The measurment of helplessness in rheumatoid arthritis. The development of the Arthritis Helplessness Index

Article (PDF Available)inThe Journal of Rheumatology 12(3):462-7 · July 1985with103 Reads
Source: PubMed
We describe the development of the Arthritis Helplessness Index (AHI), a self-report instrument designed to measure patients' perceptions of loss of control with arthritis. The participants in this research were 219 patients with rheumatoid arthritis (RA) who completed a quantity of mailed materials, including the AHI, functional measures and other psychological scales. Significant evidence of reliability and validity of the AHI was found. Greater helplessness correlated with greater age, lesser education, lower self-esteem, lower internal health locus of control, higher anxiety, and depression, and impairment in performing activities of daily living using a health assessment questionnaire. Over one year, changes in helplessness correlated with changes in difficulty in performing activities of daily living. The AHI appears to be a useful measure for further studies in RA and a valuable clinical tool in monitoring the psychological status of patients with RA.
    • "Author's personal copy OR ''harm'' OR ''catastrophizing''. Pain/health beliefs measures including the Arthritis Self-Efficacy Scale (ASES; Lorig et al., 1989 ), Rheumatoid Arthritis Self-Efficacy Scale (RASE; Hewlett et al., 2008 ), Multidimensional Health Locus of Control Questionnaire (MHLC; Wallston et al., 1994), Illness Perception Questionnaire (IPQ; Weinman et al., 1996), Survey of Pain Attitudes (SOPA; Jensen et al., 1987), Beliefs About Pain Control Questionnaire (BPCQ; Skevington, 1990), Rheumatology Attitudes Index (RAI; Callahan et al., 1988), Arthritis Helplessness Index (AHI; Nicassio et al., 1985), Tampa Scale for Kinesiophobia (TSK; Vlaeyen et al., 1995), Fear Avoidance Belief Questionnaire (FABQ; Waddell et al., 1993), and Pain Catastrophizing Scale (PCS; Sullivan et al., 1995) were also search terms. The broad search field, ''anywhere'' was used to identify citations. "
    [Show abstract] [Hide abstract] ABSTRACT: In this meta-analysis, we evaluated overall strengths of relation between beliefs about pain, health, or illness and problems in functioning (i.e., functional impairment, affective distress, pain severity) in osteoarthritis and rheumatoid arthritis samples as well as moderators of these associations. In sum, 111 samples (N = 17,365 patients) met inclusion criteria. On average, highly significant, medium effect sizes were observed for associations between beliefs and problems in functioning but heterogeneity was also inflated. Effect sizes were not affected by arthritis subtype, gender, or age. However, pain belief content emerged as a significant moderator, with larger effect sizes for studies in which personal incapacity or ineffectiveness in controlling pain was a content theme of belief indices (i.e., pain catastrophizing, helplessness, self-efficacy) compared to those examining locus of control and fear/threat/harm beliefs. Furthermore, analyses of longitudinal study subsets supported the status of pain beliefs risk factors for later problems in functioning in these groups.
    Article · Aug 2016
    • "The total score ranges from 6 to 24, and higher scores represent more anxiety. The arthritis helplessness index [20] (AHI) is a 15-item scale that assesses how helpless the person feels as a result of their arthritis. Items are rated on a scale from 1 (strongly disagree) to 4 (strongly agree). "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose To examine the measurement properties of measures of psychological constructs in people with knee osteoarthritis. Method Participants with osteoarthritis of the knee completed the beck depression inventory (BDI-II), state-trait anxiety inventory (STAI), arthritis helplessness index (AHI), fatigue severity scale (FSS), coping strategies questionnaire (CSQ), beliefs about pain control questionnaire (BPCQ), illness perceptions questionnaire-revised (IPQ-R), pain self-efficacy questionnaire (PSEQ) at home as part of a set of measures covering different aspects of osteoarthritis pain. The questionnaires were returned by pre-paid envelope. Rasch analysis was used to check the psychometric properties of the scales in people with osteoarthritis. Results The STAI-SF was an acceptable measure of anxiety and the revised FSS an acceptable measure of fatigue, with removal of items 1 and 2. The BDI subscales were acceptable for measuring negative thoughts and behaviours related to depressive symptomatology with some modifications to the scale. The helplessness scale of the AHI was acceptable as a measure of helplessness. The PSEQ was an acceptable measure of self-efficacy and the CSQ as a measure of cognitive coping strategies. The BPCQ and IPQ-R did not fit the Rasch model. Conclusions These findings indicate that questionnaires need to be checked for their ability to measure psychological constructs in the clinical groups to which they will be applied. Implications for Rehabilitation For people with osteoarthritis, the STAI-SF is an acceptable measure of anxiety and the revised FSS an acceptable measure of fatigue with removal of items 1 and 2. The BDI subscales, but not the total score, are acceptable for measuring depressive symptomatology with some modifications to the scoring of the scale. And helplessness can be measured using the Helplessness subscale of the AHI. The PSEQ was an acceptable measure of self-efficacy and cognitive coping strategies can be measured with the CSQ. Rasch analysis highlighted lack of unidimensionality, disordered response thresholds and poor targeting in some measures commonly used for people with osteoarthritis.
    Full-text · Article · Mar 2016
    • "**Unknown, addition of very high unusual dose or intensification of two or more drugs at a time, intensifying instead of tapering/discontinuing. the effect of patient reported outcomes such as helplessness could be mediated through several factors. For example, patients with high levels of helplessness are known to experience higher levels of anxiety, depression , low self-esteem, impaired activities of daily living, low socioeconomic status and more symptoms such as fatigue, pain and stiffness242526. This may in turn lead to poor concordance with therapy and/or reduce patient motivation to comply with a physician's recommendation. "
    [Show abstract] [Hide abstract] ABSTRACT: Treat-to-target (T2T) strategies using a protocol of pre-defined adjustments of disease-modifying anti-rheumatic drugs (DMARDs) according to disease activity improve outcomes for patients with rheumatoid arthritis (RA). However, successful implementation may be limited by deviations from the protocol. The aim of this study was to determine the prevalence of protocol deviation, explore the reasons and identify subsets of patients in whom treatment protocols are more difficult to follow. In this retrospective cohort study, treatment-naïve patients with RA of less than one year's duration, attending a dedicated early arthritis clinic between 2001 and 2013, were followed for three years from initiation of combination therapy with conventional DMARDs which was subsequently modified according to a T2T protocol. At each clinic visit, whether deviation from the protocol occurred, the type of deviation and the reasons for deviation were assessed. The relationship between protocol deviations and baseline variables was determined using linear regression analysis. In total, 198 patients contributed 3,654 clinic visits. The prevalence of protocol deviations was 24.5% and deviation in at least at one clinic visit was experienced by 90.4% of patients. The median time to first deviation was 30 weeks. Continuing existing treatment rather than intensifying therapy was the most common type of deviation (59.9%). Patient and physician related factors were the most common reasons for deviation, each accounting for 24.7% of deviations, followed by toxicities (23.3%) and comorbidities (20.0%). The prevalence of protocol deviations was lower among patients who achieved remission after three years (13.1%; 162 deviations out of 1,228 visits) compared with those who were not in remission (30.9%; 523/1692) (P <0.0001). On multivariate analysis, only body mass index (P = 0.003) and helplessness score (P = 0.04) were independent predictors of protocol deviations although the predictive power of the model was not strong (R (2) = 0.17). Deviation from a T2T protocol occurred in one quarter of visits, indicating that applying the T2T approach is feasible in clinical practice. Failure to escalate dose when indicated was commonly encountered, and just under half of the observed deviations were related to either toxicities or comorbidities and were therefore justifiable on clinical grounds.
    Full-text · Article · Dec 2015
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