Disability in Valued Life Activities in Persons with Rheumatoid Arthritis

描述（由申请人提供）：本项目将描述类风湿关节炎（RA）患者在有价值生命活动（VLAs）中的残疾，以及与维持这些活动相关的因素和可能防止VLA残疾后负面心理结果的因素。类风湿性关节炎的相同身体表现可能导致行动困难或自我护理活动困难，也可能导致更复杂的自主活动困难，如爱好或与朋友社交。在生存或自给自足所必需的活动之外，人们认为有意义或愉快的活动范围很广，我们称之为“有价值的生活活动”。VLAs的表现似乎与心理健康和功能满意度有关。虽然VLA的丧失已被发现是抑郁症状发作的一个危险因素，但VLA表现困难的影响尚不清楚。此外，许多丧失VLAs能力的人并没有出现抑郁症状；保护VLA残疾后个体免受心理困扰的因素尚未确定。本研究将在Verbrugge和Jette残疾过程模型的基础上，评估VLA残疾，确定VLA维持的相关因素、VLA残疾的心理结局以及VLA残疾后心理健康维持的相关因素。受试者将在年度电话访谈中被问及这些话题。访谈将包括评估VLA残疾和心理结果的项目，以及VLA残疾和心理困扰的潜在风险和保护因素的问题。这些项目将包括现有的量表和可用的调查项目，以及专门为本研究开发的项目。基于研究模型（图1）的分析将集中在3个主要领域：(1)描述5年期间RA患者的VLA残疾，(2)描述VLA残疾的心理结果，以及(3)确定VLA残疾后维持VLA和维持心理健康的相关因素。将开发数学模型来描述研究模型背景下的这些关系，使用横断面和纵向分析。本研究的结果将提供有助于减少VLA残疾和VLA残疾可能导致的心理困扰的信息，从而提高RA患者的生活质量。

DESCRIPTION (provided by applicant): This project will describe disability in valued life activities (VLAs) among persons with rheumatoid arthritis (RA), as well as factors associated with maintenance of those activities and factors that may protect against negative psychological outcomes following VLA disability. The same physical manifestations of RA that may cause difficulty in mobility or in performing a self-care activity may also cause difficulty in more complex, discretionary activities such as hobbies or socializing with friends. The wide range of activities that individuals find meaningful or pleasurable, above and beyond activities necessary for survival or self-sufficiency, is what we term "valued life activities". Performance of VLAs appears to be linked to psychological well-being and satisfaction with function. Although loss of VLAs has been found to be a risk factor for the onset of depressive symptoms, effects of difficulties in VLA performance are not known. Also, many individuals who lose the ability to perform VLAs do not develop depressive symptoms; factors that protect individuals from psychological distress after VLA disability have not been identified. This study will estimate VLA disability and identify factors associated with maintenance of VLAs, psychological outcomes of VLA disability, and factors associated with maintenance of psychological well-being after VLA disability, building on the Verbrugge and Jette disablement process model. Subjects will be queried about these topics in annual telephone interviews. Items to assess VLA disability and psychological outcomes will be included in the interview, as well as questions about potential risk and protective factors for VLA disability and psychological distress. These items will consist of existing scales and survey items when available, and items developed specifically for this study. Analyses based on the study model (Figure 1) will focus on 3 major areas: (1) description of VLA disability among individuals with RA over a 5-year period, (2) description of psychological outcomes of VLA disability, and (3) identification of factors associated with maintenance of VLAs and maintenance of psychological well-being after VLA disability. Mathematical models will be developed to describe these relationships in the context of the study model, using both cross-sectional and longitudinal analyses. The findings from this study will provide information that may help minimize VLA disability and the psychological distress that might result from VLA disability, thereby improving quality of life of persons with RA.