type D) personality, combining high negative affectivity and social inhibition, is linked to poor health in various populations. Because patients with fibromyalgia experience high negative affect and show signs of social inhibition, this study aimed to examine the prevalence of Type D's components and their associations with health in an additive (worse health with both components present) or synergistic way (components amplifying each other's effects). METHOD Type D personality and physical and mental health were assessed online by 558 patients with self-reported fibromyalgia (94% women, age 47 ± 11 (21-77)years) by the Type D Scale-14 and RAND-36 Health Status Inventory. RESULTS Using the standard cutscores, Type D personality was present in 56.5% of patients. Negative affectivity alone and combined with social inhibition was associated with worse mental and, more limited, physical health, but no interactive (synergistic) associations were found. CONCLUSIONS Type D personality in fibromyalgia exceeds prevalence estimates in general, cardiovascular and chronic pain populations. Some indication of an additive but not of a synergistic effect was found, particularly for mental health, with clearly the largest associations for negative affectivity. The high prevalence of Type D's components may have specific treatment implications.
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Affiliation(s)
- Henriët van Middendorp
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands; Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
| | - Marianne B Kool
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
| | - Sylvia van Beugen
- Health, Medical, and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands.
| | - Johan Denollet
- Department of Medical and Clinical Psychology, Tilburg University, The Netherlands.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, USA.
| | - Rinie Geenen
- Department of Clinical and Health Psychology, Utrecht University, The Netherlands; Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, The Netherlands.
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16
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Overman CL, Kool MB, Da Silva JAP, Geenen R. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol 2015; 35:409-15. [PMID: 26272057 PMCID: PMC4752960 DOI: 10.1007/s10067-015-3035-6] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 11/26/2022]
Abstract
Fatigue is a common, disabling, and difficult-to-manage problem in rheumatic diseases. Prevalence estimates of fatigue within rheumatic diseases vary considerably. Data on the prevalence of severe fatigue across multiple rheumatic diseases using a similar instrument is missing. Our aim was to provide an overview of the prevalence of severe fatigue across a broad range of rheumatic diseases and to examine its association with clinical and demographic variables. Online questionnaires were filled out by an international sample of 6120 patients (88 % female, mean age 47) encompassing 30 different rheumatic diseases. Fatigue was measured with the RAND(SF)-36 Vitality scale. A score of ≤35 was taken as representing severe fatigue (90 % sensitivity and 81 % specificity for chronic fatigue syndrome). Severe fatigue was present in 41 to 57 % of patients with a single inflammatory rheumatic disease such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, Sjögren's syndrome, psoriatic arthritis, and scleroderma. Severe fatigue was least prevalent in patients with osteoarthritis (35 %) and most prevalent in patients with fibromyalgia (82 %). In logistic regression analysis, severe fatigue was associated with having fibromyalgia, having multiple rheumatic diseases without fibromyalgia, younger age, lower education, and language (French: highest prevalence; Dutch: lowest prevalence). In conclusion, one out of every two patients with a rheumatic disease is severely fatigued. As severe fatigue is detrimental to the patient, the near environment, and society at large, unraveling the underlying mechanisms of fatigue and developing optimal treatment should be top priorities in rheumatologic research and practice.
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Affiliation(s)
- Cécile L Overman
- Department of Clinical and Health Psychology, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands.
| | - Marianne B Kool
- Department of Clinical and Health Psychology, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands
| | - José A P Da Silva
- Department of Rheumatology, Hospitais da Universidade de Coimbra, 3000-075, Coimbra, Portugal
| | - Rinie Geenen
- Department of Clinical and Health Psychology, Utrecht University, PO Box 80.140, 3508 TC, Utrecht, The Netherlands
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, PO Box 85.500, 3508 GA, Utrecht, The Netherlands
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17
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Boyington JEA, Schoster B, Callahan LF. Comparisons of Body Image Perceptions of a Sample of Black and White Women with Rheumatoid Arthritis and Fibromyalgia in the US. Open Rheumatol J 2015; 9:1-7. [PMID: 25674181 PMCID: PMC4319189 DOI: 10.2174/1874312901409010001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 12/03/2014] [Accepted: 12/06/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To explore the disease-related, body image (BI) perceptions of women diagnosed with, rheumatoid arthritis (RA) and fibromyalgia (FM). METHODS A purposive sample of twenty-seven females participated in individual semi-structured phone interviews to elicit BI perceptions relative to pain, activity limitations and coping measures. Sessions were digitally recorded, transcribed verbatim, and content analyzed. RESULTS Body image perceptions relative to 5 major themes emerged in the analysis. They focused on Pain, Disease Impact on Physical and Mental Function, Weight, Diseased-Induced Fears and, Coping measures. Pain was a common experience of all participants. Other troubling factors verbalized by participants included dislike and shame of visibly affected body parts, and disease-induced social, psychological and physical limitations. RA participants thought that manifested joint changes, such as swelling and redness, undergirded their prompt diagnosis and receipt of health care. Contrarily, women with fibromyalgia perceived that the lack of visible, disease-related, physical signs led to a discounting of their disease, which led to delayed health care and subsequent frustrations and anger. All but one participant used prayer and meditation as a coping measure. CONCLUSION The body image perceptions evidenced by the majority of participants were generally negative and included specific focus on their disease-affected body parts (e.g. joints), mental function, self-identity, health care experiences, activity limitations and overall quality of life. Given the global effect of RA and FM, assessment and integration of findings about the BI perceptions of individuals with FM and RA may help define suitable interdisciplinary strategies for managing these conditions and improving participants' quality of life.
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Affiliation(s)
| | - Britta Schoster
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA ; Division of Rheumatology ; Department of Medicine, UNC, Chapel Hill, NC, USA ; Department of Social Medicine, UNC, Chapel Hill, NC, USA
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18
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Pirjo J, Arman M. Translation and cultural adaptation of the Illness Invalidation Inventory for use in Sweden. BMC Psychol 2014; 2:57. [PMID: 25685355 PMCID: PMC4297439 DOI: 10.1186/s40359-014-0057-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 12/19/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study describes the translation and cultural adaptation procedure and guidelines for the Illness Invalidation Inventory for use in Sweden. Invalidation includes responses to negative social interactions and to the lack of positive social interactions, responses that can negatively affect health and suffering. Although invalidation is a recognized phenomenon, in Sweden no instruments exist that describe and measure invalidation. To this end, this study evaluates the translation and adaptation of the Illness Invalidation Inventory as an instrument for measuring invalidation in a Swedish context. METHODS Internationally recognized ten-step guidelines were used. Both forward and back translations were performed. Patients from a patient organization for chronic pain were recruited and cognitive interviews were performed using concurrent think aloud protocols, probing techniques and observations of behaviour. Analysis of data collected from cognitive interviews was inspired by the generic response model and a centralized review procedure and thorough documentation was emphasized. RESULTS Although difficulties regarding concepts were found, these issues were solved during the process. The Swedish version contains the same number of items as the original questionnaire. Four of eight items required revision after cognitive interviews. CONCLUSIONS The study highlights the importance of using guidelines to produce translations and to ensure validity and results. The results indicate that the Illness Invalidation Inventory can be used in Sweden to measure invalidation.
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Affiliation(s)
- Järemo Pirjo
- Department of Neurobiology Care Sciences and Society (NVS) Karolinska Institutet, Huddinge, S-141 83 Sweden
| | - Maria Arman
- Department of Neurobiology Care Sciences and Society (NVS) Karolinska Institutet, Huddinge, S-141 83 Sweden
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