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Cho SK, Sung YK, Choi CB, Bang SY, Cha HS, Choe JY, Chung WT, Hong SJ, Jun JB, Kim J, Kim TH, Kim TJ, Koh EM, Lee HS, Lee J, Lee SH, Lee SS, Lee SW, Park SH, Yoo DH, Yoon BY, Bae SC. What factors affect discordance between physicians and patients in the global assessment of disease activity in rheumatoid arthritis? Mod Rheumatol 2016; 27:35-41. [PMID: 27143194 DOI: 10.1080/14397595.2016.1176310] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify the level of agreement between patients with rheumatoid arthritis (RA) and physicians in the global assessment of disease activity and to explore factors influencing their discordance. METHODS A total of 4368 patients with RA were analyzed from the KORean Observational study Network for Arthritis (KORONA) database. Patients were divided into four subgroups according to difference from their physicians in the assessment of disease activity by substracting physician's visual analog scale (VAS) from patient's VAS as follows: positive discordance group I (10 mm ≤ discordance <25 mm), positive discordance group II (≥25 mm), concordance (<|10| mm), and negative discordance (≤ -10mm). Multinomial logistic regression analysis was performed to identify factors associated with discordance. RESULTS Only 1350 (29.2%) patients were classified in the concordance group. Positive discordance was found in 52.3% of the patients (n = 2425), with 33.7% (n = 1563) showing marked discordance (≥25 mm). The high disease activity (OR =1.41), gastrointestinal (GI) disease (OR =1.28), pain (OR =1.12), fatigue (OR =1.07) were consistently associated with positive discordance. CONCLUSION More than half of patients with RA thought their disease more severe than their physicians. In addition to high disease activity, pain, fatigue, and sleep disturbance or GI disease were associated with the discordance between physicians and patients with RA.
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Affiliation(s)
- Soo-Kyung Cho
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
| | - Yoon-Kyoung Sung
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
| | - Chan-Bum Choi
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
| | - So-Young Bang
- c Hanyang University Guri Hospital , Guri , South Korea
| | - Hoon-Suk Cha
- d Sungkyunkwan University School of Medicine, Samsung Medical Center , Seoul , South Korea
| | - Jung-Yoon Choe
- e Catholic University of Daegu School of Medicine , Daegu , South Korea
| | | | | | - Jae-Bum Jun
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Jinseok Kim
- h Jeju National University Hospital , Jeju , South Korea
| | - Tae-Hwan Kim
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Tae-Jong Kim
- i Chonnam National University Hospital , Gwangju , South Korea
| | - Eun-Mi Koh
- d Sungkyunkwan University School of Medicine, Samsung Medical Center , Seoul , South Korea
| | - Hye-Soon Lee
- c Hanyang University Guri Hospital , Guri , South Korea
| | - Jisoo Lee
- j Ewha Women's University Mokdong Hospital , Seoul , South Korea
| | - Sang-Heon Lee
- k Konkuk University Medical Center , Seoul , South Korea , and
| | - Shin-Seok Lee
- i Chonnam National University Hospital , Gwangju , South Korea
| | - Sung Won Lee
- f Dong-A University Hospital , Busan , South Korea
| | - Sung-Hoon Park
- e Catholic University of Daegu School of Medicine , Daegu , South Korea
| | - Dae-Hyun Yoo
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea
| | - Bo Young Yoon
- l Inje University Ilsan Paik Hospital , Goyang , South Korea
| | - Sang-Cheol Bae
- a Hanyang University Hospital for Rheumatic Diseases , Seoul , South Korea.,b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
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- b Clinical Research Center for Rheumatoid Arthritis (CRCRA) , Seoul , South Korea
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LARSSON G, VON ESSEN L, SJÖDÉN PO. Are importance–satisfaction discrepancies with regard to ratings of specific health-related quality-of-life aspects valid indicators of disease- and treatment-related distress among patients with endocrine gastrointestinal tumours? Eur J Cancer Care (Engl) 2007; 16:493-9. [DOI: 10.1111/j.1365-2354.2007.00781.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
This study examines how acute hand injuries affect patients in their roles as spouse, caregiver, and/or worker. Qualitative data from patient interviews were used to analyze how these life roles were affected by the individuals' hand injuries. Data were extracted from interviews of three hand patients who had one or more roles of spouse, caregiver, and/or worker affected by their injury. Data were then examined and categorized for each life role by participant. Participants' views of how hand therapy affected their recovery and resumption of occupational role performance were also examined. Results showed that the participants expressed profound degrees of change in their ability to perform satisfactorily in their various life roles.
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Affiliation(s)
- Jaime Starck Schier
- Sports Medicine Center, Hand Clinic, Memorial Hermann Hospital System, Houston, TX, USA.
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Blalock SJ, Patel RA. Drug therapy concerns questionnaire: initial development and refinement. J Am Pharm Assoc (2003) 2006; 45:160-9. [PMID: 15868758 DOI: 10.1331/1544345053623465] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To develop a scale, designed for self-administration, to assess patient perceptions of drug therapy problems (DTPs). DESIGN Cross-sectional survey. SETTING California Central Valley. PARTICIPANTS 200 community-dwelling adults taking at least one prescription medication. MAIN OUTCOME MEASURE 78 items assessing patient perceptions of DTPs. INTERVENTIONS Self-administered questionnaire completed by study participants. RESULTS Based on a Medication Evaluation and Response Model proposed in this article, items were developed to assess patient perceptions about potential or actual DTPs. Scales for five of the seven problem domains specified a priori were reliable based on participant responses: Perceived Efficacy, Overmedication Concerns, Adverse Drug Reaction Concerns, Adherence Issues, and Knowledge. Barriers and Intrusiveness were eliminated from, the questionnaire because of weak factor loadings. After making changes in domain assignment and eliminating redundant and weak items, five items remained in each of the five reliable scales, with Cronbach's alpha values ranging from 0.76 to 0.82. Each of the five scales was significantly associated with patient satisfaction with their medications. Individuals who reported fewer DTPs expressed greater overall satisfaction with their medications. In a forward stepwise regression analysis, four of the five scales exhibited independent associations with medication satisfaction, explaining 58.0% of the total variance in satisfaction [F(4,178) = 61.48, P < .0001]. Only the Knowledge scale failed to exhibit an independent association with satisfaction. CONCLUSION The findings from this initial stage of scale development are encouraging. The association between the scales and medication satisfaction suggests that the scales may be useful in learning more about those factors that influence how patients evaluate their medications.
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Affiliation(s)
- Susan J Blalock
- School of Pharmacy, CB# 7360, University of North Carolina, Chapel Hill, NC 27599-7360, USA.
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Abraído-Lanza AF, Revenson TA. Illness intrusion and psychological adjustment to rheumatic diseases: a social identity framework. ACTA ACUST UNITED AC 2006; 55:224-32. [PMID: 16583409 PMCID: PMC3718019 DOI: 10.1002/art.21849] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the extent to which arthritis intruded upon 4 social roles (spouse, homemaker, parent, worker). In accordance with propositions set forth by social identity theory and the identity-relevant stress hypothesis, we hypothesized that 1) illness intrusion would predict psychological well-being and 2) role importance would moderate the relationship between illness intrusion and psychological adjustment, such that intrusion into highly valued roles would be the most psychologically distressing. METHODS Participants were recruited from the practices of rheumatologists affiliated with a major urban hospital. A total of 113 individuals (73% women) with diagnosed rheumatic disease completed a mailed questionnaire. RESULTS For all 4 roles, illness intrusion was related to decreased psychological well-being. In the worker and parent roles, the effects of illness intrusion on adjustment were moderated by whether respondents valued these particular roles. For example, psychological well-being was lowest among those individuals whose illness intruded greatly upon work and who highly valued their worker role identity. CONCLUSION The findings highlight the advantages of assessing both domain-specific illness intrusion and role importance in predicting psychological well-being among persons with rheumatic diseases. Importantly, results also demonstrate the utility of applying a social identity framework in understanding adjustment processes among persons with chronic illness.
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Affiliation(s)
- Ana F Abraído-Lanza
- Mailman School of Public Health, Department of Sociomedical Services, Columbia University, 722 West 168 Street, 5th Floor, New York, NY 10032, USA.
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Lee SS, Park MJ, Yoon HJ, Park YW, Park IH, Park KS. Evaluating the Korean version of the Multidimensional Health Assessment Questionnaire in patients with rheumatoid arthritis. Clin Rheumatol 2005; 25:353-7. [PMID: 16273310 DOI: 10.1007/s10067-005-0049-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Revised: 06/16/2005] [Accepted: 06/16/2005] [Indexed: 12/01/2022]
Abstract
Although the Health Assessment Questionnaire (HAQ) and the Modified Health Assessment Questionnaire are useful tools for assessing and monitoring patients with rheumatic diseases, they have a "floor effect" and do not fully reflect the psychological status of patients. Recently, the Multidimensional Health Assessment Questionnaire (MDHAQ) was developed to overcome these shortcomings. We translated the MDHAQ into the Korean language and evaluated its reliability and validity for use with Korean-speaking patients with rheumatoid arthritis (RA). The questionnaire was translated into the Korean language by three translators, who were aware of its objectives, and it was translated back into the English language by three different translators. One question was modified to reflect Korean culture, and imperial measures were changed to metric measures because most Koreans use the metric system. The Korean MDHAQ was administered to 136 patients with RA who were attending the outpatient rheumatology clinic at the Chonnam National University Hospital (Gwangju, South Korea). Test-retest reliability was assessed in 101 patients after 1 week. To assess criterion validity, we compared MDHAQ scores with HAQ scores and the American College of Rheumatology (ACR) functional class. To test construct validity, the MDHAQ was compared to ACR core criteria (tender and swollen joint count, pain, patient's global assessment, physician's global assessment, erythrocyte sedimentation rate, and C-reactive protein), the Beck Depression Inventory (BDI), and the State-Trait Anxiety Inventory (STAI). The test-retest reliability was analyzed by computing kappa statistics, which ranged from 0.60 to 0.76. Cronbach's alpha coefficient ranged from 0.892 to 0.938. The MDHAQ was significantly correlated with the HAQ and ACR functional class (all p<0.001). The correlations between the MDHAQ scores and the ACR core set, BDI, and STAI were all high and statistically significant. The Korean version of the MDHAQ is a reliable, valid tool for assessing Korean patients with RA.
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Affiliation(s)
- Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School, Hak-Dong 5, Dong-Ku, Gwangju 501-746, South Korea.
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Hommel KA, Wagner JL, Chaney JM, White MM, Mullins LL. Perceived importance of activities of daily living and arthritis helplessness in rheumatoid arthritis; a prospective investigation. J Psychosom Res 2004; 57:159-64. [PMID: 15465070 DOI: 10.1016/s0022-3999(03)00600-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2002] [Accepted: 10/03/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the contribution of perceived importance of activities of daily living (ADL) to arthritis-specific helplessness in a sample of rheumatoid arthritis (RA) patients over a 1-year period. METHOD Forty-two individuals from an outpatient rheumatology clinic completed measures of ADL importance, helplessness, depression, pain, and disability; the physician's assistant provided objective ratings of disability. RESULTS Time 1 importance of ADL predicted a significant amount of variance in Time 2 arthritis helplessness after statistically controlling disease and psychological covariates. Moreover, increased perceived ADL importance predicted decreased arthritis helplessness over the 1-year period. CONCLUSIONS Results indicate that RA patients' experience of arthritis-specific helplessness may be minimized over time when performing ADL is perceived as important. Furthermore, these findings provide preliminary evidence for one possible antecedent to increased perceptions of arthritis helplessness in individuals with RA.
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Affiliation(s)
- Kevin A Hommel
- Division of Psychology MLC 3015, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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Rapkin BD, Schwartz CE. Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health Qual Life Outcomes 2004; 2:14. [PMID: 15023229 PMCID: PMC408464 DOI: 10.1186/1477-7525-2-14] [Citation(s) in RCA: 298] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2004] [Accepted: 03/15/2004] [Indexed: 01/17/2023] Open
Abstract
Mounting evidence for response shifts in quality of life (QOL) appraisal indicates the need to include direct measurement of the appraisal process itself as a necessary part of QOL assessment. We propose that directly assessing QOL appraisal processes will not only improve our ability to interpret QOL scores in the traditional sense, but will also yield a deeper understanding of the appraisal process in the attribution of and divergence in meaning. The published evidence for response shift is reviewed, and an assessment paradigm is proposed that includes the explicit measurement of QOL appraisal process parameters: 1) induction of a frame of reference; 2) recall and sampling of salient experiences; 3) standards of comparison used to appraise experiences; and 4) subjective algorithm used to prioritize and combine appraisals to arrive at a QOL rating. A QOL Appraisal Profile, which measures key appraisal processes, is introduced as an adjunct to existing QOL scales. The proposed theoretical model, building on the Sprangers and Schwartz (1999) model and highlighting appraisal processes, provides a fully testable theoretical treatment of QOL and change in QOL, suggesting hypothesized causal relationships and explanatory pathways for both cross-sectional and longitudinal QOL research.
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Affiliation(s)
- Bruce D Rapkin
- Department of Psychiatry and the Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Carolyn E Schwartz
- QualityMetric Incorporated, Waltham, MA, USA
- Health Assessment Lab, Waltham, MA, USA
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
- DeltaQuest Foundation, Concord, MA, USA
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A Longitudinal Examination of Causal Attributions and Depression Symptomatology in Rheumatoid Arthritis. Rehabil Psychol 2004. [DOI: 10.1037/0090-5550.49.2.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Are Happy People Healthier? The Specific Role of Positive Affect in Predicting Self-Reported Health Symptoms. JOURNAL OF RESEARCH IN PERSONALITY 2001. [DOI: 10.1006/jrpe.2001.2327] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hewlett S, Smith AP, Kirwan JR. Values for function in rheumatoid arthritis: patients, professionals, and public. Ann Rheum Dis 2001; 60:928-33. [PMID: 11557648 PMCID: PMC1753375 DOI: 10.1136/ard.60.10.928] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although many disability questionnaires measure fact very efficiently, they do not allow for consideration of the relevance of that disability to the patient. Data suggest that professionals misinterpret the relevance of disability for the patient and thus, also, the outcome of treatment. OBJECTIVES Firstly, to examine agreement on levels of importance for the items on a validated disability scale (Health Assessment Questionnaire (HAQ) and Modified HAQ (MHAQ)), within groups of patients with rheumatoid arthritis, health professionals, and controls. Secondly, to see if functional items important to patients are included in the HAQ, and whether the HAQ items are important to patients. METHODS 25 patients with RA, 25 rheumatology health professionals, and 25 healthy controls were asked to rate the importance of the HAQ (20 items) and MHAQ (eight domains). Before seeing the HAQ, patients were asked to generate items of function important to them. RESULTS Only a slight-fair agreement within each group was found for the level of importance of the HAQ and MHAQ, and also within any combination of the groups (kappa values <0.38). Most of the functional items valued by patients were contained on the HAQ (70%), and no HAQ items were consistently rated as unimportant. CONCLUSION Patients, professionals, and healthy controls do not agree on the importance of disabilities. These data support the need to assess the personal impact of disability, as well as disability itself. Individual importance of disability weighted by level of disability is proposed as a model for calculating the personal impact of disability. A new tool to assess the personal impact of disability is being developed.
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Affiliation(s)
- S Hewlett
- University of Bristol Rheumatology Academic, Division of Medicine, Bristol Royal Infirmary, UK.
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Rejeski WJ, Martin KA, Miller ME, Ettinger WH, Rapp S. Perceived importance and satisfaction with physical function in patients with knee osteoarthritis. Ann Behav Med 2001; 20:141-8. [PMID: 9989320 DOI: 10.1007/bf02884460] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This investigation examined the determinants of satisfaction with physical function for participants in an Observational Arthritis Study in Seniors (OASIS). The sample consisted of 480 men (51%) and women (49%) over the age of 65 years who had difficulty performing activities of daily living due to knee pain. As part of baseline testing for OASIS, participants completed a measure that assessed satisfaction with function for six physical activities. After controlling for relevant covariates, scores on the satisfaction index were regressed on seven conceptually relevant predictor variables. The results revealed that satisfaction with physical function is a distinct construct from level of function, irrespective of whether the latter variable is measured objectively or subjectively. When entered into a hierarchical regression model, 6-minute walk test data accounted for 11% of the variance in satisfaction scores, whereas perceived difficulty accounted for an additional 22%. Moreover, a significant interaction term between importance and perceived difficulty revealed that patients who rated the activities as important and who had high levels of perceived difficulty had the lowest satisfaction scores. Discussion focuses on the determinants of satisfaction with physical function with emphasis on the interaction between perceived difficulty and importance.
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Affiliation(s)
- W J Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC 27109, USA
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Larsson G, Sjödén PO, Oberg K, von Essen L. Importance-satisfaction discrepancies are associated with health-related quality of life in five-year survivors of endocrine gastrointestinal tumours. Ann Oncol 1999; 10:1321-7. [PMID: 10631460 DOI: 10.1023/a:1008360718646] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Little is known about the health-related-quality of life (HRQoL) of patients with endocrine gastrointestinal tumours. In this study, HRQoL was investigated in long-term survivors of endocrine GI tumours. PATIENTS AND METHODS A questionnaire including the EORTC QLQ-C30 and ratings of importance of and satisfaction with a variety of HRQoL aspects was mailed to patients with carcinoid tumours (n = 64), or endocrine pancreatic tumours (EPT, n = 55). Median time since diagnosis was 120 months (range 60-360). The majority of patients (77 of 119) had ongoing treatment. RESULTS The EORTC QLQ-C30 ratings suggest that in spite of a long disease duration and treatment, patients perceived their HRQoL as relatively good. There were no major differences in HRQoL ratings between patients with carcinoid tumours and those with EPT. Patients whose ratings of importance was higher than their ratings of satisfaction with a specific HRQoL aspect also evidenced a low HRQoL for that aspect. CONCLUSIONS The results indicate that survivors of endocrine GI tumours enjoy a relatively good HRQoL and suggest that importance > satisfaction discrepancies identify patients with a low quality of life.
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Affiliation(s)
- G Larsson
- Department of Medicine, Uppsala University, Sweden.
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Pincus T, Swearingen C, Wolfe F. Toward a multidimensional Health Assessment Questionnaire (MDHAQ): assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. ARTHRITIS AND RHEUMATISM 1999; 42:2220-30. [PMID: 10524697 DOI: 10.1002/1529-0131(199910)42:10<2220::aid-anr26>3.0.co;2-5] [Citation(s) in RCA: 270] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To develop components of a multidimensional Health Assessment Questionnaire (MDHAQ) through the addition of new items in the "patient-friendly" HAQ format, including advanced activities of daily living (ADL), designed to overcome "floor effects" of the HAQ and modified HAQ (MHAQ) in which patients may report normal scores although they experience meaningful functional limitations, and psychological items, designed to screen efficiently for psychological distress in routine care. METHODS The new MDHAQ items, as well as scales for pain, fatigue, helplessness, and global health status on a 2-page questionnaire, were completed by 688 consecutive patients with various rheumatic diseases, including 162 with rheumatoid arthritis (RA), 114 with fibromyalgia, 63 with osteoarthritis, 34 with systemic lupus erythematosus, 20 with vasculitis, 18 with psoriatic arthritis, 16 with scleroderma, and 261 with various other rheumatic diseases, over 2 years at a weekly academic rheumatology clinic. RESULTS The new MDHAQ items have good test-retest reliability and face validity. MHAQ scores were highest in patients with RA, and scores for other scales were highest in patients with fibromyalgia. On the advanced ADL, 58% of patients reported difficulty with errands, 68% with climbing stairs, 79% with walking two miles, 87% with participating in sports and games, and 94% with running or jogging two miles. On the psychological items, 75% of patients reported difficulty with sleep, 63% with stress, 61% with anxiety, and 57% with depression. Normal MHAQ scores were reported by 23% of patients and normal HAQ scores by 16% of patients who completed these questionnaires, while fewer than 5% had normal scores on the MDHAQ. CONCLUSION The MDHAQ items overcome in large part the "floor effects" seen on the HAQ and MHAQ, and are useful to screen for problems with sleep, stress, anxiety, and depression in the "patient-friendly" HAQ format. These data support the value of completion of a simple 2-page patient questionnaire by each patient at each visit to a rheumatologist.
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Affiliation(s)
- T Pincus
- Division of Rheumatology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA
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Pincus T, Swearingen C, Wolfe F. Toward a multidimensional health assessment questionnaire (MDHAQ): Assessment of advanced activities of daily living and psychological status in the patient-friendly health assessment questionnaire format. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/1529-0131(199910)42:10%3c2220::aid-anr26%3e3.0.co;2-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
The purpose of this study was to examine the relationship of age and pain severity (i.e. mild versus severe pain) in predicting coping strategies of individuals with rheumatoid arthritis (RA). An age-stratified sample (N = 121) of individuals diagnosed with rheumatoid arthritis completed a modified version of the Coping Strategies Questionnaire (CSQ). Individuals were asked to report the coping strategies used for mild versus severe pain. Findings included: (1) older adults were more likely than younger adults to report use of maladaptive coping strategies in the context of mild, but not severe, RA pain, (2) older adults' reported patterns of coping reflected less-than-anticipated expertise in dealing with RA pain, and (3) individuals, regardless of age, reported use of more active coping strategies in the context of mild pain and use of more maladaptive coping strategies in the context of severe pain. The present study suggests that research regarding illness and coping is most informative when it captures the individual-situational interaction of dealing with stressors such as chronic pain.
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Affiliation(s)
- Ken W Watkins
- Health Behavior and Health Education, School of Public Health, University of Michigan, 109 Observatory, Ann Arbor, MI 48109-2029, USA Department of Psychology, Towson University, Towson, MD, USA Department of Psychology and The Center for Applied Cognitive Research on Aging, University of Michigan, Ann Arbor, MI, USA Gerontology Center and Department of Psychology, University of Georgia, Athens, GA, USA
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Daltroy LH, Larson MG, Eaton HM, Phillips CB, Liang MH. Discrepancies between self-reported and observed physical function in the elderly: the influence of response shift and other factors. Soc Sci Med 1999; 48:1549-61. [PMID: 10400256 DOI: 10.1016/s0277-9536(99)00048-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
GOAL To explore the influence of social, psychological, and health factors on self-report of function. SUBJECTS A convenience sample of 289 community-dwelling elderly aged 65-97 years. METHODS We compared a measure of function based on observed performance, the Physical Capacity Evaluation (PCE) with a self-reported measure of functional limitations (HAQ), in a cross-sectional study. Stepwise multiple regression identified variables predicting self-reported disability, controlling for observed function. RESULTS Controlling for PCE, self-reports of greater disability (HAQ) were predicted by current joint pain or stiffness, use of prescription medications, urban dwelling, depression, female gender, lack of memory problems, arthritis and lack of exercise. A final model included recent decline in function, dissatisfaction with function, gender, joint pain or stiffness, and observed function, explaining 85% of the variance in self-reported disability. The hypothesis that aging is associated with declining expectations of functional ability was not supported. However, recent health problems affected participants' reporting of limitations, consistent with a recalibration-type response shift. Perceived decline in function over the past six months, a fall within the last month, illness in the last week and pain or stiffness on the day of the exam all raised self-reports of disability. As suggested by adaptation level theory, subjects with recent problems might have an inflated perception of limitations due to shifts in their internal standards. When administered first, the observed performance test improved correlations between observed and self-reported function, primarily among those who did not report a recent decline in function. This suggests that this group may have benefited more from salient information about their abilities provided by performing the PCE before self-report. CONCLUSION Our data confirm the importance of social, psychological, and health influences in self-report of disability, and are consistent with the hypothesis that people may recalibrate their self assessments based on recent health problems.
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Affiliation(s)
- L H Daltroy
- RBB Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital, Boston, MA 02115, USA.
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Blalock SJ, Orlando M, Mutran EJ, DeVellis RF, DeVellis BM. Effect of satisfaction with one's abilities on positive and negative affect among individuals with recently diagnosed rheumatoid arthritis. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1998; 11:158-65. [PMID: 9782807 DOI: 10.1002/art.1790110303] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the effect that self-evaluation processes have on psychologic well-being among individuals with rheumatoid arthritis (RA). METHODS The study used a longitudinal research design with 4 data collection points. Participants were 227 adults with recently diagnosed RA. Data were collected via mailed questionnaire and telephone interview. Two dimensions of psychologic well-being were assessed--positive affect and negative affect. RESULTS We found that, among participants who viewed the abilities being evaluated as very important, greater satisfaction at time 1 was associated with less negative affect at time 2 and time 4. Satisfaction was not associated with positive affect at any of the time points, however. CONCLUSION Study findings indicate that dissatisfaction with illness-related abilities can exacerbate psychologic distress. The findings also highlight the need for research examining the role that positive affect plays in adaptation to RA.
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Affiliation(s)
- S J Blalock
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina at Chapel Hill 27599-7330, USA
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20
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Abraído-Lanza AF. Latinas with arthritis: effects of illness, role identity, and competence on psychological well-being. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 1997; 25:601-627. [PMID: 9485576 PMCID: PMC3657204 DOI: 10.1023/a:1024682800238] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Tested a theoretical model on the effects of social role identity, illness intrusion, and competence on psychological well-being among 109 low-income Latinas with arthritis. All six roles studied were rated as highly important identities. Sex-role nontraditionalism was associated with less importance of the homemaker, mother, and grandmother roles. Negative affect increased as a function of intrusions into valued identities. Having important role identities contributed to feelings of competence (i.e., self-esteem and self-efficacy), which in turn, contributed to psychological well-being. Competence also mediated the effects of pain, identity, and illness intrusions on psychological well-being. Results suggest competence processes play an important role in well-being.
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Affiliation(s)
- A F Abraído-Lanza
- Columbia University, School of Public Health, New York, New York 10032, USA
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21
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Katz PP, Alfieri WS. Satisfaction with abilities and well-being: development and validation of a questionnaire for use among persons with rheumatoid arthritis. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1997; 10:89-98. [PMID: 9313397 DOI: 10.1002/art.1790100204] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To develop a questionnaire to measure satisfaction with abilities and well-being of persons with rheumatoid arthritis (RA). METHODS We used data from a panel study of persons with RA (n = 446). The 13 items of the Satisfaction with Abilities and Well-Being Scale (SAWS) were based on problematic aspects of RA and domains of life activities. RESULTS The SAWS demonstrated internal consistency (Cronbach's alpha = 0.93). Two subscales were identified, Satisfaction with Abilities and Satisfaction with Well-Being, which also demonstrated internal consistency (alpha = 0.91 and alpha = 0.82, respectively). Construct validity was supported by significant correlations with psychosocial and clinical variables. After controlling for demographic, psychosocial, and clinical characteristics, there was a significant inverse association between SAWS scores and depressive symptoms scores. CONCLUSIONS The SAWS appears to be a valid and reliable measure of satisfaction with abilities and well-being among persons with RA. Longitudinal studies will examine the role of satisfaction in the development of depressive symptoms.
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Affiliation(s)
- P P Katz
- Department of Medicine, University of California, San Francisco 94109, USA
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22
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Yelin E, Callahan LF. The economic cost and social and psychological impact of musculoskeletal conditions. National Arthritis Data Work Groups. ARTHRITIS AND RHEUMATISM 1995; 38:1351-62. [PMID: 7575685 DOI: 10.1002/art.1780381002] [Citation(s) in RCA: 336] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To provide an indication of the economic, social, and psychological impact of musculoskeletal conditions in the United States. METHODS Review of the literature combined with estimates of data concerning health care utilization and acute and chronic disability due to musculoskeletal conditions, from the 1990-1992 National Health Interview Survey. RESULTS The cost of musculoskeletal conditions was $149.4 billion in 1992, of which 48% was due to direct medical care costs and the remainder was due to indirect costs resulting from wage losses. This amount translates to approximately 2.5% of the Gross National Product, a sharp rise since the prior studies, even if part of the increase is an artifact of improved accounting methods. Each year, persons with musculoskeletal conditions make 315 million physician visits, have more than 8 million hospital admissions, and experience approximately 1.5 billion days of restricted activity. Approximately 42% of persons with musculoskeletal conditions--more than 17 million in all--are limited in their activities. CONCLUSION The economic and social costs of musculoskeletal conditions are substantial. These conditions are responsible for a sizable amount of health care use and disability, and they significantly affect the psychological status of the individuals with the conditions as well as their families.
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Affiliation(s)
- E Yelin
- Arthritis Research Group, University of California, San Francisco 94109, USA
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23
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Hewlett S, Young P, Kirwan J. Dissatisfaction, disability, and rheumatoid arthritis. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1995; 8:4-9. [PMID: 7794980 DOI: 10.1002/art.1790080104] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To investigate dissatisfaction with function in patients with rheumatoid arthritis (RA), and to see if dissatisfaction can be adequately explained by level of function. METHODS Fifty patients with RA were assessed for disease activity, psychological status, disability, expectation of future disability, and satisfaction with both global function and individual activities of daily living (ADL). RESULTS Fifty percent of patients expressed dissatisfaction with global function, which correlated more strongly with pain (r = 0.474) and psychological status than with function (r = 0.398). Only 10% predicted improvement in global function. Seventy-two percent expressed dissatisfaction with performing at least one ADL. CONCLUSIONS Patient dissatisfaction with both global function and individual ADL function is high and cannot adequately be explained by disability alone. Correlation with pain and psychological status implies that modifying these variables (perhaps through education programs about pain relief or relaxation) could reduce dissatisfaction.
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Hirano PC, Laurent DD, Lorig K. Arthritis patient education studies, 1987-1991: a review of the literature. PATIENT EDUCATION AND COUNSELING 1994; 24:9-54. [PMID: 7862599 DOI: 10.1016/0738-3991(94)90024-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Arthritis is a chronic disease that is estimated to affect 14.5% of the American population and is the leading cause of functional dependency in the activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) in all persons over the age of 65 years. Clinical studies have shown that medical care, including the use of medications, can offer a 20-50% improvement in reported arthritis symptoms. Data from patient education studies suggest that a further improvement of 15-30% is attainable through patient education interventions. This literature review has been completed to update the reviews of patient education studies by Lorig and Riggs in 1983 and Lorig, Konkol, and Gonzalez in 1987. More specifically, the objectives of this review are: (1) to provide a summary of arthritis patient education studies published or presented since 1987; (2) to summarize the findings concerning the effectiveness of arthritis patient education studies which attempt to change knowledge, behavior, psychosocial status, and health status; (3) to discuss shifting trends in observed outcomes of arthritis patient education studies; and (4) to discuss implications for the future.
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