bluuebunny/crossref_metadata_2025 huggingface dataset:
One‐year evaluation of cognitive‐behavioral intervention in osteoarthritis
Authors: Calfas Karen J. , Kaplan Robert M. , Ingram Rick E.
Published: February 2007

We compared a cognitive‐behavior modification and a traditional education intervention for adults with osteoarthritis (OA). Forty OA patients were randomly assigned to one of two groups: cognitive‐behavior modification or didactic lectures. During ten weekly sessions, the cognitive‐behavior group learned methods for coping with pain and the disabilities associated with OA. The traditional education group experienced a series of lectures from health care professionals. Prior to the interventions and following 2, 6, and 12 months, patients in both groups were evaluated with a general Quality of Well‐being (QWB) scale, the Arthritis Impact Measurement Scales (AIMS), the Beck Depression Inventory (BDI), and other measures. Although there were some differences between the two groups at 2‐month follow‐up, by the end of 1 year, physical and psychological functioning did not differ significantly between the two groups. In comparison to baseline, both groups demonstrated initial changes on QWB, depression, and the pain component of the AIMS. Improvements in depression remained through the 1‐year follow‐up. Multiple regression analysis demonstrated that the mobility and physical activity aspects of the AIMS were significant long‐term predictors of outcome (1 year) for general quality‐of‐Life measures. One‐year outcomes for depression were significantly predicted from scores on social support and mobility measures from the AIMS. We conclude that cognitive‐behavior modification and education produce similar effects on long‐term physical and psychological functioning in OA patients.
Cardiovascular functional disorder in primary fibromyalgia. A noninvasive study in 17 young men
Authors: Visuri Tuomo , Lindholm Harri , Lindqvist Ari , Dahlström Seppo , Viljanen Antti
Published: February 2007

Cardiovascular functional stability was studied in 17 young men (20‐year‐old conscripts) with the symptoms of primary fibromyalgia (PF). They were compared to 20 medical students of the same age. The subjects underwent an orthostatic test, deep breathing test, Valsalva maneuver, and a handgrip test. They were evaluated by an autoanamnestic questionnaire on vegetative symptoms and laboratory tests on blood chemistry. The heart rate of the PF group after 8 min of active standing was 32 ± 15 beats/min greater than at supine rest. The corresponding figure for the constrols was 23 ± 7 beats/min (p = 0.001). Twelve conscripts with PF (71%) presented sympathicotonic cardiovascular reaction on the orthostatic test (p < 0.001). Four of these sympathicotonic conscripts and two other conscripts (total 35%) had an abnormal high index of dystonic symptoms (p = 0.01). The results suggest that young men with symptoms of PF have not only cardiovascular dystonic symptoms but also increased sympathetic nervous reactivity of the cardiovascular system.
A comparison of pain perceptions in women with fibromyalgia and rheumatoid arthritis. Relationship to depression and pain extent
Authors: Burckhardt Carol S. , Clark Sharon R. , Bennett Robert M.
Published: February 2007

Two studies were conducted to characterize the pain of fibromyalgia syndrome (FMS); to compare it to rheumatoid arthritis (RAJ pain; and to examine the relationships between depression, pain extent, and pain description. Two methods of administering the McGill Pain Questionnaire (MPQ) were used. When the MPQ was administered in the standard manner, FMS pain could not be distinguished from RA pain. When participants were allowed to select as many words from an adapted MPQ as they wished, significant differences in word choice emerged. Depression and pain extent were major predictors of group differences in the evaluation of pain. However, depression scores contributed only 50% of the explanation for the differences in pain extent, with group membership contributing the other 50%. These. findings suggest that the character and extent o/pain in FMS are at least partially due to peripheral sensory components and not simply centrally controlled pain amplification secondary to depression.
Dietary intake and circulating vitamin levels of rheumatoid arthritis patients treated with methotrexate
Authors: Morgan Sarah L , Hine R Jean , Vaughn William H , Brown Allen
Published: February 2007

The nutrient intakes and circulating vitamin levels of 32 patients with rheumatoid arthritis who were treated with methotrexate were evaluated over a 6‐month period. Dietary data were obtained and blood was drawn prior to the initiation of and following 12and 24 weeks of methotrexate therapy. More than 50% of the patients had food intakes providing less than 67% of the recommended dietary allowance for zinc, vitamin E, foh'c acid, pyridoxine, qnd magnesium. Patients 51 years or older had better nutrient intakes than patients less than 51 years. Of the patients, 22% consumed vitamin supplements at thetime they were recruited for the study. Mean circulating vitamin levels measured over the6‐month period were within normal limits. Our findings agree with previously published reports that patients with rheumatoid arthritis, particularly the subpopulation taking methotrexate, consume diets that are marginal in some nutrients. Additional research needs to be done to identify more sensitive nutrient assays and to establish more definitively the nutrient needs of patients with rheumatoid arthritis taking several therapeutic agents.
Effect of a walking program on gait characteristics in patients with osteoarthritis
Authors: Peterson M. G. E. , Kovar‐Toledano P. A. , Otis J. C. , Allegrante J. P. , Mackenzie C. R. , Gutin B. , Kroll M. A.
Published: February 2007

This paper reports the results of a study of the gait of 102 patients with osteoarthritis of theknee. Functional status was measured by a 6‐min test of walking distance; the stride characteristics associated with the walk test were assessed. Stride characteristics were measured by a StrideAnalyzer. Patients were randomized to an 8‐week educational and walking program (the intervention group) or to a weekly telephone survey (the control group). The intervention group patients had a 15% increase in walking distance (P < 0.0001) and increases of 9.1% in stride length at freewalking speeds (P < 0.007) and 17% in stride length at fast walking speeds (P < 0.01) comparedtothe control group. The results of this study have shown that the walking and educational program was effective in improving gait function in patients with osteoarthritis of the knee.
Self‐management of osteoarthritis
Authors: Hampson Sarah E , Glasgow Russell E , Zeiss Antonette M , Birskovich Stephen F , Foster Lyn , Lines Alana
Published: February 2007

Osteoarthritis is the most prevalent activity‐limiting condition among older persons. In addition to, or instead of, taking nonsteroidal anti‐inflammatory drugs, people use a variety of activities to manage their osteoarthritis. This study describesthe self‐management methods reported by 61 participants aged 60 years or older assessed on two occasions 8 months apart. A questionnaire was developed to assess levels of use of 10 self‐management methods including low‐impact activity, rest, range‐of‐motion exercises, relaxation, heat (or cold), taking medication, jointprotection, massage, splints, and any other activity. On a typical day, participants usedabout four of these activities to manage Osteoarthritis symptoms, and significantly more on a day that their arthritis was worse than usual. Three self‐management scales were formed from groups of activities suggested by factor analysis (medication taking, typical management, and worse‐day passive management) that demonstrated adequate internal consistency and stability across the two assessments. The findings are discussed in terms of the importance of developing a brief measure of Osteoarthritis self‐management, and the substantial individual variation in subsets of methods used.
Effect of counselor training on skills development and psychosocial status of volunteers with systemic lupus erythematosus
Authors: Peterson Margaret G. E. , Horton Roberta , Engelhard Enid , Lockshin Michael D , Abramson Theodore
Published: February 2007

Volunteers with systemic lupus erythematosus were recruited for a telephone service to provide psychosocial support to peers. The volunteers attended an 8‐week counselor training program. The aim was to evaluate the impact of the training on counselors' skill development and to record possible changes in the counselors' psychosocial status. A second group of trainees (n = 15) was used as a delayed control for the first group (n = 14). The data were analyzed using multivariate repeated measures analysis of variance. Tests chosen to monitor psychosocial status included: Arthritis Impact Measurement Scales Anxiety and Depression subscales, Arthritis Helplessness Index, Wallston General Self‐Efficacy Scale, University of California at Los Angeles Loneliness Scale, Rosenberg Self‐Esteem, and Campbell Personal Competence scales. Tests selected to measure skills and knowledge development included the Carkhuff Communications and Discrimination Skills Inventories and the Applied Knowledge Assessment scale. The latter was developed in‐house and tested for reliability. Only the Carkhuff Communications Skills (P < 0.001) and the Applied Knowledge Assessment (P < 0.001) showed significant changes pre‐ and post‐test within subjects. These results persisted at the 6‐month level.
Gender, depression, and ankylosing spondylitis
Authors: Barlow Julie Helen , Macey Stephen John , Struthers George Robert
Published: February 2007

Depression has been established as a common reaction to rheumatoid arthritis but has rarely beeninvestigated among people with other forms of arthritis. The present study examined the prevalence and determinants of depressive symptoms in people with ankylosing spondylitis, focusing on gender differences and set in the context of widely held medical views concerning the psychosocial nature of ankylosing spondylitis patients. Results showed that approximately one third of the ankylosing spondylitis patients reported a high level of depressive symptoms and that women reported more depression than men. No evidence was found to support the stereotype of the “typical” ankylosing spondylitis patient as being less depressed than people with other forms of arthritis. Pain was found to be a major determinant of depression for women, but was of lesser importance for men. The implications of these findings are discussed.
Improved training of house officers in a rheumatology consult service
Authors: Mazzuca Steven A , Brandt Kenneth D , Katz Barry P
Published: February 2007

This study examined whether the clinical environment could be used to increase internal medicinehouse officers' adoption of care recommendations taught in a didactic conference. Subjects were11 internal medicine house officers who served 6‐week rheumatology elective rotations. At the start of each of four rotation periods, house officers attended a 1‐hour conference in which periarticular rheumatic disorders associated with knee pain (anserine bursitis, pseudothrombo‐phlebitis) and shoulder pain (bicipital tendinitis) were discussed. All house officers also practiced physical examination techniques on anatomic models simulating the disorders. During alternate rotation periods, reminder sheets were appended to the records of arthritis patients with histories of chronic knee or shoulder pain. The frequency with which house officers followed conference recommendationswas documented by direct observation (6 house officers in 17 encounters with reminders, 5 house officers in 30 encounters without reminders). Specific questioning about a recent history of knee or shoulder pain and the performance of four of five recommended physical examination maneuvers were increased significantly by reminder sheets in patients' charts (P < 0.05 for all). Although rheumatology faculty often have limited options available to increase the number of house officer trainees or to intensify clinical activity, qualitative improvements within existing logistic parameters are feasible by assuring that the clinical environment (e.g., patient records) contains salient cues that will prompt desired actions.
Medical student use of history and physical information in diagnostic reasoning
Authors: Gruppen Larry D , Palchik Nancy S , Wolf Fredric M , Laing Timothy J , Oh Mary S. , Davis Wayne K.
Published: February 2007

Clinical data gathering is central to clinical competence. Although research has demonstrated the value to experienced clinicians of information obtained from the history, little is known of how medical students use this information. In the present study, two case simulations (in rheumatoid arthritis and systemic lupus erythematosis) were developed to assess medical student information gathering and utilization. The results indicate that most of the students were already considering the correct diagnosis as a possibility after the presenting complaint and patient description. However, the medical history exerted the strongest influence on transforming the correct diagnosis from just another diagnostic possibility into the favored diagnostic candidate. Students who failed to list the correct diagnosis in the differential diagnosis after obtaining the history were significantly less likely to reach the correct diagnosis at the end of the case. These results confirm the critical importance of the history in medical problem solving.
Relationship of pain behavior to disease activity and health status in rheumatoid arthritis
Authors: Parker Jerry C , Callahan Charles D , Smarr Karen L , McClure Karla W , Stucky‐ropp Renég , Anderson Sharon K , Walker Sara E
Published: February 2007

The purpose of the study was to investigate the contributions of disease activity, health status, and self‐efficacy to the pain behavior exhibited by patients with rheumatoid arthritis. Measures included the Arthritis Impact Measurement Scales, the Arthritis Self‐Efficacy Scale, a visual analogue scale for pain, and the McGill Pain Questionnaire. Joint counts and ratings of pain behavior also were obtained. All measures were collected at both baseline and 6 months. Hierarchicalmultiple regression analyses revealed that disease activity, as measured by joint count, was significantly related to a modified pain behavior index at both time intervals. With joint count entered into the regression model, no other variable consistently increased the predictive accuracy of the model. There were no significant correlations between the modified pain behavior index and either the visual analogue scale for pain or the McGill Pain Questionnaire scores. The results suggest that painbehavior in male rheumatoid arthritis patients is more closely related to disease activity than to self‐reported pain, health status, or perceived self‐efficacy.
Use of self ‐ administered joint counts in the evaluation of rheumatoid arthritis patients
Authors: Abraham Noval , Blackmon Deborah , Jackson James R , Bradley Laurence A , Lorish Christopher D , Alarcón Graciela S
Published: February 2007

The validity and reliability of self‐administered joint counts are reported in a group of32 rheumatoid arthritis patients being followed at a university‐based practice located in theSoutheast region of the United States, serving low to middle income urban and rural patients. Adequate inter‐rater reliability among the patients' and the research assistant's joint counts was obtained for upper (r = 0.74), lower (r = 0.96), and upper and lower extremities (r = 0.89). Convergent validity correlations for pain, helplessness, and the Joint Alignment and Motion scale were found to be adequate. We conclude that rheumatoid arthritis patients can reliably assess their joint counts. Self joint counts along with other validated self‐reportsof health status may be applicable to busy outpatient settings, as well as in clinical research.
Comparison of peak isometric knee extensor torque in children with and without juvenile rheumatoid arthritis
Authors: Giannini Manuela Jasso , Protas Elizabeth J.
Published: February 2007

This study compared peak isometric knee extensor torque in children with juvenile rheumatoid arthritis (JRA) and healthy children. A secondary purpose was to determine the relationship between measures of articular disease severity and peak isometric knee extensor torque. Peak torque was measured with a computerized dynamometer. Twenty‐eight children with JRA and 28 children without JRAwere matched for age, sex, and body surface area. Peak isometric knee extensor torque was significantly lower among the children with JRA than their respective control (P < 0.05, paired Student's t‐test, one‐tailed). There was no relationship between peak torque and measures ofarticular disease severity among the children with JRA. Subjects complained of quadriceps muscle discomfort as a result of the isometric muscle test. One child with JRA complained of increased knee pain and swelling. Peak isometric knee extensor torque appears to be a useful variable for characterizing muscle function deficits in children with JRA. Isometric muscle performance did not correlate with articular disease severity. The results suggest that isometric strengthening programs are indicated for this patient population. We recommend that clinicians monitor patients for joint and muscle symptoms during exercise training sessions.
Differential strength decline in patients with osteoarthritis of the knee: revision of a hypothesis
Authors: Hall Kathy D , Hayes Karen W , Falconer Judith
Published: February 2007

A quadriceps‐to‐hamstring isometric peak torque ratio (Q/H ratio) of approximately 2.0 is considered necessary for appropriate knee biomechanics. Lower ratios may affectthe function of persons with osteoarthritis (OA) and the progression of the disease. This study examined theisometric Q/H ratio in subjects with and without OA of the knee and explored the effect of age, pain, and joint enlargement on the ratio. Twenty‐one pairs of subjects (OA, control) were matched on age (X = 62.6 years; SD = 13.9), gender (F = 17, M = 4), and leg dominance (Dominant = 10, Nondominant = 11). Isometric quadriceps and hamstring peak torque, knee pain, and joint enlargement were measured. Paired t‐tests demonstrated that the OA group had significantly lower quadriceps peak torque than the control group but did not have significantly lower hamstring peak torque or gravity‐corrected isometric Q/H ratio. Age correlated with the ratio in subjects without OA (p = −0.46; P = 0.03) but not in subjects with OA. Pain was not significantly correlated with the ratio in either group. Joint enlargement correlated with the ratio in the OA group (p = −0.45; P = 0.03). The gravity‐corrected isometric Q/H ratio appears to decrease with age in subjects without OA. In subjects with OA, the Q/H ratio appears not to change with disease, pain, or age. Joint enlargement may decrease the ratio and merits further study.
Adapting the systemic lupus erythematosus self‐help (slesh) course for latino SLE patients
Authors: Robbins Laura , Allegrante John P , Paget Stephen A
Published: February 2007

The Systemic Lupus Erythematosus Self‐Help (SLESH) Course is an effective self‐management program that provides knowledge and enabling skills to people with systemic lupus erythematosus (SLE) and their families to assist them in coping with the disease. However, many acknowledge that the program has largely failed to meet the needs of people from diverse cultural backgrounds. In order to better understand how the SLESH Course can be more responsive to the needs of people from diverse cultural groups, we conducted a case study to analyze the content, process, and logistics of the course. The purpose of our study was to determine the essential variables to be considered in adapting the program for Latino SLE patients. Utilizing a three‐phase approach that involved keyinformant interviews, focus groups, and evaluation of skill‐building activities, we found that culturally determined health beliefs, language of preference, and outreach efforts are the key variables that must be considered in adapting the SLESH Course for the target population. Culturally determined health beliefs, such as the importance of family roles rather than individual need and an emphasis on the interdependency of family members, need to be considered in adapting self‐help programs like the SLESH Course for Latino SLE patients.
The assessment and management of low back pain: a critical review
Authors: Katz Jeffrey N
Published: February 2007

Abstract Missing 105.
Is group physical therapy superior to individualized therapy in ankylosing spondylitis? A randomized controlled trial
Authors: Hidding Alita , van der Linden Sjef , Boers Maarten , Gielen Xandra , de Witte Luc , Kester Arnold , Dijkmans Ben , Moolenburgh Daniël
Published: February 2007

Purpose. To study the effects of adding supervised group physical therapy to unsupervised individualized therapy in ankylosing spondylitis.

Methods. One hundred forty‐four patients were randomized to exercises at home, or the same plus weekly group physical therapy for 9 months. Endpoints were spinal mobility, fitness[maximum work capacity by ergometry], functioning (Sickness Impact Profile, Health Assessment Questionnaire for the Spondylar‐thropathies, and Functional Index), and patient's global assessment of change on a 10‐cm visual analogue scale.

Results. Thoracolumbar flexion and extension increased by an average of 0.5 cm (9%) after home exercises, and by 0.9 cm (16%) after group therapy. Maximum load in ergometry decreased by 2 W (1%) after home exercises, but increased by 7 W (4%) after group therapy. Global assessment improved by 0.3 (6%)after home exercises, and by 1.7 (34%) after group therapy. These three differenceswere statistically significant. There were no significant differences in chest expansion, cervical rotation, or the self‐assessments of functioning.

Conclusions. Group physical therapy proved superior to individualized therapy in improving thoracolumbar mobility and fitness, and had an important effect on global health reported by the patients.
A musculoskeletal outreach screening, treatment, and education program for urban minority children
Authors: Kasper Mark J , Robbins Laura , Root Leon , Peterson Margaret G. E. , Allegrante John P
Published: February 2007

Purpose. A hospital‐based outreach program was initiated to screen minority children in medically underserved areas of New York City for musculoskeletal diseases. We examine the number of such diseases in this population, and evaluate the program's success to facilitate referral and follow‐up of children with referral conditions.

Methods. Screenings were conducted at schools and day‐care centers. Children requiringfurther evaluation were referred to the sponsoring hospital, a major referral center for musculoskeletal diseases. Bilingual educational strategies, transportation reimbursement, and coverage for uninsured children were used to foster participation and increase follow‐up.

Results. A total of 2,523 children were screened, 168 (6.7%) of whom were referred forone of 45 different musculoskeletal disorders, including scoliosis and back problems, foot problems, in‐ and out‐toeing, knee or hip pain, and problems of joint range of motion. Sixtyseven percent of those referred had a follow‐up medical consultation.

Conclusions. A substantial proportion of urban minority children have previously undiagnosed musculoskeletal disorders that, if left untreated, have the potential to lead to significant disability in later life. Targeted screening programs can be effective in identifying such disorders, and providing an apportunity for early diagnosis, treatment, and education.
Self‐care agency in persons with rheumatoid arthritis
Authors: Ailinger Rita L , Dear Margaret R
Published: February 2007

Using a framework based on Orem's self‐care deficit theory, five hypotheses related to conditioning factors in self‐care agency were tested. The study sample consisted of 60 outpatients with a diagnosis of rheumatoid arthritis in a large research hospital. Patients completed the Exercise of Self‐Care Agency instrument and the Health Assessment Questionnaire; a physician rated their arthritis severity. Twenty percent of subjects had high scores on self‐care agency, 63% had average scores, and 16% had low scores. The conditioning factor of age was not relatedto selfcare agency. However, education and the duration of illness were related to self‐care agency in this group of persons with rheumatoid arthritis.
Promoting self‐care in clients with arthritis
Authors: Neuberger Geri Budesheim , Smith Katharine Vogel , Black Sharon Oetker , Hassanein Ruth
Published: February 2007

Preliminary work regarding the development and pilot study of an individualized instructionalprogram for rheumatoid arthritis clients is presented. The effect of the individualized instructional program was tested with 31 outpatients. Using analysis of covariance, the experimental group subjectsscored significantly higher on the knowledge post‐test when compared to scores of control group subjects (P = 0.0045). Analysis of variance for repeated measures revealed no significant difference in performance of tasks for the control group and experimental group (P = 0.08). In a follow‐up study, the effect of the self‐instructional program, practice time, and contracting were explored for their effect on adherence to self‐care activities. Experimentalgroups (n = 42) scored significantly better than the control group (n = 11) on the knowledge post‐test (P < 0.01), performance of joint protection practices (P = 0.01), range of motion exercises (P = 0.01), and adherence to joint protection practices at home (P < 0.01). Groups did not differ on adherence to range of motion exercises at home (P = 0.83).
Factors affecting unprescribed remedy use among people with self‐reported arthritis
Authors: Cronan Terry A , Kaplan Robert M , Kozin Franklin
Published: February 2007

Objective. The purpose of the study is to determine the frequency and consequences of use of unprescribed remedies by people with self‐reported osteoarthritis, and to find methodsfor predicting such use.

Methods. A random digit telephone survey was used to contact respondents. A 90‐item questionnaire evaluated demographic characteristics, type of disorder, area affected, severity of problem, and symptoms encountered.

Results. Among 1,811 contacts, 21% had musculoskeletal complaints. Of those withself‐reported musculoskeletal disorders, 84% had used at least one unprescribed remedyduring the past 6 months. People with self‐reported rheumatoid arthritis used more such remedies than those with self‐reported osteoarthritis, and those with a greater degree of disability used more unprescribed remedies than those who were less affected. Unprescribed remedies were rated as effective as prescribed remedies.

Conclusions. Unprescribed remedies are used frequently, particularly by those with painful and disabling arthritis. These remedies may be effective. Harmful and expensive remedies are used rarely.
Heat and cold in the management of rheumatoid arthritis
Authors: Hayes Karen W
Published: February 2007

Heat and cold are used often in the management of patients with rheumatoid arthritis (RA). The primary uses of heat have been to relieve pain and improve the extensibility of periarticular tissuesprior to mobility exercises. Cold is also used as a means of reducing pain prior to exercise and functional activities and to reduce the effects of inflammation. The effects that occur with these agents may be beneficial symptomatically and may also have an effect on the pathological process. In spite of the fact that they are often used by both patients and health care providers with apparent success, there is not a substantial body of evidence attesting to the efficacy of heat or cold in patients with RA. The purposes of this review are to examine that evidence and summarize the effectiveness of heat and cold in the management of joint complaints of patients with RA.
Juvenile rheumatoid arthritis: pain‐related and psychosocial aspects and their relevance for assessment and treatment
Authors: Jaworsk Theresa M
Published: February 2007

Objective. To review literature in the area of juvenile rheumatoid arthritis that has focused on pain experience, functional losses, and psychosocial functioning.

Methods. This article provides a critical review of research addressing these three primary issues.

Results. Subjective and behavioral measures have been developed to assess pain in juvenile rheumatoid arthritis patients, but further work is needed to determine the validity and reliability of these instruments. Tools to assess functional losses in juvenile rheumatoid arthritis patients also appear promising in preliminary studies. Patients can be at risk for difficulties in psychosocial functioning, although research suggests that there are a variety of family, parental, and childvariables that influence child and sibling adaptation. Methodologic shortcomings prevent definitive conclusions in this area.

Conclusions. Although methodologic limitations have plagued this research in the past, new advances are facilitating improved understanding of children and adolescents with juvenile rheumatoid arthritis. Implications for future study with this challenging population are offered.
Physical interventions in the management of pain in arthritis an overview for research and practice
Authors: Minor Marian A , Sanford Marilyn K
Published: February 2007

This paper reviews arthritis‐related literature on the effectiveness of a number of physical interventions to reduce pain. Original research reports as well as information from principle texts and review articles of thermal agents, topical applications, phoresis, transcu‐taneous electrical nerve stimulation, cold laser, and exercise are included. Although the biophysical actions of many physical interventions are partially understood, their effects on pain and function have not been defined clearly. The results of studies of one or a combination of physical interventions were generally inconsistent and reflected a wide variety of research designs and methods. Most physical agents, used alone, had minimal effects on pain. Interventions that combined physical agents and exercise were more successful in attenuating pain and also decreasing impairment. Research and clinical experience have provided insights into appropriate selection of physical intervention and their effectiveness in achieving treatment goals in arthritis care. However, considerable investigation into the mechanismsof action, differential effects of dose, staging and treatment combinations, and the relation of pain, impairment, and function remains to be undertaken.
Cognitive‐behavioral treatment of rheumatoid arthritis pain maintaining treatment gains
Authors: Keefe Francis J , van Horn Yolanda
Published: February 2007

Objective. This paper critically reviews research studies examining the long‐term effects of cognitive‐behavioral therapy interventions for managing pain in rheumatoid arthritis patients.

Methods and Results. The first section of the paper evaluates long‐term results obtained in studies of cognitive‐behavioral therapy, arthritis education inter ventions, and combined cognitive‐behavioral therapy‐arthritis education interventions. These studies show that although some rheumatoid arthritis patients are able to maintain initial improvements inpain and disability, other rheumatoid arthritis patients do not. In the second section of this review, a cognitive‐behavioral model of maintenance of pain coping skills is presented. This modelmay be useful in increasing our understanding of the relapse process and in planning interventions toenhance and prolong cognitive‐behavioral therapy treatment gains. The final section of thispaper addresses important future directions for research. The need for empirical studies of relapse and maintenance processes is underscored.

Conclusions. Controlled studies are needed to test the utility of new cognitive‐behavioral interventions designed to enhance the long‐term maintenance of treatment gains inRA patients. We suggest that a focus on issues of relapse and maintenance may be just as important for medical and surgical interventions for rheumatoid arthritis pain, as it is for cognitive‐behavioral therapy interventions.
Joint protection behavior in patients with rheumatoid arthritis following an education program a pilot study
Authors: Hammond Alison
Published: February 2007

Purpose. Joint protection (JP) education is a common feature in rheumatoid arthritis (RA) treatment programs. However, no objective studies have been published demonstrating patients' behavior changes following such education. This study evaluated whether RA patients' hand movement patterns altered following a JP education program.

Methods. An assessment procedure was constructed to assess application of four JP principles related to altering patterns of hand use during common everyday activities (making a hot drink and snack meal).

Results. Eleven RA patients were assessed. There was no significant behavioral change at 6 weeks post‐JP education (t = 10; P > 0.1). In contrast, follow‐up interviews of self‐perceived JP behavior showed all subjects considered JP relevant for them and seven believed they had changed to using these techniques.

Conclusions. This suggests education led to attitudi‐nal change but that behavioral change requires longer and more targeted input than is currently normally provided.
Evaluation of the Jebson hand function test for use in patients with rheumatoid arthritis
Authors: Sharma Siraj , Schumacher H. Ralph , McLellan A. Thomas
Published: February 2007

Purpose. We have evaluated the Jebson hand function (JHF) test for use in patients with rheumatoid arthritis (RA).

Methods. The JHF test was administered to 25 patients with RA. Results were compared to normative data and related to ability to perform activities of daily living (ADL), pain, and deformity.

Results. The JHF test detects differences between patients with RA and normals; all components except for writing show correlations with ADL and deformity. There were no significant correlations with pain.

Conclusions. The JHF test is a useful adjunct to evaluation of the hand in RA.
Appraisal of and coping with arthritis‐related problems in household activities, leisure activities, and pain management
Authors: Giorgino Karen B. , Blaloc Susan J. , Devellis Robert F. , Devellis Brenda M. , Keefe Francis J. , Jordan Joanne M.
Published: February 2007

Purpose. We examined whether or not there are systematic differences in how people appraise different types of illness‐related problems and in how they cope with these problems.

Methods. Two hundred thirty‐five adults with recently diagnosed rheumatoid arthritis completed a mailed questionnaire followed by a telephone interview. A series of stress appraisal and coping variables were assessed in relation to three areas: household activities, leisure activities, and pain management.

Results. Pain Differed significantly from household and leisure activities with regard to several appraisal and coping variables. Participants reported the least control over problems with pain, while attaching the most importance to pain control. Leisure activities also stood out as unique on several variables. Participants perceived greater ability and were more satisfied with their ability in relation to leisure activities.

Conclusion. These findings show that, at least early in the disease, appraisal and coping strategies differ across the areas of household activities, leisure activities, and pain management.
Sexuality and rheumatic disease the significance of gender
Authors: Majerovitz S. Deborah , Revenson Tracey A.
Published: February 2007

Purpose. This study examined the relationship between functional disability and sexual satisfaction for both rheumatic disease patients and their spouses and compared their levels of sexual satisfaction to those of healthy comparison couples.

Methods. One hundred thirteen rheumatic disease couples and 37 comparison couples completed mailed questionnaires. Rheumatologists rated American College of Rheumatology functional classification.

Results. Greater functional disability was related to greater sexual dissatisfaction for patients and spouses. Rheumatic disease and comparison couples did not differ in sexual dissatisfaction. Women reported greater sexual dissatisfaction than men among patients, spouses, and comparison couples.

Conclusions. Couples coping with rheumatic disease are able to maintain satisfying sexual relationships. However, when patients are more disabled, sexual dissatisfaction is greater among both patients and spouses. Health providers must be sensitive to issues of sexuality and be prepared to address these concerns among both patients and their partners. Men and women may have different concerns regarding sexuality.
Assessing depression in fibromyalgia patients
Authors: Burckhardt Carol S. , O'Reilly Connie A. , Wiens Arthur N. , Clark Sharon R. , Campbell Stephen M. , Bennett Robert M.
Published: February 2007

Purpose. This study investigated the relationships among four methods of detecting depression in patients with fibromyalgia.

Methods. Data were obtained from 100 women (mean age 43 years) who had been diagnosed with fibro‐myalgia. Instruments included a computerized Diagnostic Interview Schedule (C‐DIS), Beck Depression Inventory (BDI), an adjusted “disease‐free” BDI (BDI‐A), and Minnesota Multiphasic Personality Inventory depression subscale (MMPI‐D). Chance‐corrected concordance, sensitivity, specificity, and accuracy among the four methods were calculated.

Results. The C‐DIS detected 22% and BDI‐A 29% with current major depression. The BDI and MMPI‐D yielded higher estimates of 55% of the 44%, respectively. Agreement on the diagnosis among the four methods was significantly greater than chance. When compared with the C‐DIS, the BDI was the most sensitive instrument and the BDI‐A most specific.

Conclusions. The C‐DIS and BDI‐A appear to be more reliable methods for determining the presence of major depression in women with fibromyalgia than are the MMPI‐D or standard BDI.
Osteoarthritis pain assessment in family practice
Authors: de Bock G. H. , van Marwijk H. W. J. , Kaptein A. A. , Mulder J. D.
Published: February 2007

Purpose. The objective is to study the assessment of pain severity, following the conventional family physician routines, in patients with peripheral osteoar‐thritis.

Methods. The patient's perception of pain and the physician's assessment of the pain were measured by means of questionnaires and were compared in a study population of 198 patients with osteoarthritis.

Results. A rather low association was found between a patient's perception of pain and the physician's assessment of pain.

Conclusions. It is an accepted fact that too much treatment can have undesirable effects, and that inadequate management of symptoms seems to be associated with a reduced quality of life in osteoarthritic patients. In the absence of a high correlation between patient's perception and physician's assessment of pain severity, it is concluded that a patients' pain questionnaire could be a very useful instrument for improving the care given to patients with osteoarthritis in family practice.
Reliability and validity of self‐paced walking time measures for knee osteoarthritis
Authors: Marks R.
Published: February 2007

This study assessed the reliability and validity of self‐paced walking time as an outcome measure for osteo‐arthritis (OA) of the knee. The 13‐m timed walking tests were carried out twice on two separate occasions for 15 patients using photocells. Validity was examined by comparing the walking time data with results of other methodologies for evaluating osteoarthritic gait. As indicated by intra‐ and inter‐day intraclass correlation coefficients of 0.97 and 0.88 the gait measurements were reliable. The measurements also compared favorably with a validated subjective functional index for knee OA (P < 0.01). The findings suggest that measurements of self‐paced walking time can provide both reliable and valid data for evaluating functional performance in this patient population.
Clinical implications of depression in rheumatoid arthritis
Authors: Morrow Kelly A. , Parker Jerry C. , Russell Johnna L.
Published: February 2007

The clinical implications of depression in the context of rheumatoid arthritis are described. An overview of the diagnostic criteria for depression is provided, with specific focus on major depression and the associated subtypes. The neurobiological literature on major depression is briefly reviewed and the implications of the depression literature for the care of persons with rheumatoid arthritis are discussed.
Characteristics of participants in water exercise programs compared to patients seen in a rheumatic disease clinic
Authors: Meyer Cleda L. , Hawley Donna J.
Published: February 2007

Purpose.To determine if community‐based water exercise programs are serving people with significant levels of disability and pain.

Methods.Eighty‐seven participants in water exercise classes and 174 patients from a rheumatic disease clinic were matched for age, sex, and diagnosis and comparisons were made between the groups for the study variables.

Results.Patients had significantly higher disability, pain, global disease severity, anxiety, and depression and lower grip strength than participants. Osteoarthritis (OA) patients (n = 126) compared to OA participants (n = 63) had similar significant differences for all variables. Rheumatoid arthritis (RA) patients' (n = 48) scores were all more severe than RA participants' scores (n = 24), and these differences were similar in magnitude to OA differences, but only global disease severity and grip strength were statistically significantly different.

Conclusions.Water exercise classes are reaching persons with important levels of dysfunction and pain, but more severely affected patients are underrepresented in such programs.
Anatomical urinary stress incontinence in women with rheumatoid arthritis: Its frequency and coping strategies
Authors: Adams Cara , Lorish Chris , Cushing Connie , Willis Elisabeth , Jackson James , Walter Jane
Published: February 2007

Objective. The objectives of this study were to develop a valid screening tool for anatomical urinary stress incontinence (AUSI), to use it to determine the frequency of AUSI in women with RA, and to identify the cognitive, behavioral, and psychological coping strategies used by these women to deal with incontinence.

Methods. A screening tool concerning AUSI was validated by comparing self‐reported incidences of AUSI with clinical evaluation. Questionnaires regarding presence of AUSI and cognitive, behavioral, and psychological coping strategies were sent to 750 women clinically diagnosed with RA.

Results. Of the 262 respondents (35% response rate), 21% had characteristics of AUSI, a rate similar to general population studies. Coping strategies varied depending on whether the women were at home or away from home and whether the women were alone or with others.

Conclusions. There is a need for women with incontinence and the health care workers who serve them to be educated about AUSI and its treatments.
Acupuncture for the treatment of pain of osteoarthritic knees
Authors: Takeda Wendy , Wessel Jean
Published: February 2007

Objective. The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis (OA) of the knee.

Methods. Forty subjects (20 men, 20 women) with radiographic evidence of OA of the knee were stratified by gender and randomly assigned to either the experimental (real acupuncture) or control (sham acupuncture) groups. Subjects were treated three times per week for 3 weeks and evaluated at three test sessions. Outcome measures were: 1) the Pain Rating Index of the McGill Pain Questionnaire, 2) the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and 3) pain threshold at four sites at the knee.

Results. The analyses of variance showed that both real and sham acupuncture significantly reduced pain, stiffness, and physical disability in the OA knee, but that there were no significant differences between groups.

Conclusions. Acupuncture is not more effective than sham acupuncture in the treatment of OA pain.
Physical performance characteristics of women with fibromyalgia
Authors: Mannerkorpi Kaisa , Burckhardt Carol S. , Bjelle Anders
Published: February 2007

Objective. The aim of this study was to examine physical performance in women with fibromyalgia (FM) using methods that are easy to use in clinical settings and to compare our findings with published norms or a healthy comparison group.

Methods. Measures of shoulder pain and range‐of‐motion, isometric shoulder endurance, neck rotation, leg strength, hand grip strength, back flexibility, 6‐minute walk distance, and symptom duration were completed on 97 subjects with FM. The comparison group was 30 age‐matched healthy women.

Results. The FM group had significantly lower physical functioning scores on all variables when compared to the healthy group or published norms. When pain at rest was controlled, pain on motion was the most significant predictor of variance in shoulder range of motion, whereas range of motion was the most significant predictor of right shoulder endurance and grip strength of both hands.

Conclusions. Women with FM are markedly below average in physical performance abilities when measured by clinical tests.
Weather, beliefs about weather, and disease severity among patients with fibromyalgia
Authors: Hagglund Kristofer J. , Deuser William E. , Buckelew Susan P. , Hewett John , Kay Donald R.
Published: February 2007

Objective. This investigation 1) examined the relationships among actual weather, disease severity, and symptoms for individuals with fibromyalgia, 2) assessed subjects' beliefs about weather affecting their symptoms, and 3) examined differences between individuals with high and low “weather sensitivity.”

Methods. Eighty‐four individuals meeting Yunus' criteria for the diagnosis of fibromyalgia participated. Subjects completed the Weather and Pain Questionnaire (WPQ), the Arthritis Impact Measurement Scales (AIMS), the Symptom Checklist‐90‐Revised (SCL‐90‐R), and a Visual Analog Scale (VAS) assessing pain. A tender point index and a myalgic score were also obtained.

Results. Subjects reported that weather affected musculoskeletal symptoms predominantly. The strongest relationship was found between weather beliefs and self‐reported pain scores. Subjects with high weather sensitivity tended to have more functional impairment and psychological distress.

Conclusions. Individuals with fibromyalgia believe that weather worsens their symptoms, but it is unlikely that physiologic changes are associates with actual weather.