ClinicalTrials.gov identifier: NCT00088764.
Disease severity and domain-specific arthritis self-efficacy: Relationships to pain and functioning in patients with rheumatoid arthritis†
Version of Record online: 12 FEB 2010
Copyright © 2010 by the American College of Rheumatology
Arthritis Care & Research
Volume 62, Issue 6, pages 848–856, June 2010
How to Cite
Somers, T. J., Shelby, R. A., Keefe, F. J., Godiwala, N., Lumley, M. A., Mosley-Williams, A., Rice, J. R. and Caldwell, D. (2010), Disease severity and domain-specific arthritis self-efficacy: Relationships to pain and functioning in patients with rheumatoid arthritis. Arthritis Care Res, 62: 848–856. doi: 10.1002/acr.20127
- Issue online: 28 MAY 2010
- Version of Record online: 12 FEB 2010
- Accepted manuscript online: 12 FEB 2010 12:00AM EST
- Manuscript Accepted: 2 FEB 2010
- Manuscript Received: 2 APR 2009
- NIH. Grant Number: AR-049059
To examine the degree to which disease severity and domains of self-efficacy (pain, function, and other symptoms) explain pain and functioning in rheumatoid arthritis (RA) patients.
Patients (n = 263) completed the Arthritis Impact Measurement Scales 2 to assess pain and functioning (physical, affective, and social), the Arthritis Self-Efficacy Scale to assess 3 self-efficacy domains (pain, physical function, and other). Disease severity was assessed with C-reactive protein level, physician's rating, and abnormal joint count. Structural equation modeling was used to examine 3 hypotheses: does disease severity have a direct relationship with pain and each area of functioning, does disease severity have a direct relationship with each arthritis self-efficacy domain, and do the self-efficacy domains mediate the relationship between disease severity and RA pain and each area of functioning.
Disease severity was related to pain, physical functioning, and each self-efficacy domain (β = 0.28–0.56, P < 0.001). Each self-efficacy domain was related to its respective domain of functioning (e.g., self-efficacy for pain was related to pain; β = 0.36–0.54, P < 0.001). Self-efficacy mediated the relationship between disease severity and pain and functioning (β = 0.12–0.19, P < 0.001). Self-efficacy for pain control and to perform functional tasks accounted for 32–42% of disease severity's total effect on their respective outcomes (e.g., self-efficacy for pain control accounted for 32% of disease severity's total effect on pain). Variance accounted for by the total model was 52% for pain, 53% for physical functioning, and 44% for affective and social functioning.
Disease severity and self-efficacy both impact RA functioning, and intervening in these areas may lead to better outcomes.