Hewlett Sarah, Cockshott Zoë, Almeida Celia, Richards Pam, Lowe Rob, Greenwood Rosemary, Kirwan John
School of Nursing, University of the West of England, Bristol UK.
Musculoskeletal Care. 2008 Mar;6(1):49-67. doi: 10.1002/msc.125.
Patient education in rheumatoid arthritis (RA) aims to improve health outcomes by prompting people to adopt self-management behaviours. One precursor for initiating behaviour change is self-efficacy (SE), a belief that you can do a task. This study tested the sensitivity to change of a new scale to measure SE for self-management in people with RA, the Rheumatoid Arthritis Self-Efficacy scale (RASE). Exploratory analysis examined potential predictors of change in SE.
People with RA at 11 rheumatology centres, who had accepted an education programme as part of clinical care, completed questionnaires at baseline, and two and eight weeks after their programme end. Programmes were not standardized, as this was a pragmatic study in clinical practice.
A total of 128 patients participated. After controlling for baseline scores, the RASE showed small but significant improvements in SE from baseline (RASE 107.57, CI 105.42-109.72) to two weeks after programme end (RASE 110.80, CI 108.60-112.99), and eight weeks (RASE 110.62, CI 108.40-112.85, p<0.001). Standardized response means, calculated both by absolute and percentage change, were 0.339 and 0.371 at two weeks after programme end, and 0.321 and 0.352 at eight weeks. Changes in the RASE were associated with behaviour initiation at two and eight weeks (r=0.419, r=0.342, p<0.001). No substantial predictors of change in SE could be identified.
The RASE is sensitive to change in a cohort of people with RA in the UK receiving education programmes as routine clinical care. Exploratory analysis did not identify clinical or psychological factors that predict change in SE, suggesting that programmes should not be restricted to particular patients.
类风湿关节炎（RA）患者教育旨在通过促使人们采取自我管理行为来改善健康状况。启动行为改变的一个先兆是自我效能感（SE），即相信自己能够完成一项任务。本研究测试了一种新的量表——类风湿关节炎自我效能量表（RASE），用于测量RA患者自我管理的自我效能感对变化的敏感性。探索性分析研究了自我效能感变化的潜在预测因素。
11个风湿病中心的RA患者接受了作为临床护理一部分的教育项目，在基线时、项目结束后两周和八周完成问卷调查。由于这是一项临床实践中的务实研究，项目未标准化。
共有128名患者参与。在控制基线分数后，RASE显示自我效能感从基线（RASE 107.57，CI 105.42 - 109.72）到项目结束后两周（RASE 110.80，CI 108.60 - 112.99）以及八周（RASE 110.62，CI 108.40 - 112.85，p<0.001）有小幅但显著的改善。通过绝对变化和百分比变化计算的标准化反应均值在项目结束后两周分别为0.339和0.371，在八周时分别为0.321和0.352。RASE的变化与两周和八周时的行为启动相关（r = 0.419，r = 0.342，p < 0.001）。未发现自我效能感变化的实质性预测因素。
在英国接受教育项目作为常规临床护理的RA患者队列中，RASE对变化敏感。探索性分析未发现预测自我效能感变化的临床或心理因素，这表明项目不应局限于特定患者。
