No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Prophylactic hydrotherapy
... One step further, physical exercise in an aquatic environment may be more beneficial for pain relief. The pain-relieving effect of AE may stem from the combined effect of exercise, warm water, and buoyancy on thermoreceptors and mechanoreceptors [17], water pressure, water viscosity, and water temperature stimulate the senses during AE, promoting the triggering of thermoreceptors and mechanoreceptors and blocking the conduction of nociceptors (nociceptors are small-diameter nerve fiber endings that respond to the tissue environment) [53]. At the same time, the temperature and pressure of the water stimulate the skin, and while submerged in water, methionine encephalin plasma levels rise and reduce plasma levels of β-endorphin, corticotropin, and prolactin [53]. ...
... The pain-relieving effect of AE may stem from the combined effect of exercise, warm water, and buoyancy on thermoreceptors and mechanoreceptors [17], water pressure, water viscosity, and water temperature stimulate the senses during AE, promoting the triggering of thermoreceptors and mechanoreceptors and blocking the conduction of nociceptors (nociceptors are small-diameter nerve fiber endings that respond to the tissue environment) [53]. At the same time, the temperature and pressure of the water stimulate the skin, and while submerged in water, methionine encephalin plasma levels rise and reduce plasma levels of β-endorphin, corticotropin, and prolactin [53]. It deserves to be mentioned that the process of muscle activity produces several cytotoxic substances, the continuous accumulation of which activates sensitizes, or awakens nociceptors thereby producing pain, cytotoxic substances including histamine, serotonin, bradykinin, adrenaline, etc. [54], some research has reported increased levels of glutamate in fibromyalgia patients, which as a neurotransmitter transmitting pain stimulates the nociceptors, while the bradykinin stimulates the release of norepinephrine and prostaglandins to sensitize the nociceptors further. ...
Background
Aquatic exercise (AE) is becoming ever more popular as a physical therapy, while it is unclear what precise improvements it will produce and how effective it will be in comparison with other non-surgical therapies. The study aimed to assess whether AE positively impacts chronic musculoskeletal disorder patients in terms of pain, physical function, and quality of life.
Methods
PRISMA guidelines were followed, and our study protocol was published online at PROSPERO under registration number CRD42023417411. We searched PubMed, Embase, Web of Science, and Cochrane library databases for English-language articles published before April 11, 2023, including studies from all relevant randomized controlled trials (RCTs). After screening, we ultimately included 32 RCTs with a total of 2,200 participants. We also performed subgroup analyses for all included studies. This meta-analysis calculated standardized mean difference (SMD) with 95% confidence interval (CI), and the variance was estimated using a random-effects model. The quality of the included studies was assessed by using the Cochrane collaborative "risk of bias" assessment tool (version 2.0). Thus ensuring that the literature included is of high quality.
Results
This meta-analysis included 32 trials with 2,200 participants; these patients were all between the ages of 38–80. The study showed that compared to the no exercise (NE) group, patients in the AE group experienced a remarkable reduction in pain (SMD: -0.64, P < 0.001), a significant increase in physical function (SMD: 0.62, P < 0.001), and a statistically significant improvement in quality of life (SMD: −0.64, P < 0.001). When compared to land-based exercise (LE), AE significantly relieves patients' pain (SMD: −0.35, P = 0.03).
Conclusions
This is the first systematic review and meta-analysis to study whether AE could improve chronic musculoskeletal disorders. The evidence suggests that AE benefits pain, physical function, and quality of life in adults with chronic musculoskeletal conditions compared to NE. Furthermore, when compared to LE, AE continues to provide a better improvement in patient pain. More long-term clinical trials are needed to confirm AE's positive effects and improvement mechanisms and the more existential advantages compared to LE.
... Reilly and Bird established that in a community swimming pool, group therapy was more beneficial as compared to the individual approach in the hospital pool. This was maybe due to focusing on the improvement of wellbeing and health rather than disease and promoting social relationships Reilly, 2001). ...
Management of ailments using water, clay and medicinal mineral water is an ancient treatment modality since it includes a collection of processes or practices validated by science. Balneotherapy is different from hydrotherapy. In balneotherapy, the temperature of bathrooms and the use of medicinal mineral clays or water is fundamental. In contrast, hydrotherapy is the internal or external application of water in any condition (ice, steam, liquid) to promote health or manage various disorders at varying durations, temperatures, locations and pressures. Pelotherapy or mud therapy is one of the interventions in balneology that comprises the application of mud externally for healing purposes. As far as people are returning to nature, this therapy is advised and found to be effective for many health issues, including dermatological disorders, chronic inflammations of body systems and fibromyalgia. This chapter will discuss the ancient Greco-Arabic, Roman and Turkish bathhouses, the difference between balneotherapy and hydrotherapy, the effects of peloids and mineral baths on human health, balneotherapy and hydrotherapy in fibromyalgia, balneotherapy and hydrotherapy in dermatological disorders and balneotherapy and hydrotherapy for back pain and rheumatism.
... Excessive laxity of connective tissue may occur in many genetic disorders, such as Down syndrome, osteogenesis imperfecta, and Marfan and Ehlers-Danlos syndromes 10,11 . Laxity of connective tissue should therefore be treated not as a separate disease syndrome, but as a pathological condition resulting from disturbances in the collagen structure due to assorted genetic backgrounds 10,12,13 . The Beighton Score (BS) is the basic tool for the assessment of JH 14 . ...
Excessive laxity of the connective tissue refers to a group of inherited abnormalities manifested by disturbances in the functioning of internal organs, including the gastrointestinal tract. Increased susceptibility to stretching of the distal part of the large intestine and abnormal colonic motor function could explain the predisposition to the development of functional constipation in some children. Our aim was to determine whether patients with functional constipation are more likely to be characterized by congenital laxity of connective tissue compared to the population of healthy children. Children diagnosed with functional constipation according to the Rome III criteria were prospectively enrolled in the study (study group, S) and compared to otherwise healthy children (control group, C). Excessive laxity of the connective tissue was evaluated using the Beighton Score (BS) and expressed as median and interquartile range (IQR). The study included 411 patients (median age 7.8 years, min 3 years, max 18 years; 49% male), comprising 211 patients in the S group and 200 children in the C group. The median BS in the S group was significantly higher than in the C group (median: 5 points [IQR: 1-4.5] vs 2 points [IQR: 3-7], respectively; p = 0.000). Furthermore, increased connective tissue laxity was observed more frequently in females (p < 0.05). Increased connective tissue laxity was more frequent in children with functional constipation, especially in girls. Excessive laxity of the connective tissue may be one of the etiological factors of functional constipation in children.
... A hidroterapia promove reações diferentes daquelas experimentadas em solo, melhorando a circulação periférica, beneficiando o retorno venoso, além de proporcionar um efeito massageador e relaxante ao paciente, atuando dessa forma nas principais queixas de pacientes com OA. Os exercícios na água são muito bem tolerados, especialmente em água aquecida, pois o ambiente morno ajuda a reduzir a dor e espasmos musculares (REILLY; BIRD, 2001). ...
RESUMO
A osteoartrose (AO) constitui em um processo degenerativo que acomete as articulações, sobretudo nas junções de suporte de peso. Com o aumento da longevidade populacional há um aumento de doenças crônicas interferindo no bem-estar. Uma das formas de tratar esta disfunção é através da hidrocinesioterapia, que pode oferecer ao idoso, qualidade de vida através da fisioterapia aquática. O objetivo deste trabalho foi realizar uma revisão de literatura sobre a aplicabilidade da hidrocinesioterapia e seus efeitos na funcionalidade e qualidade de vida do idoso com gonartrose e coxoartrose. Foram realizadas visitas a quatro bibliotecas de instituições de nível superior do Estado do Pará: ESAMAZ, UEPA, UFPA, UNAMA, bem como utilizadas quatro bases de dados eletrônicas: LILACS, PUBMED, SciELO, MEDLINE. Utilizou-se dos descritores: artrose, hidrocinesioterapia, coxoartrose, gonartrose, funcionalidade do idoso, juntos e separados. Foram selecionados periódicos nacionais e internacionais publicados em português e inglês. Os critérios de inclusão foram a publicação de artigos e referências no período de 1998 à 2012. A OA ocupa o terceiro lugar na lista dos segurados afastados do trabalho que recebem auxílio-doença. E de acordo com os resultados obtidos, conclui-se que a atuação fisioterapêutica através da aplicabilidade da técnica de hidrocinesioterapia é de extrema importância e benéfica na funcionalidade do idoso. Proporcionando menos dores álgicas, menos instabilidades, melhora na força muscular, melhora da flexibilidade e melhora da amplitude de movimento, facilitando então suas atividades de vida diária e melhorando sua qualidade de vida.
Palavras-Chaves: Osteoartrose, Hidroterapia, Recuperação Funcional, Qualidade de Vida.
... Thus, aquatic exercises are well tolerated because the water thermal environment helps to reduce pain and muscle spasms, (18) increasing total sleep time (VITORINO, et al., 2006), improving peripheral circulation, benefiting venous return, as well as providing a massager and relaxing effect. (19) The transcutaneous electrical nerve stimulation (TENS) has produced important results in the fight against pain. (20) TENS is a method to produce pain relief by applying a biphasic rectangular wave pulse through electrodes on the skin surface. ...
Fibromyalgia is a non-inflammatory rheumatic syndrome of unknown etiology manifested in the musculoskeletal system through diffuse and chronic pain and presence of tender points, which may be associated with fatigue, anxiety, muscle stiffness, skin sensitivity, pain after exercise, functional impairment and sleep disorders. Objective: This study aimed to perform a systematic literature review in order to check which physiotherapy resources are mostly used today and what are the most significant results in the treatment of fibromyalgia. Method: An integrative literature review was conducted by searching electronic databases of indexed data such as Latin American and Caribbean Health Sciences (LILACS), MEDLINE/ PubMed and Scientific Electronic Library Online (SCIELO). Randomized clinical trials were selected in the period from January 2001 to June 2013 published in Portuguese, English and Spanish. Methodological quality was assessed using the Jadad Quality Scale. Results: Overall, 522 studies were reviewed in full and only 13 were included after application of the exclusion criteria. Among these, articles that addressed the use of electrotherapic resources (n = 4), hydrotherapy (n = 3), conventional therapy (n = 3), physical exercise (n = 2) and multidisciplinary treatment (n = 1) were identified, with diversified results, protocols and application times of each methodology. Conclusion: It has been found that there are a small number of studies with scientific relevance published in the last 10 years evidencing techniques that have obtained better results in the treatment of patients with fibromyalgia. Further studies with better design aimed at obtaining more conclusive results should be conducted.
... 11 Eg zer siz uy gu la ma la rı, izo met rik, izo to nik ve ek lem ha re ket açık lı ğı nı sağla yı cı eg zer siz le ri içer mek tey di. 12 Ma saj uy gu la mala rı pres yon, vib ras yon ve per küs yon yön tem le ri ni içe ren ma nu el ve ya me ka nik uy gu la ma lar dan oluşmuş tur. 13 ...
Objective: Spa therapy is one of the oldest forms of natural therapies for rheumatic diseases. The statement of the American College of Rheumatology positioned spa therapy as an essential complementary therapy for rheumatic diseases. Despite accumulating data in recent years, spa therapy has not been considered in all its aspects. One such area is mortality of spa therapy. The aim of this study was therefore to determine the number of deaths during spa therapy. Material and Methods: Data from 9224 patients admitted for spa therapy at the Bursa Military Spa Hospital between January 2000, and March 2007, were analyzed retrospectively. Patients stayed 21 days in the hospital. Patients were underwent a spa therapy treatment package consisted of thermal mud pack treatment, electrotherapy, massage and exercise therapy in addition to thermal mineral water baths. Results: Death had occurred in only 4 of these 9224 patients (0.04%), one during bathing (0.01%). All patients who died in the hospital had osteoarthritis. All deaths in the spa hospital were result of cardiovascular arrest. Conclusion: Low mortality rate was observed among our study population who received spa therapy.
... A hidroterapia promove reações diferentes daquelas experimentadas em solo, melhorando a circulação periférica, beneficiando o retorno venoso, além de proporcionar um efeito massageador e relaxante, atuando dessa forma nas principais queixas de pacientes com AR. Os exercícios na água são muito bem tolerados, especialmente em água aquecida, pois o ambiente morno ajuda a reduzir a dor e espasmos musculares 14 . A água oferece suave resistência durante os movimentos e, ainda, a oportunidade de treinamento em várias velocidades. ...
Rheumatoid arthritis (RA) has both joint and extra-joint manifestations and may directly affect patients' quality of life. Hydrotherapy is a very useful resource for treating RA due the water physical properties and physiological effects. The aim of this study was to evaluate the impact of a hydrotherapy program on RA female patients' symptoms and health-related quality of life. Eight volunteers, aged 56,4±5.2 years old, were selected for this study, all with RA diagnosis. Before and after treatment they were submitted to a physical therapy evaluation that included application of the Short Form-36 Questionnaire (SF-36) and assessment of pain, morning stiffness, and quality of sleep, by means of visual analogue scales. The treatment consisted of ten 45-minute hydrotherapy sessions, held twice a week. Collected data were statistically analysed, and significance level set at p<0.05. At the end of treatment results showed significant decrease in pain (p=0.004) and morning stiffness (p=0.003), and improvement in quality of sleep (p=0.006). Also, significant improvement was detected in most SF-36 domains (p<0.05). The proposed aquatic therapy program may be thus said to having improved health-related quality of life, reduced pain and morning stiffness, and improved quality of sleep of women with RA.
... Reilly and Bird found that group therapy in a community swimming pool was more effective than individual treatment in the pool of a hospital. This was probably due to concentrating on health improvement and well being, instead of disease, and to encouraging social interaction [44]. ...
The use of water for medical treatment is probably as old as mankind. Until the middle of the last century, spa treatment, including hydrotherapy and balneotherapy, remained popular but went into decline especially in the Anglo-Saxon world with the development of effective analgesics. However, no analgesic, regardless of its potency, is capable of eliminating pain, and reports of life-threatening adverse reactions to the use of these drugs led to renewed interest in spa therapy. Because of methodologic difficulties and lack of research funding, the effects of 'water treatments' in the relief of pain have rarely been subjected to rigorous assessment by randomised, controlled trials. It is our opinion that the three therapeutic modalities must be considered separately, and this was done in the present paper. In addition, we review the research on the mechanism of action and cost effectiveness of such treatments and examine what research might be useful in the future.
... Whether this gain is sufficient to justify provision of hydrotherapy facilities in a hospital setting is debatable. For ambulatory patients with arthritis provision of aquatic exercise through community initiatives may be more effective in terms of public health [26]. We cannot say whether hydrotherapy offers advantages over other forms of intensive rehabilitation to people with severe disability; this remains to be explored. ...
Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis.
One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change--a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests.
Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS.
Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores.
The Rajendra Jinjwaria quality of life-22 (RJQOL-22) scale will help assess the overall quality of life in various acute and chronic diseases such as rheumatoid arthritis, osteo arthritis, and other conditions that affect the quality of life such as cardiovascular, HIV, and cancer. The tool was developed from 29 January 2019 to 01 May 2023 by Rajendra Kumar Jinjwaria at King George's Medical University Lucknow and Banaras Hindu University, Uttar Pradesh, India. The validity of the RJQOL-22 scale was established as per the content validity index (CVI) 98% and validated by more than 100 expert faculty across the world. The scale is standardized and highly valid for assessing the quality of life in acute and chronic diseases. The overall reliability of the scale based on a study was estimated to be (>0.983) through (Cronbach’s alpha value) and it indicates a highly reliable scale. While the individual reliability of group I and group II was 0.989 and 0.978 respectively. The acceptable cut-off value of coefficients was 0.7 for moderate and 0.8 for high reliability. This indicates that the tool used in the studies was highly reliable.
Triple blind Randomised controlled trial to evaluate the effectiveness of hydrotherapy versus land based exercise on pain and quality of life among Rheumatoid arthritis
Bathing in water (balneotherapy or spa therapy) has been used frequently in classical medicine as a cure for many of disease and osteoarthritis. The aim of balneotherapy is to improve the range of joint movements, cause muscle strengthening, relieve muscle spasm maintain or improve functional mobility, soothe pain and as a consequence to relieve patients' suffering and let them feel well. In this article, a literature search vas performed to evaluate the effectiveness of balneotherapy on osteoarthritis, recent 10 years until 2002.
The aim of this study was two-fold: to compare symptoms and daily activity in patients with inflammatory rheumatic diseases across periods with and without aquatic exercises, and to examine whether the patients reached an acceptable state of symptoms during the periods with aquatic exercises.
Thirty-six patients reported pain, fatigue, stiffness and ability to carry out daily activities across periods with and without aquatic exercises. The study has an interrupted time-series design and variables were collected with text messages on mobile phones twice a week over a period of 35 weeks.
There was a significant reduction in pain, fatigue, stiffness and enhanced level of daily activity (p > 0.05) during periods of aquatic exercises compared to periods without. Further, a significantly higher proportion of patients reached an acceptable state for both pain and fatigue during periods with aquatic exercises.
Living with an inflammatory rheumatic disease is a lifelong challenge. Pain and fatigue are considered major obstacles for daily functioning and adequate self-management strategies are requested. Based on the high proportion of patients reporting to be in an acceptable state of both pain and fatigue during periods with aquatic exercises, the intervention should be regarded as an important self-management tool rather than a treatment option assuming long-lasting effects. Copyright © 2014 John Wiley & Sons, Ltd.
Copyright © 2014 John Wiley & Sons, Ltd.
Despite advances in pharmacological therapy, physical treatment continues to be important in the management of ankylosing spondylitis (AS). The objective of the present study was to evaluate the effects and tolerability of combined spa therapy and rehabilitation in a group of AS patients being treated with TNF inhibitors. Thirty AS patients attending the Rheumatology Unit of the University of Padova being treated with TNF inhibitors for at least 3 months were randomized and assessed by an investigator independent from the spa staff: 15 were prescribed 10 sessions of spa therapy (mud packs and thermal baths) and rehabilitation (exercises in a thermal pool) and the other 15 were considered controls. The patients in both groups had been receiving anti-TNF agents for at least three months. The outcome measures utilized were BASFI, BASDAI, BASMI, VAS for back pain and HAQ. The evaluations were performed in all patients at the entry to the study, at the end of the spa treatment, and after 3 and 6 months. Most of the evaluation indices were significantly improved at the end of the spa treatment, as well as at the 3 and 6 months follow-up assessments. No significant alterations in the evaluation indices were found in the control group. Combined spa therapy and rehabilitation caused a clear, long-term clinical improvement in AS patients being treated with TNF inhibitors. Thermal treatment was found to be well tolerated and none of the patients had disease relapse.
This study was designed to obtain information concerning the general efficacy of out-patient physiotherapy for knee osteoarthritis, a disabling disease affecting approximately 1% of the population. Efficacy was initially studied retrospectively by reviewing the medical records of 26 Canadian out-patients. Then a six-month follow-up telephone survey was conducted on 14 of these patients (eight men and six women), mean age 59.2 years (range 24–77) who had received an average of 15.8 treatments including exercise (85.7%), education (42.8%), electrotherapy (35.7%), ice/heat (35.7%), and manual therapy (28.5%).The results showed initial objective improvements in knee strength in 47% of cases; reduced knee pain levels in 76% of cases; and improvements in knee range of motion in 53% of cases. At the six-month follow-up 79% of the patients interviewed had maintained improvement in stair climbing, level walking and sit-to-stand activities.It is concluded that a high proportion of patients with moderate to severe knee joint disease may experience continued functional benefits from relatively brief out-patient physiotherapy programmes, despite the poor outlook often associated with the disease.
A group of 120 patients with rheumatoid arthritis or osteoarthritis volunteered to be subjects for this study of aerobic versus nonaerobic exercise. Patients were stratified by diagnosis and randomized into an exercise program of aerobic walking, aerobic aquatics, or non-aerobic range of motion (controls). The retention rate for the 12-week program was 83%. Exercise tolerance, disease-related measures, and self-reported health status were assessed. The aquatics and walking exercise groups showed significant improvement over the control group in aerobic capacity, 50-foot walking time, depression, anxiety, and physical activity after the 12-week exercise program. There were no significant between-group differences in the change scores for flexibility, number of clinically active joints, duration of morning stiffness, or grip strength. Our findings document the feasibility and efficacy of conditioning exercise for people who have rheumatoid arthritis or osteoarthritis.
Women with rheumatoid arthritis performed 1 of 3 low intensity aerobic exercise protocols (15, 25, and 35 minutes) 3 times per week for 12 weeks. A nontraining group served as controls. All exercise groups improved their aerobic capacity, exercise time, and joint counts. Subjects described improvement in activities of daily living and reduced joint pain and fatigue. Exercise duration up to 35 minutes can be therapeutic, and as little as 15 minutes of exercise 3 times/week is sufficient to improve aerobic capacity in rheumatoid arthritis patients with severe limitations.
Thirty-four patients with rheumatoid arthritis, aged 38 to 63 years (mean age 56 years), were studied before and after a 6-week stay in hospital. Twenty-three of these patients underwent special physical training twice a day during this period. Physical performance, cardio-respiratory fitness and muscle strength improved significantly in the training group. In the control group there were no major changes in these measurements during this period except for an increase in muscle strength. Perceived exertion during submaximal exercise was much lower in the training group following the conditioning. Joint status was virtually unchanged over the experimental period in both groups. It is postulated that the low physical performance seen in these types of RA patients may, to a large extent, be attributed to lack of physical activity.
Low back pain affects 80% of adults some time in their lives. It is expensive, costing more than $16 billion per year, and causes 40-50% of all lost work days. A variety of disorders can cause low back pain, but the majority of time the problem is self-limiting and resolves within a few weeks. There are specific risk factors associated with low back pain, temporary measures that can be helpful to decrease discomfort, and specific ways to prevent future episodes. The most important management modality is education, and most patients are treated in the outpatient setting. Nursing care is frequently provided by telephone. Using the nursing process, the nurse can assess and advise patients in a systematic, timely manner while maintaining a nursing focus.
This report provides a history of exercise therapy, gives background for and defines relevant terms, and describes common gross manifestations of osteoarthritis (OA). Bias and dogmatism concerning arthritis treatment are examined. Treatment using exercise and physical medicine modalities with reference to recent pertinent literature is reviewed. Human and animal studies demonstrating the efficacy of conditioning and strengthening in the treatment of OA are analyzed critically, and methods to enhance compliance and directions of future exercise research are discussed.
Ankylosing spondylitis (AS) is a form of arthritis characterised by an early onset and an active style of treatment involving regular exercise. Self-help groups for AS patients have developed in many countries as a means of promoting exercise treatment. The empirical section presents a comparative study of members and non-members of such groups along psychosocial dimensions including health locus of control, social support, and health behaviour. Self-help group members were distinguished by a combination of factors including a low reliance on powerful others health locus of control beliefs, greater satisfaction with available support, and increased frequency of exercise. A subsample showed improvements on physiological measurements over a 6-month period. The utility of including psychosocial variables in examination of rheumatic diseases is discussed and practical implications of these findings for health care professionals and future research are considered.