Understanding Heterogeneity in Patients' Conceptualisation of Treatment for Rheumatoid Arthritis: A Cluster Analysis.

OBJECTIVE: Uptake of treat-to-target (TTT) strategies for rheumatoid arthritis (RA) management is low. Our objective was to understand the heterogeneity in patients' conceptualisation of RA treatment to inform interventions improving TTT uptake. DESIGN: Eligible participants recruited from an online research registry rated 56 items (on 5-point scales) reflecting concepts raised from patient interviews. Using items describing adhering to physician recommendations to create a binary criterion variable for medication adherence, we conducted a principal components analysis on the remaining items using Varimax rotation, describing how these factors predict adherence over and above demographic characteristics. We further use optimal sets in regression to identify the individual concepts that are most predictive of medication adherence. RESULTS: We found significant heterogeneity in patients' conceptualisation of RA treatment among 621 persons with RA. A scree plot revealed a four-factor solution explained 38.4% of the variance. The four factors expected to facilitate TTT uptake were (% variance explained): (1) Access to high quality care and support (11.3%); (2) low decisional conflict related to changing disease-modifying antirheumatic drugs (DMARDs) (10.1%); (3) endorsement of a favourable DMARD risk/benefit ratio (9.9%); and (4) confidence that testing reflects disease activity (7.2%). These factors account for 13.8% of the variance in full medication adherence, fully explaining the only significant demographic predictor, age of the patient. The individual items most predictive of poor adherence centre on the lack of effective patient-physician communication, specifically insufficient access to information from rheumatologists, along with the need to seek information elsewhere. CONCLUSION: Patients' conceptualisation of RA treatment varies; however, almost all patients have difficulty escalating DMARDs, even with access to quality information and an understanding of the benefits of TTT. Tailored interventions are needed to address patient hesitancy to escalate DMARDs.

Measurement properties of a self-report index of ergonomic exposures for use in an office work environment.

Office work-related upper extremity symptoms and disorders have been associated with static work posture, repetition, and inadequate recovery in the anatomic structures of the neck and upper extremities. Despite these associations, relatively little research has been conducted on the development of practical measures of these ergonomic exposures. The present study examines the measurement properties of an upper-extremity-specific self-report index of ergonomic exposures. Ninety-two symptomatic office workers completed a Web-based questionnaire measuring demographic variables, ergonomic exposures, pain, job stress, and functional limitations. Comparisons of internal consistency, construct validity, and discriminative and predictive abilities were made between the self-report index and an observational exposure assessment checklist. Results indicated that the self-report index had acceptable measurement properties. Furthermore, higher levels of self-reported ergonomic exposures were associated with upper extremity pain, symptom severity, and functional limitations. In contrast, higher levels of observed exposure were related only to lower levels of general physical function. The self-report measure has potential for use in occupational health surveillance programs for office work environments and as an outcome measure of ergonomic exposure in intervention trials. These results also suggest the need for using multiple methods when assessing ergonomic exposures.

Job stress management and ergonomic intervention for work-related upper extremity symptoms.

In practice the secondary prevention of work-related upper extremity (WRUE) symptoms generally targets biomechanical risk factors. Psychosocial risk factors have also been shown to play an important role in the development of WRUE symptom severity and future disability. The addition of a stress management component to biomechanically focused interventions may result in greater improvements in WRUE symptoms and functional limitations than intervening in the biomechanical risk factors alone. Seventy office workers with WRUE symptoms were randomly assigned to an ergonomics intervention group (assessment and modification of work station and stretching exercises) or a combined ergonomic and job stress intervention group (ergonomic intervention plus two 1-h workshops on the identification and management of workplace stress). Baseline, 3- and 12-month follow-up measures of observed ergonomic risks and self-reported ergonomic risks, job stress, pain, symptoms, functional limitation, and general physical and mental health were obtained from all participants. While both groups experienced significant decreases in pain, symptoms, and functional limitation from baseline to three months with improvements continuing to 12 months post baseline, no significant differences between groups were observed for any outcome measures. Findings indicate that the additional two-session job stress management component did not significantly enhance the short- or long-term improvements brought about by the ergonomic intervention alone.