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Title: The needs and level of coherence of patients with rheumatoid arthritis

Abstract:

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease. Traditional symptoms of the disease include pain and edemas of symmetric joints of hands and feet accompanied by morning stiffness. Statistical data indicate that women are affected by this disease three times more frequently than men. The peak of incidence is in the fourth and fifth decade of life. RA is a progressive disease with periods of exacerbations and remissions. The period of disease exacerbation is related to the exclusion of the patient from everyday life. In this period, the joints are very painful, both during the movement and during the rest. Very strong pain limits the movement of the patient and is responsible for their poor condition. Most frequently, the joints are edematous, and the skin in the areas of the joints is slightly red, warm and it responds to touch with pain. The period of disease remission is hope for the improvement of health state of the patient, whereas the period of exacerbation and impairment of joints function causes the decrease of the mood, depressive state and other psychological conditions. The characteristic feature of the course of the RA is progressive joint destruction, and it can lead to profound disability. The diagnosis of RA is shocking for the patients and it can disturb the existing scheme of functioning and suppress the sense of safety, comprehensibility, manageability and meaningfulness.The purpose of the thesis: The purpose of the thesis was to evaluate the needs and the level of coherence of the patients with RA.Material and methods: The research was conducted by using the diagnostic poll method, the survey technique. The level of coherence was evaluated, with particular attention paid to the sense of manageability, meaningfulness and comprehensibility. The sense of manageability was studied with the use of standardized tools: the Short-Form Health Survey (SF-36) and the Generalized Self-Efficacy Scale (GSES). The sense of meaningfulness was assessed with the use of the Satisfaction with Life Scale (SWLS) and the Inventory of Socially Supportive Behaviors (ISSB) Short-Form. Using the Acceptance of Illness Scale (AIS), the sense of comprehensibility was studied. In order to determine the needs of patients with RA, an authorial questionnaire was employed: Needs of Patients with Rheumatism Scale (NPR).The research was conducted among patients being in the period of exacerbation (100 patients) and in the period of remission (24 patients). The results of the study were compared with the group of healthy people (who don’t suffer from RA) (126 people). The study was carried out in the Departments of Rheumatology and in outpatient Clinics of Rheumatology of J. Dietl Specialist Hospital and in The University Hospital in Cracow.Statistical calculations were made, and it was assumed that the statistical significance is ɑ=0.05. All the values of p<0.05 were interpreted as indicative of significant relations.Results: The quality of life of the patients with RA was presented as two fields of human functioning. Functioning in the physical dimension, that is Physical Component Summary (PCS) and functioning in the mental dimension, that is Mental Component Summary (MCS). ; Both were lower in the patients being in the period of exacerbation than in the patients in the period of remission. In the groups of RA patients, mental functioning was better than physical functioning. Among the patients with RA, being in the period of exacerbation, low and medium feeling of life satisfaction was dominating. In the period of remission, it was medium. Social support for RA patients in the period of exacerbation was similar to the level of social support for healthy people. Social support for patients with RA in the period of remission was definitely lower than in the case of patients being in the period of exacerbation. The RA patients in the period of exacerbation had low sense of their own effectiveness. It was high in the period of remission. In the period of remission they represented higher level of acceptance of the disease than patients who were in the period of exacerbation. The RA patients being in the period of exacerbation had their needs satisfied to a lower degree than the patients in the period of remission. Among the patients being in the period of exacerbation, the level of manageability was 54%, the level of meaningfulness was 47%, and the level of comprehensibility reached 51%. The general level of coherence for this group of patients was evaluated as 51%. Among the patients being in the period of remission, the level of manageability achieved 69%, the level of meaningfulness was 45%, and the level of comprehensibility – 74%. The general level of coherence for this group of patients was evaluated as 63%. The level of coherence of the RA patients in the period of remission was higher than in the RA patients being in the period of exacerbation.Conclusions: All components evaluating the sense of manageability and comprehensibility were higher in the RA patients being in the period of remission comparing to patients in the exacerbation period. Among the RA patients with exacerbation, the level of meaningfulness was higher than in the patients being in the period of remission. Patients with RA in the period of remission had higher general level of coherence than RA patients in the period of exacerbation.It is crucial to identify the level of coherence of the patients with RA and the individual needs of these patients, and help them to achieve the satisfactory needs, to maintain the self-care ability of patients. Appropriate care of RA patients could decrease the economic, social and family costs related to this disease.

Place of publishing:

Kraków

Level of degree:

2 - studia doktoranckie

Degree discipline:

choroby narządów ruchu

Degree grantor:

Uniwersytet Jagielloński. Collegium Medicum. Wydział Nauk o Zdrowiu.

Promoter:

Jolanta Jaworek ; Małgorzata Kulesa-Mrowiecka

Date issued:

2017

Format:

application/pdf

Identifier:

oai:dl.cm-uj.krakow.pl:4254

Call number:

ZB-128495

ControlNumberVIRTUA:

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Language:

pol

Access rights:

tylko w bibliotece

Location of original object:

Biblioteka Medyczna Uniwersytetu Jagiellońskiego- Collegium Medicum

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Last modified:

May 24, 2021

In our library since:

Aug 28, 2018

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24

Number of object content views in PDF format

14

All available object's versions:

http://dl.cm-uj.krakow.pl:8080/publication/4255

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ZB-128495 May 24, 2021
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