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Pain and its relation to participation in valued activities in rheumatoid arthritis
Jönköping University, School of Health and Welfare, HHJ. ADULT.
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There has been a dramatic change over the past two decades for persons with rheumatoid arthritis (RA) not only due to early diagnosis, structured treatment, and aggressive medication but also due to an increased demand of participation in work life and society. Despite these treatment changes, RA continues to impact these individuals’ participation in valued daily activities. Participation in valued daily activities provides wellbeing and the opportunity for engagement and participation. By persons with RA pain has been highlighted as one of the most restrictive symptoms. This thesis uses the International Classification of Functioning, Disability, and Health (ICF) as a conceptual framework to describe disability and how participation is related to pain.

Aims: The overall aim of this thesis was to explore and describe the relationship between pain and participation in valued activities, in RA. Paper I compared pain and activity limitations in women and men with contemporary treated early RA with persons who were diagnosed ten years earlier. Paper II described experiences of pain and pain’s relationship with daily activities. Paper III examined difficulties performing valued life activities in relation to pain intensity. Paper IV described personal factors, including self-efficacy and pain acceptance, and studied whether personal factors are mediators of the relationbetween pain and performance of valued life activities.

Methods: Different methodological approaches were used to provide a comprehensive understanding of pain and participation in valued activities in persons with RA. A prospective longitudinal cohort study was used to compare women and men treated with contemporary treated RA (n=276) with their counterparts ten years earlier (n=373) (Paper I). This study was followed by a focus group study where 33 persons with RA participated in seven focus groups (Paper II). Subsequently, Papers III and IV were conducted based on data from The Swedish Rheumatology Quality Registry (SRQ) and data from a postal questionnaire that gathered data on demographics, pain, personal factors, and participation in valued life activities (n=737). In addition, these studies used descriptive and analytical statistics with multiple regression and structural equation modelling (SEM).

Results: Pain and activity limitations were still pronounced in women and men with RA despite recent treatment advances (Paper I). The relationship between participation and pain was dynamic and is related to fatigue, stress, and mood, factors that generated difficulties finding a suitable level of activity, resulting in difficulties balancing daily activities (Paper II). Both women and men reported restrictions in participation in valued life activities. Pain was identified as having an important relationship to difficulties performing valued life activities (Paper III). Personal factors were found important as mediators for pain in relation to participation (Paper IV).

Conclusions: This thesis found a continued need for multidisciplinary interventions despite current treatments. Pain was identified as related to participation restrictions and had an important relationship to difficulties performing valued life activities. Pain and participation in valued activities needs to be comprehensively analysed and treated in the context of the person’s perspective and needs and demands of persons with RA. The subjective experience of participation, the engagement, must be highlighted. Personal factors mediated the relationship between pain and participation and this finding supports the value of self-management interventions to enable participation in valued activities

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2015. , 100 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 61
National Category
Health Sciences
Identifiers
URN: urn:nbn:se:hj:diva-27646ISBN: 978-91-85835-60-7 (print)OAI: oai:DiVA.org:hj-27646DiVA: diva2:843982
Public defence
2015-09-18, Forum Humanum, Hälsohögskolan, Jönköping, 13:00
Opponent
Supervisors
Available from: 2015-08-03 Created: 2015-08-03 Last updated: 2015-12-22Bibliographically approved
List of papers
1. Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project
Open this publication in new window or tab >>Pain and activity limitations in women and men with contemporary treated early RA compared to 10 years ago: the Swedish TIRA project
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, 259-264 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier.

METHOD: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years.

RESULTS: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2.

CONCLUSIONS: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-26391 (URN)10.3109/03009742.2014.997285 (DOI)000359960100001 ()25786818 (PubMedID)2-s2.0-84937796766 (Scopus ID)
Available from: 2015-04-29 Created: 2015-04-29 Last updated: 2017-12-04Bibliographically approved
2. Pain and Daily Activities in Rheumatoid Arthritis
Open this publication in new window or tab >>Pain and Daily Activities in Rheumatoid Arthritis
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2012 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 34, no 15, 1245-1253 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to describe experiences of pain and its relationship to daily activities in people with rheumatoid arthritis (RA). Method. Seven semi-structured focus group discussions were conducted with 33 men and women of different ages with RA. Data were analysed with content analysis. Results. Pain affected everyday life and may be a barrier to perform valued activities. Regarding the impact of pain on participation and independence, personal factors and the social environment were found to be important. It could be a struggle to find the right activity balance, since it was easy to be overactive, triggering subsequent elevation of pain levels. However, the participants also described activities as a mediator of pain and a distraction from it.Conclusion. The relationship between pain and daily activities in RA was complex. Pain as an impairment was expressed to be related to activity limitations and participation restrictions, as well as to contextual factors. These findings highlight the clinical importance of paying attention to the complexity of pain and its relation to daily activities and participation.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keyword
client perspective, content analysis, ICF, pain, participation, Rheumatoid arthritis
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-17115 (URN)10.3109/09638288.2011.638034 (DOI)HHJADULTIS (Local ID)HHJADULTIS (Archive number)HHJADULTIS (OAI)
Available from: 2012-01-13 Created: 2012-01-13 Last updated: 2017-12-08Bibliographically approved
3. Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis
Open this publication in new window or tab >>Pain and difficulties performing valued life activities in women and men with rheumatoid arthritis
2015 (English)In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 34, no 8, 1353-1362 p.Article in journal (Refereed) Published
Abstract [en]

This study aimed to examine the difficulties with performing valued life activities in relation to pain intensity in women and men with rheumatoid arthritis (RA). In total, 737 persons with RA (73 % women) from three rheumatology units in Sweden responded to a questionnaire measuring performance of 33 valued life activities and self-rated pain. The relationships between performance of valued life activities (VLAs) and pain (measured by visual analogue scale (VAS)) were analysed based on gender. Multiple linear regression analyses were conducted with the total VLA score as dependent variable. Women reported more pain and difficulties in performing valued life activities than men. Across genders, 85 % reported at least one valued life activity affected by RA. Significantly more women than men encountered difficulties in performing some activities such as cooking, gardening and meeting new people. Women reported higher pain intensity (35 mm) than men (31 mm). Almost all 33 difficulty ratings for valued life activities were higher among persons with high pain (>40 mm) than persons with lower pain. Difficulty ratings for valued life activities correlated positively with pain in persons with lower pain, but not among those with high pain. The results highlight the importance of addressing pain, especially among women with RA, as they reported pain to impact on their valued life activities. Interestingly, this was evident also in women with lower levels of pain.

Keyword
Disability; Gender; HAQ; Participation restrictions; VAS; VLA
National Category
Health Sciences
Identifiers
urn:nbn:se:hj:diva-26392 (URN)10.1007/s10067-015-2874-5 (DOI)000359267100006 ()25618175 (PubMedID)2-s2.0-84922341299 (Scopus ID)
Available from: 2015-04-29 Created: 2015-04-29 Last updated: 2017-12-04Bibliographically approved
4. Self-efficacy and painacceptance in relation to pain and performance of valued life activities inwomen and men with RA
Open this publication in new window or tab >>Self-efficacy and painacceptance in relation to pain and performance of valued life activities inwomen and men with RA
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(English)Article in journal (Other academic) Submitted
Keyword
Disability, ICF, mediation, pain, personal factors, SEM, VLA
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-27645 (URN)
Available from: 2015-08-03 Created: 2015-08-03 Last updated: 2015-12-22

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