OBJECTIVE: To examine effects of an individual education program using the treating rheumatoid arthritis to target (RA T2T) strategy in patients with moderate-severe rheumatoid arthritis. METHODS: Patients were assigned randomly to an educational intervention (n=33) or conventional care group (n=33). The intervention was a nurse-delivered 9-month educational program consisting of 3 monthly sessions and monthly telephone counseling. The assessments occurred at the baseline and every 3 months in both groups, but only the intervention group completed the 9-month education follow-up. The outcome variables included the disease activity (DAS28), functional disability (KHAQ), fatigue (FACIT-Fatigue), and quality of life (SF-36). Repeated measures ANOVA and a Bonferroni multiple comparison were used to evaluate the outcome variables comparing the groups and follow-up times. RESULTS: Significant interactions were observed between the groups and follow-up times in the disease activity (p=0.041), fatigue (p=0.042), and physical (p=0.006) and mental (p=0.031) health-related quality of life, but there was no significant interaction in the functional disability (p=0.110). Significant differences were noted between the groups at the 9-month period (p=0.048) in disease activity and fatigue, and at the 6-month (p=0.023) and 9-month periods (p=0.027) in the physical health-related quality of life. CONCLUSION: This education program using the RA T2T strategy had significant benefits on the disease activity, fatigue, and quality of life in patients with moderate to severe rheumatoid arthritis, and the results suggested that this contributed to positive clinical outcomes as a good practical nursing intervention.
Arthritis, Rheumatoid* ; Counseling ; Education* ; Fatigue ; Follow-Up Studies ; Humans ; Nursing, Practical ; Patient Education as Topic ; Quality of Life ; Telephone

To evolve a management plan for rheumatoid arthritis, it is necessary to understand the patient's symptom experience and disablement process. This paper aims to introduce and critique two models as a conceptual foundation from which to construct a new model for arthritis care. A Disability Intervention Model for Older Adults with Arthritis includes three interrelated concepts of symptom experience, symptom management strategies, and symptom outcomes that correspond to the Theory of Symptom Management. These main concepts influence or are influenced by contextual factors that are situated within the domains of person, environment, and health/illness. It accepts the bidirectional, complex, dynamic interactions among all components within the model representing the comprehensive aspects of the disablement process and its interventions in older adults with rheumatoid arthritis. In spite of some limitations such as confusion or complexity within the model, the Disability Intervention Model for Older Adults with Arthritis has strengths in that it encompasses the majority of the concepts of the two models, attempts to compensate for the limitations of the two models, and aims to understand the impact of rheumatoid arthritis on a patient's physical, cognitive, and emotional health status, socioeconomic status, and well-being. Therefore, it can be utilized as a guiding theoretical framework for arthritis care and research to improve the functional status of older adults with rheumatoid arthritis.
Activities of Daily Living ; Aged ; Arthritis, Rheumatoid/*nursing ; *Disability Evaluation ; Disabled Persons ; Frail Elderly ; Humans ; *Models, Theoretical

PURPOSE: The purpose of this study was to investigate the relationship between the level of pain and fatigue in rheumatoid arthritis patients. METHOD: The subjects for this study were 120 patients registered in S University Hospital, and the period of data collection was from June 20, 2005 to October 15, 2005. RESULTS: The research instruments used in this study were the Graphic Rating Scale of Pain and Fatigue, and the cronbach's alpha of Fatigue scale was .90. In data analysis, SPSSWIN 12.0 program was used for descriptive statistics. The results were as follows. 1) The range of total pain scores was from 10 to 100 and the mean score of the pain in rheumatoid arthritis patients was 53.70. 2) The range of total fatigue scores was from 20 to 58 and the mean score of the fatigue in rheumatoid arthritis patients was 36.04. 3) There was a significant difference in pain according to duration of disease(F=3.934, p<.05). 4) There was a significant difference in fatigue according to duration of disease(F=3.442, p<.05). 5) The level of fatigue was significant correlation with the level of pain in rheumatoid arthritis patients(r=.217, p<.01). CONCLUSION: The level of fatigue was significant correlation with the level of pain in rheumatoid arthritis patients. Therefore nursing interventions decreasing the pain perceived by rheumatoid arthritis patients are needed to decrease there fatigue levels.
Arthritis, Rheumatoid* ; Data Collection ; Fatigue* ; Humans ; Nursing ; Statistics as Topic

This study was conducted to compare activities of daily living, fatigue and depression between rheumatoid arthritis patients and healthy persons. The subjects consisted of 53 rheumatoid arthritis patients and 53 healthy persons at a university hospital in Daegu City. Data were collected by means of structured interviews with questionnaires from July 20, 1999 to August 25, 1999. The instrument used in this study were the activities of daily living scale developed by Katz et al. (1970) and Barthel(1973), Multidimensional Assessment of Fatigue by Belza et al.(1995) and CES-D(Center for Epidemiologic Studies-Depression) scale. Analysis of data was done by use of descriptive statistics, Pearson Correlation, Chi-square test, t-test, ANOVA, MANCOVA and Duncan with the SPSS program. The major findings are summarized as follows: 1. The first hypothesis that the rheumatoid arthritis patients will have a lower degree of activities of daily living than the healthy persons was supported (F=4.584, p=.035). 2. The second hypothesis that the rheumatoid arthritis patient will have a higher degree of fatigue than the healthy persons was supported (F=7.799, p=.006). 3. The third hypothesis that the rheumatoid arthritis patients will have a higher degree of depression than the healthy persons was supported (F=4.768, p=.031). With the above results, it can be concluded that rheumatoid arthritis patients had a lower degree of activities of daily living and a higher degree of fatigue and depression than the healthy persons. Therefore, by providing appropriate nursing intervention, activities of daily living would be much better and fatigue and depression would be alleviated.
Activities of Daily Living* ; Arthritis, Rheumatoid* ; Daegu ; Depression* ; Fatigue* ; Humans ; Nursing ; Surveys and Questionnaires

The aim of this study was to investigate the differences in the level of disease condition and ADL by self-efficacy in patients with rheumatoid arthritis. The subjects of the study consisted of eighty-four outpatients with rheumatoid arthritis at a university hospital in Taegu between July 20, 1999 and August 25, 1999. The instruments used in this study were the self-efficacy developed by Lorig et al. (1989), the pain scale developed by Lee and Song(1987), the erythrocyte sedimentation rate(ESR), the pain joint count to measure disease condition scale, and the ADL scale developed by Katz et al. (1970) and Barthel(1973). Analysis of data was done by use of descriptive statistics: Pearson Correlation, Chi-square test, t-test, ANOVA and Scheffe, with the SPSS program. The major findings can be summarized as follows: 1. The first hypothesis, "There will be differences in the level of disease condition by self-efficacy in patients with rheumatoid arthritis" was partially supported. 1-1. "There will be differences in the level of pain by self-efficacy in patients with rheumatoid arthritis" was supported(F=3.422, p=.037). 1-2. "There will be differences in the level of ESR by self-efficacy in patients with rheumatoid arthritis" was the Disease Condition and supported (F=3.314, p=.041). 1-3. "There will be differences in the level of pain joints count by self-efficacy in patients with rheumatoid arthritis" was rejected(F=2.602, p=.080). 2. The second hypothesis, "There will be differences in the level of ADL by self-efficacy in patients with rheumatoid arthritis" was supported(F=7.067, p=.001). With the above results, it can be concluded that the higher level of self-efficacy contributed to the better level of disease condition and ADL in patients with rheumatoid arthritis. Therefore, by providing nursing intervention to promote the level of self-efficacy of rheumatoid arthritis patients with low self-efficacy, disease condition and ADL would be much better.
Activities of Daily Living* ; Arthritis, Rheumatoid* ; Blood Sedimentation ; Daegu ; Humans ; Joints ; Nursing ; Outpatients

The propose of this study was to identify fatigue, pain and coping of pain and to compare the variables between fibromyalgia and chronic arthritis. The sample consisted of 133 patients who visited H university hospital. Data were collected by questionnaire from May 1 to September 30, 1999. Data was analyzed by descriptive statistics. chi-test. pearson correlation coefficient. and ANOVA. As a results, most of all patients felt fatigue and the mean score of the fatigue was above average. The mean score of rheumatoid arthritis and fibromyalgia patients on pain was higher than Osteoarthritis patients. and there was the statistically significant difference among three groups on pain(F=10.63. p=0.00). There was also the statistical difference among three groups on coping of pain(F=4.74, p=0.01). The mean score of rheumatoid arthritis and fibromyalgia patients on coping of pain was higher than Osteoarthritis patients. Fatigue showed positive relationship with pain(r= .262, p= .002). and pain showed positive relationship with coping of pain(r=.319. p=.000). According to this finding, fibromyalgia patients and rheumatoid arthritis patients felt high fatigue and pain, therefore the development of nursing intervention for relieving fatigue and pain would be needed.
Arthritis* ; Arthritis, Rheumatoid ; Fatigue* ; Fibromyalgia* ; Humans ; Nursing ; Osteoarthritis ; Surveys and Questionnaires

This study was done to identify the relationships among family support, role conflict end Lii quality of life of patients with arthritis. And it was investigated the effects of family support on role conflict and the quality of their lives. The subjects were 98 patients with arthritis. The instruments used in this study were used Family Support Scale by Kang( 1985), Modified Quality of Life Scale by Ro(1988), and Role Conflict Scale developed by the researcher. The results of study were as follows : 1. Disease characteristics related to role conflict were pain iritensity( r = .35, p< .001) and limitation of activities of daily living(ADL)(r =37, p< .001). That related to quality of life was pain(r= -.27,p<.01). 2. There were no significant variations family support, role conflict and quality of life between rheumatoid arthritis and osteogenic arthritis patients. The patients with rheumatoid arthritis had more than twice the number of. affected joints as comparing to osteogenic arthrrt:s. But there were no differences the pain intensity and limitation of activity of ADL. 3. As applying to arthritis patients in general : There was a significant negative relationship between family support and role conflict(r=-.28, p<.01). There was a significant negative relationship between role conflict and quality of life(r= -.46, p<.01). There was a sigmfrcant positive re lationship between family supprt and quality of life(r=.58, p<.01). Family support, as an intervening variabe, had an impact on quality of life and role conflict. In conclusion, family support is an important variable in improving the quality of life of patients with arthritis. And especially role conflict has a significant influence on the quality of their lives, Therefore, we have to devehope nursing interventions for higher levels of family support through family education and support programs. In future studies, it would be well to investigate for effects and qualities of role conflict in the lives of patients with arthritis.
Activities of Daily Living ; Arthritis* ; Arthritis, Rheumatoid ; Education ; Family Conflict* ; Humans ; Joints ; Nursing ; Quality of Life*

This study was undertaken to investigate the casual perceptions and health seeking behaviors of Rheumatoid arthritis patients, define and understand the typology, and find the relationship between causal perceptions and health seeking behavioral types. There were six types(Physical Fatigue, Dispensation of Nature, Causality to Environment, Conscience of Guilty, Rationally perceiving, Psychological Stress) of subjective opinion about Causal Perceptions of Rheumatoid Arthritis Patients. And there were four types(Oriental medical Treatment, Information Seeking Dietary Control, Western Medical Treatment) of subjective opinion about Health Seeking Behaviors. In the relationship between types of the causal perceptions and health seeking behaviors, oriental medical treatment and information seeking type were common health seeking behaviors of all six causal perception types, Only difference for internal causal perception types was related to hospital instructions and external causal perception types were related to dietary control. The result of this study can help health care provides, especially nurses to understand the types of causal perceptions and health seeking behaviors of Rheumatoid arthritis patients to gain treatment educational nursing intervention to aid health care.
Arthritis, Rheumatoid* ; Conscience ; Delivery of Health Care ; Fatigue ; Humans ; Nursing

This study was carried out to identify the important risk factors for reduced bone mass of postmenopausal RA patients and to develop discriminant function which can classify postmenopausal RA patients with either reduced or normal bone mass. Through the literature review, individual characteristics such as age, body weight, height. age of menarche, duration of menopause, gravity, parity, and breast feeding period and factors of life style such as milk consumption exercise habit. alcohol intake, cigarette smoking, coffee consumption, disease activity, corticosteroid therapy were identified as influencing factors of reduced bone mass in RA patients Sixty eight postmenopausal women with rheumatoid arthritis aged between 42 and 76 were selected among those who checked bone mineral density in lumbar spine and femur from October. 1998 to April. 1999 at Dong-a university hospital in Pusan. Assessment of disease activity, duration of disease and corticosteroid therapy were made by the same rheumatologist and included Ritchie articular index, erythrocyte sedimentation rate, and C-reactive measuring bone protein on mineral density. Cumulative steroid dosage was calculated from the daily dosage multiplied by the number of days received. The information of other risk factor including health assessment score, individual characteristics and life style factors were collected by questionnaire. Bone mineral density(BMD) was measured using DXA at lumbar spine and femoral Ward's triangle. Discriminant function (regression equation) was developed for estimating the likelihood of the presence or absence of reduced bone mass. The results are as follows: Among the subjects, thirteen(l9.1%) exhibited osteoporosis in lumbar spine and twenty four(35.3%) exhibited osteoporosis in femoral Ward's triangle. For lumbar spine, the variables significant were age, body weight, health assessment score, while for femoral Ward's triangle, age, body weight, duration of disease. But disease activity and corticosteroid therapy were not signigicant to distinguish reduced bone mass from normal bone mass. When the discriminant function was evaluated by comparing the observed outcome with predicted outcome, the discriminant function correctly classified 85.4% of patients with reduce bone mass and 63.0% of patients with normal bone mass in the lumbar spine and 100% of patients with reduced bone mass and 9.1% of patients with normal bone mass in the femoral Ward's triangle. In summary, we found that osteoporosis in postmenopausal women with RA is more evident at the femur than the lumbar spine. Also the important discriminant factors of reduced bone mass postmenopausal women with RA were age, body weight, duration of disease and health disability. In nursing situation, the efforts to improve of functional capacity of postmenopausal women with rheumatoid arthritis should be considered to prevent osteoporosis and fractures. Also we recommend those postmenopausal women with RA who are classified as a group of the reduced bone mass in the discriminant function should examine the bone mineral density to further examine the usefulness of this discriminant function.
Arthritis, Rheumatoid* ; Body Weight ; Bone Density ; Breast Feeding ; Busan ; Coffee ; Erythrocyte Indices ; Female ; Femur ; Gravitation ; Humans ; Life Style ; Menarche ; Menopause ; Milk ; Nursing ; Osteoporosis ; Parity ; Surveys and Questionnaires ; Risk Factors ; Smoking ; Spine

This Research is an attempt to ind out what effects the resistance exercise program has on the rheumatoid arthritis patient's functional disability and biochemical parameters. The research took place from June to November 1996, and the target included an experimental group of 25 cases of rheumatoid arthritis and a control group of 26 cases of rheumatoid arthritis taken from the Anam Medical Center at Korea University. The resistance exercise program was executed on these patients five times a week during a period of eight weeks. Before and after the experiments, measurements of functional disability score, ESR, CRP, self-efficacy, and family support were taken and closely analyzed. The results of this analysis are as follows : 1. After the experiment, the experimental group had less functional disabilities compared to the control group(t=9.11, P=0.0017). 2. After the experiment, the ESR of both the experimental and the control groups decrease, but there was not notable difference between the two groups(t=0.07, P=0.9546). 3. After the experiment, the CRP of both the experimental and the control groups decreased, with no significant different between them(t=0.53, P=0.6022). 4. After the experiment, the self-efficacy of the experimental group increased significantly compared to the control group(t=3.15, P=0.0042), but the self-efficacy had no effect on the actual practice of the program. 5. After the experiment, the family support of the experimental group was higher than of the control group(t=6.33, P=0.0013), but again the family support had no effect on the actual practice of the program. Judging from the results of these experiments, the resistance exercise program not only diminishes rheumatoid arthritis patients' functional disabilities, but also has a great influence on increasing their self-efficacy and family support. Concluding, indiminishing the functional disabilities of rheumatoid arthritis, the resistance exercise program would be appropriate nursing intervention.
Arthritis, Rheumatoid* ; Humans ; Korea ; Nursing