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Pain, fatigue and fear-avoidance beliefs in relation to physical activity and body awareness in persons diagnosed with rheumatoid arthritis
Sophiahemmet University.ORCID iD: 0000-0002-7018-2706
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Pain and fatigue are highly common and a major concern for persons diagnosed with rheumatoid arthritis (RA). Having physical limitations, which have a significant effect on daily life, is also described as a major problem for persons with RA. Research findings show that a minority of persons with RA perform maintained health-enhancing physical activity (HEPA), and that psychosocial factors seem to be the most salient and consistent factors to explain variations in HEPA. Furthermore, fear of physical activity and exercise has been described as major barriers for persons with chronic pain. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature as having either a positive or a negative impact on a person’s health and well-being. However, the concept of BA is complex and therefore greater insight into this phenomenon is needed.

Aim: The overall aim of this thesis was to investigate pain, fatigue and fear-avoidance beliefs in relation to physical activity and their correlates in persons with RA. A further overall aim was to develop a psychometric measurement of BA. A final overall aim was to deepen our understanding of BA in persons with RA.

Methods: Study I was a psychometric evaluation of a Swedish version of the Body Awareness Questionnaire (BAQ) in a student population and in adults with RA. Studies II - III were a cross-sectional survey studies in adults with RA. Study IV was a phenomenological study using the empirical phenomenological psychological (EPP) method in adults with RA.

Results: In study I, the value of Cronbach's alpha coefficients for the total score in the Swedish version of the BAQ was satisfactory. According to confirmatory factor analysis (CFA), neither a one-factor model nor a four-factor model tested in this study fulfilled the pre-specified criteria. In study II, pain was significantly associated with health-related quality of life (HRQoL) and disease activity. Fatigue was significantly associated with disease activity, BA and positive affect. The adjusted R2 was 28.6% for fatigue and 50.0% for pain. Study III showed that, for socio-demographic factors, being male and having a below average income were associated with an increased risk of high fear-avoidance beliefs about physical activity (mFABQ high). Moreover, the two disease-specific factors, which are most indicative of mFABQ high, were high level of pain and poor health. Concerning psychosocial factors, low HRQoL and low exercise self- efficacy were significantly associated with mFABQ high. The model fit was 0.27 (Nagelkerkés R2). In study IV, some general characteristics were found, which had to do with the disease giving rise to a higher degree of negatively toned BA. BA was a reactive process of searching or controlling for disease-related symptoms, or a reactive process that was triggered by emotions. In addition, BA was an active process in the sense of taking an inventory of abilities. All the participants had the ability to shift focus from BA to the outside world.

Conclusions: This thesis showed that pain, fatigue and fear-avoidance beliefs about physical activity in persons with RA have several potential correlates, including socio-demographic, disease-specific and psychosocial factors for the variables investigated. The Swedish version of the BAQ is simple to administer and should be used as a tool to measure self-reported attentiveness to normal body processes. Cronbach’s alpha coefficient for the total score was satisfactory; nevertheless, since neither of the models fulfilled the pre-specified criteria further testing of the Swedish version of the BAQ is required. BA was found to be both positively and negatively toned in persons with RA, though RA resulted in a higher degree of negatively toned BA. Thus, the ability to shift attention, from BA to activities in the outside world, could sometimes be beneficial for the person’s general health and well-being. Having the opportunity to participate in meaningful and purposeful daily real-world activities keeps the mind busy (and distracted) and can decrease the negative BA.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet , 2015. , 82 p.
Keyword [en]
Rheumatoid arthritis, Body awareness, Pain, Fatigue, Fear-avoidance beliefs about physical activity, Physical activity, Coping strategies, Cross-cultural adaptation, Concurrent think-aloud interviews, Narrative interviews, Phenomenological, Cross-sectional, Psychometrics
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-1845Libris ID: 17913135ISBN: 978-91-7549-867-6 (print)OAI: oai:DiVA.org:shh-1845DiVA: diva2:810624
Public defence
2015-05-29, Erfors- & Weitnersalen, Sophiahemmet Högskola, Vallhallavägen 91, Ingång R, Stockholm, 09:30
Opponent
Supervisors
Available from: 2015-05-07 Created: 2015-05-07 Last updated: 2016-06-09Bibliographically approved
List of papers
1. Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire
Open this publication in new window or tab >>Development and psychometric testing of the Swedish version of the Body Awareness Questionnaire
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2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 7, 1643-1651 p.Article in journal (Refereed) Published
Abstract [en]

Aim

This paper is a report of the development and psychometric testing of the Swedish version of the Body Awareness Questionnaire to measure bodily focus of attention.

Background

The Body Awareness Questionnaire has been identified as an instrument with excellent psychometric properties within the concept of body awareness. It has been used in both research and clinical settings in different contexts. However, a validated Swedish version is not available.

Method

A cross-sectional design was applied for adaptation of the Body Awareness Questionnaire and psychometric validation. Data were collected between autumn 2009 and spring 2011 from 120 patients diagnosed with rheumatoid arthritis, and from 120 students. The ‘concurrent think aloud’ method was used in a pre-test to determine the usability of the questionnaire. Cronbach's alpha was used to test the internal consistency, and confirmatory factor analysis was performed to test the construct validity.

Results

According to the confirmatory factor analysis, neither the one-factor model nor the four-factor model tested in this study fulfilled the pre-specified criteria in accordance with the Comparative Fit Index, Standardized Root Mean Squared Residual and the Root Mean Square Error of Approximation. The value of Cronbach's alpha for the Swedish version of the Body Awareness Questionnaire was satisfactory.

Conclusion

Our results indicate that the two models tested in this study do not provide a good fit to the observed data. Further refinement and testing of the Swedish version of the Body Awareness Questionnaire is therefore required. The concept of body awareness may

Keyword
Body awareness, Instrument development, Nursing, Psychometric properties, Rheumatoid arthritis, Swedish version
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-975 (URN)10.1111/jan.12020 (DOI)22994423 (PubMedID)
Available from: 2012-03-14 Created: 2012-03-14 Last updated: 2015-05-07Bibliographically approved
2. Pain and fatigue in adult patients with rheumatoid arthritis: association with body awareness, demographic, disease-related, emotional and psychosocial factors
Open this publication in new window or tab >>Pain and fatigue in adult patients with rheumatoid arthritis: association with body awareness, demographic, disease-related, emotional and psychosocial factors
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2013 (English)In: Open Journal of Nursing, ISSN 2162-5336, E-ISSN 2162-5344, Vol. 3, no 2, 293-300 p.Article in journal (Refereed) Published
Abstract [en]

Background: Patients and clinicians report pain and fatigue as key outcome measures in rheumatoid arthritis. Fatigue and pain are a major concern to patients. Aim: The objective of this study was to examine fatigue and pain in adult patients with rheumatoid arthritis (RA) and to investigate the association between pain and fatigue with body awareness, demographic, disease-related, emotional and psychosocial factors. Method: Data were collected from a sample of patients with RA (n = 120) recruited from a Rheumatology clinic in a large university hospital in Stockholm, Sweden. Eligible for inclusion were patients between 20 - 80 years of age and with a confirmed diagnosis of RA. Fatigue was measured using the Multidimensional Assessment of Fatigue (MAF) scale, while the Visual Analogue Scale (VAS) was used to assess components of pain. A multiple stepwise regression analysis was performed to evaluate factors related to fatigue and pain. In the first step a univariate analysis of variance (ANOVA) was used for all relevant independent factors. In the next step backwards stepwise regression was applied. Result: Fatigue was significantly associated with the Disease Activity Score 28-joints (DAS 28) (p = 0.049), the Body Awareness Questionnaire (BAQ) (p = 0.006), the Positive Affect (PA) scale (p = 0.008) and no smoking (p = 0.021). Pain was significantly associated with the EuroQol EQ-5D (p = 0.008) and the DAS 28 (p = 0.001). The adjusted R-square was 28.6% for fatigue and 50.0% for pain. Conclusion: This study clearly demonstrates that fatigue and pain in patients with RA appear to be associated with disease-related factors. Furthermore, fatigue was related to body awareness and emotional factors, and pain was related to health related quality of life.

Keyword
Pain, Fatigue, Emotional, Psychosocial, Rheumatoid Arthritis
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1117 (URN)10.4236/ojn.2013.32040 (DOI)
Available from: 2012-08-09 Created: 2012-08-09 Last updated: 2015-05-07Bibliographically approved
3. Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis
Open this publication in new window or tab >>Fear-avoidance beliefs about physical activity in adults with rheumatoid arthritis
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2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, 93-99 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to describe fear-avoidance beliefs about physical activity and explore how these beliefs correlate with sociodemographic, disease-specific, and psychosocial factors in adults with rheumatoid arthritis (RA). Method: This cross-sectional study is part of the Physical Activity in Rheumatoid Arthritis (PARA) 2010 study. The study participants (n = 2351) were identified through the Swedish Rheumatology Quality (SRQ) registries from six rheumatology clinics in Sweden. Univariate and backwards stepwise logistic regressions were performed. Results: Stepwise logistic regressions showed that male gender [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.26-1.91] and having a below average income (OR 1.35, 95% CI 1.12-1.63) were associated with an increased risk of high scores on the modified Fear Avoidance-Belief Questionnaire (mFABQ). The two disease-specific factors most indicative of high mFABQ scores were high level of pain (OR 1.99, 95% CI 1.40-2.84) and poor health (OR 1.59, 95% CI 1.10-2.29). With regard to psychosocial factors, low health-related quality of life (HRQoL; OR 0.44, 95% CI 0.35-0.55) and a low score on the Exercise Self-Efficacy Scale (ESES; OR 0.66, 95% CI 0.52-0.82) were significantly associated with a high mFABQ score. The model fit was 0.27 (Nagelkerke's R(2)). Conclusions: High fear-avoidance beliefs about physical activity in patients with RA were found to be associated with being male and having a below average income, a high level of pain, poor health, a low HRQoL, and low ESES score. Additional research is warranted for adults with RA to capture the multiple potential correlates to fear-avoidance beliefs about physical activity.

National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1726 (URN)10.3109/03009742.2014.932432 (DOI)25222440 (PubMedID)
Available from: 2014-11-11 Created: 2014-11-11 Last updated: 2015-05-07Bibliographically approved
4. Body awareness in persons diagnosed with rheumatoid arthritis
Open this publication in new window or tab >>Body awareness in persons diagnosed with rheumatoid arthritis
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2014 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 9, 24670- p.Article in journal (Refereed) Published
Abstract [en]

Living with rheumatoid arthritis (RA) poses physiological and psychological demands on a person. RA is a autoimmune disease that can cause pain, disability, and suffering. The ability to notice bodily inner sensations and stimuli (body awareness, BA) is described in the literature in ways that could have either a positive or a negative impact on a person's health. The concept of BA is complex and a thorough understanding is needed about what BA means from the patient's perspective. This study was therefore conducted to acquire greater insight into this phenomenon. The study is grounded in a phenomenological life-world perspective. Eighteen narrative interviews were conducted in patients (age range 23–78 years) with RA. The interviews were analyzed using the Empirical Phenomenological Psychological method. General characteristics were found running through all 18 interviews, indicating that the disease resulted in a higher degree of negatively toned BA. BA was either a reactive process of searching or controlling after disease-related symptoms or a reactive process triggered by emotions. BA was an active process of taking an inventory of abilities. All participants had the ability to shift focus from BA to the outside world. Four typologies were identified: “A reactive process on symptoms,” “A reactive process on emotional triggers,” “An active process of taking an inventory of abilities,” and “A shifting from BA to the outside world.” In conclusion, because BA can be both positively and negatively toned, health care professionals must have a good understanding of when BA is positive and when it is negative in relation to the patient. RA had caused a higher degree of negatively toned BA. Thus, the ability to shift attention from BA to activity in the outside world could sometimes be beneficial for the patient's general health.

Keyword
Body awareness, Phenomenology, Life-world perspective, Lived experience, Rheumatoid arthritis
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-1723 (URN)10.3402/qhw.v9.24670 (DOI)25363521 (PubMedID)
Available from: 2014-11-03 Created: 2014-11-03 Last updated: 2015-05-07Bibliographically approved

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