Cognitive-behavioral approaches to pain management in rheumatoid arthritis.

The purpose of this article is to review the literature on the topic of cognitive-behavioral approaches to pain management for persons with rheumatoid arthritis. Existing studies offer support for the usefulness of cognitive-behavioral techniques, but methodologic limitations were identified. Although the core element in rheumatoid arthritis pain management is optimal rheumatologic care, an important role also exists for strategies that seek to reduce the cognitive-evaluative aspects of arthritis pain.

Relationship of pain behavior to disease activity and health status in rheumatoid arthritis.

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. Hierarchical multiple 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 pain behavior in male rheumatoid arthritis patients is more closely related to disease activity than to self-reported pain, health status, or perceived self-efficacy.

The importance of enhancing self-efficacy in rheumatoid arthritis.

OBJECTIVE: To examine relationships among changes in self-efficacy and changes in other clinically relevant outcome measures. METHOD: Subjects (n = 44) were participants in a prospective, randomized stress-management study followed over 15 months. Outcome measures included self-efficacy, depression, pain, health status, and disease activity. RESULTS: Correlational analyses revealed significant associations between changes in self-efficacy (particularly total self-efficacy) and changes in selected measures of depression, pain, health status, and disease activity. The observed associations were not due to changes in medication regimen or to nonadherence to the stress-management program. CONCLUSIONS: Evidence is provided that induced changes in self-efficacy following a stress-management program were significantly related to other clinically important outcome measures.

Determinants of exercise in children.

BACKGROUND: The recognition that children are surprisingly inactive and that lifetime health beliefs and behavior patterns are formed in childhood has emphasized the need to examine the acquisition of exercise behavior in children. Although research has shown social learning theory variables to be relevant to the study of exercise determinants in an adult population, there has been little study done with child populations. The purpose of the present study was to explore the factors that may influence a child's level of physical activity. METHODS: Two hundred forty-two 5th- and 6th-grade children and their mothers were interviewed. It was hypothesized that several social learning variables would exert a particularly strong influence on level of physical activity of children. RESULTS: Regression analysis results indicated that salient predictor variables for boys included enjoyment of physical activity, friend and family support for physical activity, mother's perceived barriers to exercise, and mother's perceived family support for exercise. For girls, the salient predictor variables included enjoyment of physical activity, number of exercise-related items at home, mother's perceived family support for physical activity, mother's perceived barriers to exercise, and direct parental modeling of physical activity. CONCLUSIONS: It appears that social learning variables may be important correlates of physical activity in children.

Determinants of exercise among children. II. A longitudinal analysis.

BACKGROUND: Research has demonstrated that physical activity serves an important preventive function against the development of cardiovascular disease. The recognition that U.S. children are often sedentary, coupled with the observation that physical activity habits tend to persist into adulthood, has prompted the investigation of exercise determinants consistent with social learning theory. The purposes of the present study were to identify social learning variables relevant to children's exercise and to explore the longitudinal predictive value of the determinants. METHODS: Data were collected from 111 families (N = 54 girls, N = 57 boys) who were interviewed in both Phase 1 (fifth and sixth grades) and Phase 2 (eight and ninth grades) of this study. Data from mothers (N = 111) were collected during both phases; data from 80 fathers were collected at Phase 2 only. RESULTS: The results of simultaneous stepwise regression analyses indicated that child's enjoyment of physical activity was the only consistent predictor of physical activity during Phase 1. At Phase 2, child's exercise knowledge, mother's physical activity, and child's and mother's friend modeling/support emerged as predictors for girls. For boys, child's self-efficacy for physical activity, exercise knowledge, parental modeling, and interest in sports media were important. Longitudinally, mother's self-efficacy, barriers to exercise, enjoyment of physical activity, and child's self-efficacy for physical activity were important for girls. Only child's exercise knowledge predicted boys' physical activity. The addition of information from fathers nearly doubled the explanatory power of the predictors for both genders. CONCLUSIONS: Socialization in the family unit exerts a tremendous influence on health-related behaviors such as exercise. The relative importance of determinants seems to differ for girls and boys and the pattern of these determinants appears to change over time.

Effects of stress management on clinical outcomes in rheumatoid arthritis.

OBJECTIVE: To examine the effects of stress-management training on clinical outcomes in persons with rheumatoid arthritis (RA). METHODS: Patients with RA (n = 141) were randomly assigned to 1 of 3 groups: a stress management group, an attention control group, or a standard care control group. The stress management and the attention control groups received a 10-week intervention followed by an additional 15-month maintenance phase. RESULTS: The stress management group showed statistically significant improvements on measures of helplessness, self-efficacy, coping, pain, and health status. Selected beneficial effects were still detectable at the 15-month followup evaluation. CONCLUSION: The data indicated that stress management interventions are capable of producing important clinical benefits for persons with RA.