Multidimensional Model of Disability and Role Functioning in Rheumatoid Arthritis.
Multidimensional Model of Disability and Role Functioning in Rheumatoid Arthritis.
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DOI：
10.1002/acr.22658
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发表时间：
2015-12
影响因子：
4.7
通讯作者：
Nicassio PM
中科院分区：
文献类型：
--
作者：
Ormseth SR;Draper TL;Irwin MR;Weisman MH;Aréchiga AE;Hartoonian N;Bui T;Nicassio PM
探讨类风湿关节炎（RA）疾病负担、情绪障碍和残疾作为角色功能障碍决定因素的模型。在一项横断面设计中，从社区招募103名RA患者参加临床试验，完成自我评估疾病负担（总关节疼痛和疾病活动），情绪障碍（CES-D抑郁情绪，躯体症状，缺乏积极影响和人际关系问题），残疾（HAQ-DI粗大和精细运动）和角色功能（SF-36身体和社会）的评估。结构方程模型（SEM）被用来检查直接和间接的机制，疾病负担的角色功能。SEM结果表明，该模型具有极好的拟合，S-Bχ2 = 38.59，p = 0.135，CFI = 0.977，SRMR = 0.062，RMSEA = 0.053。中介分析表明，虽然疾病负担与不良的角色功能，其影响是共同介导的情绪障碍和残疾。在考虑情绪障碍和残疾的影响后，疾病负担对角色功能的影响不显著。结果表明，情绪障碍和残疾可能是RA疾病负担影响角色功能的重要途径。未来的纵向研究建议复制这些发现，并进一步探讨本研究中的中介机制。
To examine a model addressing the roles of rheumatoid arthritis (RA) disease burden, mood disturbance, and disability as determinants of impairments in role functioning. In a cross-sectional design, 103 RA patients recruited from the community to participate in a clinical trial completed assessments of self-assessed disease burden (total joint pain and disease activity), mood disturbance (CES-D depressed mood, somatic symptoms, lack of positive affect, and interpersonal problems), disability (HAQ-DI gross and fine motor), and role functioning (SF-36 physical and social). Structural equation modeling (SEM) was used to examine direct and indirect mechanisms linking disease burden to role functioning. SEM results indicated that the model had excellent fit, S-Bχ2 = 38.59, p = .135, CFI = .977, SRMR = .062, RMSEA = .053. Mediational analyses demonstrated that while disease burden was associated with poor role functioning, its effects were jointly mediated by mood disturbance and disability. After the effects of mood disturbance and disability were taken into account, the effect of disease burden on role functioning was not significant. The results indicate that mood disturbance and disability may serve as important pathways through which RA disease burden affects role functioning. Future longitudinal research is suggested to replicate these findings and further explore the mediational mechanisms examined in this study.