The Arthritis Impact Measurement Scales 2 (AIMS2), a multidimensional self-administered questionnaire, was used to quantify a broad range of QOL issues (20). It measures the physical, psychological, social, and occupational aspects of health status. Thus, it supports the World Health Organization's concept of health as a biopsychosocial state of well-being (12, 21). It is a 78-item questionnaire; the first 57 items are broken down into 12 scales that can be combined into 5 component models of health status: physical, affect, symptom, social interaction, and role. Physical measures include 6 items: mobility level, walking and bending, hand and finger function, arm function, self care, and household tasks. When combined, they give the physical component model of health care. Psychological measures combine the level of tension and mood to give the affect model. The social model measures social activity and social support from family and friends. The symptom model refers to the pain scales. Finally, work scales provide the role model of health status. Each scale contains 4–7 items, and each item contains 2–6 possible responses. Item responses are summed by group to produce scale scores, and then a final score is produced by normalizing or scaling to a standard of 0–10. A low value is indicative of a high health status. The remaining items relate to satisfaction, attribution, and prioritization of health issues in relation to arthritis, details of comorbidities, medication, and sociodemographics. The 12 individual scales (6 physical, 2 psychological, 2 social, 1 pain, and 1 work) were used to indicate QOL measures.
The Significant Others Scale A (SOS-A), a validated and reliable instrument (22), was used to measure satisfaction with social support because the sensitivity of the AIMS2 social support scales has not been extensively documented (21). This self-administered scale permits the user the flexibility of rating from 1 to 7 social supports. It allows the measurement of satisfaction with perceived support to be linked to the 1 relevant caregiver specified by the patient. The SOS-A assesses 4 different social support functions (2 emotional and 2 practical functions). For each of the 4 social support functions, the individual being rated is scored in terms of the actual level of support received and the ideal level of support desired. Ratings are made using a 7-point scale from 1 (never) to 7 (always). Scores are thus derived for actual and ideal levels of support. In addition, the discrepancy between the actual and ideal levels of support is determined. This discrepancy score essentially provides an index of likely satisfaction with emotional and practical social support, the 2 social support variables analyzed in this study. This measurement tool is user friendly, which gives due regard to the potential physical impairments of the subjects.
The Patient Knowledge Questionnaire (PKQ) was developed for use with patients with RA (23). It is self administered and is used to assess patients' knowledge of the disease and its treatment. Topics assessed were identified as important by patients themselves in a previous study (24). These items are also congruent with certain facts that are considered essential for adequate self management (25) and embrace 4 major areas: general arthritis knowledge, medication and compliance, exercise regimens, and joint protection (24). It was designed to measure knowledge prior to intervention. The questionnaire consists of 16 questions with a choice of 80 possible answers, 30 of them correct (100%). A “don't know” option is provided to enhance compliance.
The one caregiver specified by each individual patient was asked to complete an additional questionnaire to evaluate their knowledge of RA. This was derived from the PKQ (21), which was rephrased to address caregivers' knowledge, and retitled the Rheumatoid Arthritis Knowledge Questionnaire (RAKQ). Of the 16 questions in PKQ, only 6 (questions 4 and 11–15) required rephrasing. Completed RAKQs and PKQs were assigned 1 overall percentage score, which represented the knowledge variable.