Arthritis beliefs and self‐care in an urban American Indian population

Objective

To describe beliefs and self‐care strategies of American Indians with chronic arthritis joint pain.

Method

In‐depth interviews were conducted with a convenience sample of urban‐dwelling American Indians (n = 56) concerning self‐care and beliefs about arthritis; objective measures of arthritis disease activity were obtained through standardized interview protocols.

Results

Joint pain was not generally assumed to be arthritis nor directly related to aging. Belief that chronic pain affecting multiple joints was a serious and unexpected condition oriented American Indians' decisions to seek medical attention. However, verbal communications about pain may be subtle or under emphasized. Few coping strategies were used to control either chronic or episodic pain.

Conclusions

Chronic arthritis pain may not be optimally managed in this population. Cultural assessment should recognize that American Indian patients may understate serious symptoms. Community educational interventions should target this population to enhance self‐care, pain management, and communication of arthritis symptoms to physicians.

     

Arthritic pain among Latinos: Results from a community‐based survey

Objective

To examine factors associated with pain among Latinos with arthritis, identify common coping strategies and potentially effective interventions, and determine whether pain levels affect the level of interest in potentially useful programs.

Methods

Using a convenience sampling approach and a combination of face‐to‐face and telephone surveys, 588 Latino adults in Oregon with arthritis were interviewed. The intensity of pain during a typical day was assessed using a scale ranging from 0 (no pain) to 10 (worst pain). A score of ≥7 was defined as severe pain.

Results

More than 60% of Latinos reported severe pain. Results from an ordinary least square regression indicated that among Latinos with arthritis, women, those with lower levels of education, and those reporting poor or fair self‐rated health and functional limitations had higher levels of pain, after controlling for confounders. Those with severe pain were more likely than those with lower levels of pain to use over the counter medicine and home remedies to manage their arthritis. In addition, Latinos with greater pain were more likely to be interested in arthritis management programs.

Conclusion

These findings have important implications for public health policy. The strong interest of Latinos in various arthritis and joint pain management programs could prove to be an important avenue for supporting a population with high levels of arthritic pain and lack of health insurance. These pain management programs are all the more appealing, given the availability of a number of evidence‐based, low‐cost interventions.     

Volunteers' experiences of becoming arthritis self‐management lay leaders: “It's almost as if I've stopped aging and started to get younger!”

Objective

To determine whether undergoing training to become a lay leader and conducting an arthritis self‐management course is associated with improvements in physical and psychological health status, arthritis self‐efficacy, use of self‐management techniques, and visits to the general practitioner. In addition, we aimed to describe the experiences of training and course delivery from the older volunteers' perspective.

Methods

21 participants completed all assessments and had a median age of 58, median disease duration of 10 years, and either osteoarthritis (n = 13) or rheumatoid arthritis (n = 8). The study was a pretest–posttest design with qualitative data collected at 3 points in time: before training, 6 weeks after training, and 6 months after training. Quantitative data were collected through self‐administered postal questionnaires at baseline and 6‐month followup.

Result

Six months after training, participants reported small, significant increases in arthritis self‐efficacy for pain (P = 0.002), cognitive symptom management (P = 0.004), and communication with their physician (P = 0.024) and a small, significant decrease in depressed mood (P = 0.04). Qualitative data supported these findings, with participants reporting more confidence, happiness, and a changed outlook on life in general. Volunteerism was associated with altruistic behavior and with filling the vocational void caused by retirement.

Conclusion

Findings support the value of volunteerism and training to become lay leaders in arthritis self‐management programs. Volunteers reported positive changes both in themselves and in course participants. They enjoyed helping similar others and being involved in a worthwhile activity, and they valued their newly acquired status as lay leaders. Many had begun to apply their newfound knowledge about self‐management to their own situation, reporting less pain and more willingness “to get on with life.”

     

Arthritis onset and worsening self‐rated health: A longitudinal evaluation of the role of pain and activity limitations

Objective

To longitudinally explore the hypothesized role of worsening pain and development of activity limitations as mediators in the relationship between arthritis onset and worsening self‐rated health (SRH).

Methods

Data was obtained from the 1998/1999 and 2000/2001 cycles of the population‐based Canadian longitudinal National Population Health Survey (n = 10,859; ages ≥18; response rate: time 1 = 81.6%, time 2 = 89.2%). Respondents were asked about chronic conditions, pain, activity limitations, and self‐perceived health; change over time was assessed. Change in effect of arthritis onset on worsening SRH upon considering potential mediators was assessed through multivariate logistic regression, controlling for sociodemographic characteristics and onset of other conditions.

Results

Worsening pain fully explained the effect of arthritis onset on worsening SRH; a portion of the effect of worsening pain was mediated by the development of activity limitation. Residual direct effect of arthritis onset was statistically insignificant. Worsening pain and development of activity limitations also mediated a portion of the effects of onset of other chronic conditions but to a lesser extent than arthritis onset.

Conclusion

This is the first study to examine these relationships longitudinally. Identifying the role of mediators is necessary if target areas of prevention and/or management are sought, either at the individual or population level. Our results indicate that the development of arthritis has a significant impact on worsening SRH. Pain and development of activity limitations fully account for the relationship between arthritis onset and worsening SRH. High priority should be placed on prevention and management strategies for pain among people with arthritis.

     

A patient‐centered perspective on surgery avoidance for hip or knee arthritis: Lessons for the future

Objective

Research indicates that there is a discrepancy between need and patient preference for total joint arthroplasty (TJA), an efficacious and cost‐effective treatment for severe hip or knee arthritis. To understand this discrepancy, we conducted qualitative research to assess the illness perceptions and preferred accommodations and coping strategies of patients with advanced osteoarthritis who had expressed a preference to avoid TJA.

Methods

In‐depth interviews were conducted with a community sample of 29 men and women who were medically assessed as appropriate candidates for TJA but who had expressed a preference to avoid surgery. Inductive content analysis of text data was used to examine how patients' illness perceptions and preferred coping strategies related to surgery preference.

Results

Participants frequently rejected the medicalization of arthritis, normalizing the experience of functional decline and defining it as age normative. Participants drew on a broad set of previous experiences with informal and formal care to make decisions about how to manage their condition. Previous negative encounters in medical and surgical care, including those from a distant past or those experienced vicariously, combined with the perception (reinforced by physicians and others) that doing nothing was a viable option deterred arthritis‐related help seeking in the health care system.

Conclusion

Individuals with arthritis may benefit from additional counseling regarding effective medical and surgical treatments. Physicians may better meet patient needs by gauging patient preferences for a combination of self‐management strategies and medical interventions.     

Comparison of health‐related outcomes for arthritis,chronic joint symptoms,and sporadic joint symptoms: A population‐based study

Objective

To examine predictors and health outcomes for individuals reporting arthritis, chronic joint symptoms (CJS), or sporadic joint symptoms (SJS) compared to those without arthritis or joint symptoms.

Methods

Data from the 2008 Canadian Community Health Survey (n = 63,134, ages ≥15 years) were used for the analyses. Respondents not reporting arthritis as a long‐term chronic health condition diagnosed by a health professional were asked about joint symptoms, excluding the back and neck, over the past 12 months and whether these symptoms were present on most days in the past month (CJS) or not (SJS). Log Poisson regression was used to estimate prevalence ratios (PRs) for reporting arthritis, CJS, and SJS, and for reporting health outcomes (physical activity, pain that limits activity, activity limitation, poor/fair self‐rated health, and poor/fair self‐rated mental health) and health service use (visits to primary care physicians, specialists, physiotherapists, and chiropractors, and overnight hospital stays).

Results

Arthritis was reported by 16.0% of the population, CJS by 10.1%, and SJS by 11.6%. Individuals with arthritis were older than those with CJS or SJS. Women reported arthritis and CJS more often. After adjusting for age, sex, socioeconomic status, lifestyle factors, and comorbidities, PRs of all outcomes were higher for the arthritis and CJS groups than the SJS group, with no significant differences in PRs for the arthritis and CJS groups, except for pain that limits activity.

Conclusion

CJS were reported by 10% of the adult population. Similarities in outcomes to arthritis suggest that CJS have a substantial impact in the population, and that arthritis management advice is likely needed for this group.     

Effect of self-efficacy and physical activity goal achievement on arthritis pain and quality of life in patients with rheumatoid arthritis

Objective

To examine physical activity and achievement of physical activity goals in relation to self‐reported pain and quality of life among patients with rheumatoid arthritis (RA).

Methods

At baseline, 271 patients with RA were asked to specify a physical activity goal, and filled in questionnaires assessing physical activity, motivation, and self‐efficacy for physical activity, arthritis pain, and quality of life. Six months later, patients indicated to what extent they had achieved their baseline physical activity goal and completed the same set of questionnaires. These data were used to construct multiple mediation models that placed physical activity and physical activity goal achievement as mediators between self‐efficacy and motivation on one hand, and arthritis pain and quality of life on the other.

Results

A total of 106 patients with RA completed both questionnaires. Self‐efficacy at baseline predicted subsequent level of physical activity and achievement of physical activity goals. Goal achievement had a direct effect upon quality of life outcomes. Bootstrapping confidence intervals revealed indirect effects of self‐efficacy upon arthritis pain and quality of life through goal achievement, but not through physical activity.

Conclusion

Higher levels of self‐efficacy for physical activity increase the likelihood that patients will achieve their physical activity goals. Achievement of physical activity goals seems to be related to lower self‐reported arthritis pain, and higher levels of quality of life. In practice, clinicians can foster self‐efficacy and goal achievement by assisting patients in setting realistic and attainable exercise goals, developing action plans, and by providing feedback on goal progress.     

Arthritis beliefs and self-care in an urban American Indian population

OBJECTIVE: To describe beliefs and self-care strategies of American Indians with chronic arthritis joint pain. METHOD: In-depth interviews were conducted with a convenience sample of urban-dwelling American Indians (n = 56) concerning self-care and beliefs about arthritis; objective measures of arthritis disease activity were obtained through standardized interview protocols. RESULTS: Joint pain was not generally assumed to be arthritis nor directly related to aging. Belief that chronic pain affecting multiple joints was a serious and unexpected condition oriented American Indians' decisions to seek medical attention. However, verbal communications about pain may be subtle or under emphasized. Few coping strategies were used to control either chronic or episodic pain. CONCLUSIONS: Chronic arthritis pain may not be optimally managed in this population. Cultural assessment should recognize that American Indian patients may understate serious symptoms. Community educational interventions should target this population to enhance self-care, pain management, and communication of arthritis symptoms to physicians.     

Self-management strategies in overweight and obese Canadians with arthritis

Objective

To estimate the prevalence of overweight and obese Canadians with arthritis and to describe their use of arthritis self‐management strategies, as well as explore the factors associated with not engaging in any self‐management strategies.

Methods

Respondents to the 2009 Survey on Living with Chronic Diseases in Canada, a nationally representative sample of 4,565 Canadians age ≥20 years reporting health professional–diagnosed arthritis (including more than 100 rheumatic diseases and conditions), were asked about the impact of their arthritis and how it was managed. Among the overweight (body mass index [BMI] 25–29.9 kg/m²) and obese (BMI ≥30 kg/m²) individuals with arthritis (n = 2,869), the use of arthritis self‐management strategies (i.e., exercise, weight control/loss, classes, and community‐based programs) were analyzed. Log binomial regression analyses were used to examine factors associated with engaging in none versus any (≥1) of the 4 strategies.

Results

More than one‐quarter (27.4%) of Canadians with arthritis were obese and an additional 39.9% were overweight. The overweight and obese individuals with arthritis were mostly female (59.5%), age ≥45 years (89.7%), and reported postsecondary education (69.0%). While most reported engagement in at least 1 self‐management strategy (84.9%), less than half (45.6%) engaged in both weight control/loss and exercise. Factors independently associated with not engaging in any self‐management strategies included lower education, not taking medications for arthritis, and no clinical recommendations from a health professional.

Conclusion

Fewer than half of the overweight and obese Canadians with arthritis engaged in both weight control/loss and exercise. The provision of targeted clinical recommendations (particularly low in individuals that did not engage in any self‐management strategies) may help to facilitate participation.     

Assessing the need for arthritis training among paid carers in UK residential care homes: A focus group and interview study

Objective

The aim of the study was to perform an educational and training needs assessment for arthritis care in residential homes.

Methods

Qualitative data were collected from three purposively selected residential homes: one independent, one in a regional chain and one in a national chain. Three researcher‐led focus groups were conducted with paid carers (N = 22) using vignette exercises; interviews were undertaken with 12 residents with joint pain (N = 12), five managerial staff and two general practitioners (GPs). Data were compared and analysed thematically around care practices, communication and training.

Results

There is a lack of arthritis awareness among paid carers, although they regularly identify and manage arthritic symptoms. Residents rely on paid carers to recognize when pain and mobility problems are treatable. Senior staff and GPs rely on carers to identify arthritic problems. However, paid carers themselves undervalued the health significance of their activities and lacked the confidence to communicate important information to healthcare professionals. Few of the paid carers had received training in arthritis and many expressed a strong desire to learn about it, to improve their ability to provide better care.

Conclusions

Education for paid carers regarding arthritis is lacking and lags behind education about conditions such as dementia and diabetes. To meet the expectations of their care roles fully, paid carers require an awareness of what arthritis is and how to recognize symptoms. We suggest that training should be aimed at improving confidence in communicating with colleagues, residents and health professionals, with senior care staff receiving more in‐depth training.     

The FOOTSTEP self‐management foot care programme: Are rheumatoid arthritis patients physically able to participate?

Background: The FOOTSTEP self‐management foot care programme is a clinical and cost‐effective programme for basic foot care in the elderly. The aim of this study was to determine if patients with rheumatoid arthritis (RA) would be physically able to participate. Methods: A consecutive cohort of RA patients undergoing podiatry care underwent tests for sight, reach and grip strength to determine their physical ability to undertake self‐managed foot care. Results: Thirty RA patients (10 male, 20 female), with a median age of 61 years (range 42 to 84) and disease duration of 10 years (range one to 40), were recruited. All patients passed the sight test, whereas the reach and grip tests were passed by 77% and 67% of patients, respectively. Only 57% of patients passed all the physical tests. Patients who failed the physical tests were older, and had longer disease duration and higher physical disability, pain and general health scores but these were not statistically different. Conclusions: Just over half the patients in this present cohort may be physically able to undertake some aspects of self‐managed foot care, including nail clipping and filing, callus filing and daily hygiene and inspection. Copyright © 2008 John Wiley & Sons, Ltd.     

The internet‐based arthritis self‐management program: A one‐year randomized trial for patients with arthritis or fibromyalgia

Objective

To determine the efficacy of an Internet‐based Arthritis Self‐Management Program (ASMP) as a resource for arthritis patients unable or unwilling to attend small‐group ASMPs, which have proven effective in changing health‐related behaviors and improving health status measures.

Methods

Randomized intervention participants were compared with usual care controls at 6 months and 1 year using repeated‐measures analyses of variance. Patients with rheumatoid arthritis, osteoarthritis, or fibromyalgia and Internet and e‐mail access (n = 855) were randomized to an intervention (n = 433) or usual care control (n = 422) group. Measures included 6 health status variables (pain, fatigue, activity limitation, health distress, disability, and self‐reported global health), 4 health behaviors (aerobic exercise, stretching and strengthening exercise, practice of stress management, and communication with physicians), 5 utilization variables (physician visits, emergency room visits, chiropractic visits, physical therapist visits, and nights in hospital), and self‐efficacy.

Results

At 1 year, the intervention group significantly improved in 4 of 6 health status measures and self‐efficacy. No significant differences in health behaviors or health care utilization were found.

Conclusion

The Internet‐based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small‐group ASMP.     

Changes in self‐efficacy and health status over 5 years: A longitudinal observational study of 306 patients with rheumatoid arthritis

Objective

To investigate changes in self‐efficacy and health status over 5 years in patients with rheumatoid arthritis (RA), the relationships between these changes, and the influence of baseline values on subsequent changes.

Methods

306 adult patients with RA, born in 1926 or later, were examined by questionnaire in 1994 and again in 1999. We analyzed data regarding pain (visual analogue scale [VAS], Arthritis Impact Measurement Scale [AIMS2] symptom scale, Short Form‐36 [SF‐36] pain scale), fatigue (VAS, SF‐36 vitality scale), mental distress (AIMS2 affect scale, SF‐36 mental health scale) and self‐efficacy (Arthritis Self‐Efficacy Scales for pain and for other symptoms).

Results

On group level, all health status measures were numerically somewhat improved, and self‐efficacy slightly reduced. Changes in self‐efficacy and in corresponding health status measures were significantly correlated. For patients with above average educational level self‐efficacy for pain at baseline was positively correlated to improvement in pain measures. Good mental health at baseline was correlated to improvement in self‐efficacy for other symptoms, but only for patients with below average educational level.

Conclusion

Baseline self‐efficacy seems to influence future level of perceived pain and baseline mental health status seems to influence future self‐efficacy. These associations seem to be affected by level of education.

     

Developing recommendations for implementing the Australian Pain Society's pain management strategies in residential aged care

Objective: This study aimed to develop recommendations and a related implementation resource ‘toolkit’ to facilitate implementation of pain management strategies in Australian Residential Aged Care Facilities (RACFs). Methods: This qualitative study used written materials, focus groups and individual interviews to gather data from participants. Thirty‐four health‐care professionals with experience in the aged care sector were recruited from five Western Australian RACFs. General practitioners who had an interest in aged care were contacted via local general practice networks. Results: Findings indicated that focused education sessions were needed to support implementation. A tailored toolkit was developed to assist the process. Funding and workforce constraints were found to be threats to complete implementation in some facilities. Conclusions: A multifaceted approach is needed to promote the implementation of pain management strategies in RACFs. In particular, unlicensed care workers, who may have responsibility for recognising and reporting signs of pain, require further education to support their role in the pain management process.     

Factors related to self-efficacy in persons with scleroderma

Purpose: Scleroderma (SSc) is rare, and few studies have examined self‐efficacy in persons with the disease. Self‐efficacy is one precursor that has been shown to initiate changes in behaviour when managing chronic disease. The objective of this study was to explore the levels of self‐efficacy in persons with SSc, compare self‐efficacy in persons with limited or diffuse SSc and determine correlations between self‐efficacy, physical function and psychological variables. Methods: Sixty‐two participants with SSc completed measures assessing self‐efficacy, depression, fatigue, pain, hand function and activity limitations. The mean age of participants was 52.9 years. The mean educational level was 15.8 years. Sixty‐seven per cent were married and 87.1% were women. Thirty participants had diffuse SSc, 27 had limited SSc and five were unclassified. Results: The only significant differences between the two disease subtypes were in hand function and self‐efficacy function subscale scores. Total self‐efficacy scores significantly correlated with marital status, employment, self‐reported health, depression, functional ability, fatigue, pain and hand function. Similarly, self‐efficacy function scale scores correlated significantly with employment, self‐reported health, functional ability, pain and hand function. Self‐efficacy pain scale scores correlated significantly with fatigability. The self‐efficacy other scale scores correlated significantly with depression and fatigability. Participants with higher levels of pain and depression, more fatigue, more general disability and more hand disability had lower self‐efficacy. Conclusion: Self‐efficacy correlates with physical function and psychological variables, and could predict how patients manage their health. Self‐efficacy may increase through participation in educational programmes focusing on self‐management of these variables. Copyright © 2010 John Wiley & Sons, Ltd.     

A review of evidence about behavioural and psychological aspects of chronic joint pain among people with haemophilia

Joint pain related to haemophilia affects large numbers of people and has a significant impact on their quality of life. This article reviews evidence about behavioural and psychological aspects of joint pain in haemophilia, and considers that evidence in the context of research on other chronic pain conditions. The aim is to inform initiatives to improve pain self‐management among people with haemophilia (PWH). Reduced pain intensity predicts better physical quality of life, so better pain management should lead to improved physical quality of life. Increased pain acceptance predicts better mental quality of life, so acceptance‐based approaches to self‐management could potentially be adapted for PWH. Pain self‐management interventions could include elements designed to: improve assessment of pain; increase understanding of the difference between acute and chronic pain; improve adherence to clotting factor treatment; improve knowledge and understanding about the benefits and costs of using pain medications; improve judgements about what is excessive use of pain medication; increase motivation to self‐manage pain; reduce negative emotional thinking about pain; and increase pain acceptance. The influence of behavioural and psychological factors related to pain are similar in haemophilia and other chronic pain conditions, so there should be scope for self‐management approaches and interventions developed for other chronic pain conditions to be adapted for haemophilia, provided that careful account is taken of the need to respond promptly to acute bleeding pain by administering clotting factor.     

Redesigning care for chronic conditions: improving hospital‐based ambulatory care for people with osteoarthritis of the hip and knee

Background: Osteoarthritis of the hip and knee is a highly prevalent chronic condition in Australia that commonly affects older people who have other comorbidities. We report the pilot implementation of a new chronic disease management osteoarthritis service, which was multidisciplinary, evidence‐based, supported patient self‐management and care coordination. Methods: A musculoskeletal coordinator role was pivotal to service redesign and osteoarthritis pathway implementation. Impact evaluation included: service utilization, patient and general practitioner service experience, a ‘before and after’ audit of clinician adherence to recommendations, and 3‐ and 6‐month patient health outcomes (pain, physical function, patient and physician global health (Visual Analogue Scale), disability (Multi‐Attribute Prioritisation Tool), Partners in Health Scale and body mass index). Results: A total of 123 patients, median age of 66 years, were assessed. Documentation of osteoarthritis assessment and management improved for all parameters. At 3 months there were improvements in self‐reported pain (P < 0.001), global function (P < 0.001), physician and patient reported global health (P < 0.001), Partners in Health Score (P < 0.001) and Hip and Knee Multi‐Attribute Prioritisation Tool score (P < 0.014). Body mass index did not improve. Patients and general practitioners reported positive experiences, but there was variable uptake of recommendations by patients. The main factors influencing uptake of recommendations were access block to community services in the first 3 months and patient preferences for therapy. The cost implications for implementation were low. Conclusion: The osteoarthritis service model is feasible to implement, is well received by patients and staff, and provides a template for translation into other settings.