| Abstract |
Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune and progressive disease which causes increasing damage to the joints, while it can also affect other organs, causing significant physical, psychological and social impact on patients’ lives. Patients' partners seem to play an important role in the process of adapting to the disease, but at the same time they are, also, afflicted by it. Despite the importance of partners’ role in the management of RA, limited are the studies that include them in their design. The present study aims to gain a more comprehensive understanding of partners’ contribution to patient adjustment at both theoretical and clinical level. It includes a correlational study and a randomized clinical trial. The main aims of the correlational study were to examine: a) the role of partners' representations in shaping patients' coping strategies; b) the existence of interdependence between patients' and partners' representations in terms of patients' coping strategies and their physical and psychological health; c) the relationship between patients' and partners' representations and their psychological and physical health; and d) the relation between patients' and partners' representations incongruence on their quality of life. The study was conducted at the Rheumatology Clinic of Heraklion University Hospital. A total of 100 married, heterosexual couples (92% of the patients were women) participated. The mean age of the patients was 54.12 years (SD = 9.52) and of the partners 51.23 (SD = 7.23). All participants completed the revised version of the Revised Illness Perception Questionnaire, the Hospital Anxiety and Depression Scale to measure anxiety and depression, and the physical functioning and general health subscales of the RAND 36-item Health survey. In addition, patients completed the Coping with Health Injuries and Problems Scale to assess their management strategies. Based on our results, it appeared that partners' representations (illness consequences, personal control, treatment control, and emotional representations) were only indirectly associated with patients' coping strategies through their representations. Furthermore, statistically significant interdependent relationships were not observed between patient and partner representations with patients' coping strategies and the psychological and physical health of all participants. The only statistically significant relationship was observed between personal control representations and palliative coping strategies. Specifically, the relationship between patients' representations of personal control and palliative coping became stronger when partners identified higher levels of control for patients. Furthermore, based on the results of hierarchical regression analysis, representations of partners’ personal control are associated with patients' levels of anxiety. Consequences of the disease as recorded by patients were negatively associated with their subjective general health and physical functioning, while sense of personal control was negatively associated with levels of depression. With regard to the partners’ physical and psychological health, statistically significant relationships were not observed, except between the patients’ consequences and partners' physical functioning. Furthermore, statistically significant relationships were not observed between patients’ and partners’ representations incongruence and the patients' physical and psychological health. Regarding the partners, it appeared that incongruence about the consequences of the disease was negatively associated with anxiety and depression, incongruence about treatment control was negatively associated with general health and physical functioning and incongruence about the emotional representations of RA were positively associated with anxiety.
The aim of randomized clinical trial was to design and examine the effectiveness of a psychosocial intervention protocol for patients with RA and their partners based on the Common Sense Model and Cognitive Behavioral Therapy. Specific sub-objectives of the study were to examine a) the effectiveness of a psychosocial intervention protocol in three groups: the patient/partner group, the patient group and the control group receiving standard care for RA, focusing on the differentiation of important adjustment parameters in three different phases: before treatment, after treatment and three months after treatment, b) whether the participation of partners in treatment is considered more beneficial for patients compared to the only-patient group; and c) whether the participation of partners in the psychosocial intervention will have significant benefits for them compared to the patient and control groups with partners receiving no intervention. A total of 50 couples participated. 94% of the participants were female and 6% male. They were randomly divided into three groups. In the patient/partner group (13 couples, mean age of patients = 59.30 SD = 5.6 and mean age of partners = 62.10 SD = 7.2) the patient group (20 couples, mean age of patients = 57.50 SD 8.9 and mean age of partners = 63.7 SD 7.5) and the control group (17 couples, mean age of patients = 61.23 SD 8.2 and mean age of partners = 65.2 SD 5.7). All participants were asked to individually complete all scales that they had also completed in the correlational study at three different time phases (before the intervention, immediately after the intervention and three months later). Repeated measures analysis of variance showed significant improvement in patients' representations of personal / treatment control as well as emotional representations of the disease for both treatment groups. In contrast, the control group showed an increase in representations of disease consequences as well as worse ratings of treatment control over time. The two treatment groups, also, demonstrated significant improvements in physical and psychological health, with a reduction in anxiety and depression symptoms and an improvement in subjective general health, in contrast to the control group that experienced increased levels of anxiety. Significant improvement was also observed in the use of more functional coping strategies for the treatment groups in contrast to the control group in which there was an increase in emotion-focused strategies. It is worth mentioning that statistically significant differences were not observed in the variables under consideration between the two treatment groups. Regarding the effectiveness of the intervention on partners, it appeared that partners in the intervention group showed more functional representations of personal/ treatment control.
In conclusion, the results of the two studies offer important theoretical and clinical benefits to the study of adjustment in RA. The importance of the partner in the disease adaptation process is acknowledged as patients' partners continue to play a crucial role, even during the chronic phase of the disease, in shaping patients' representations and their subsequent coping strategies. Moreover, it is the first clinical study conducted in RA following such a psychosocial intervention protocol while also presenting data on patients' partners, demonstrating that the use of combination therapies can bring significant benefits even in psychological and physical health indicators compared to traditional treatments applied for disease management.
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