Flurey Caroline A, Morris Marianne, Pollock Jon, Richards Pamela, Hughes Rodney, Hewlett Sarah
University of the West of England, Bristol, UK.
BMC Musculoskelet Disord. 2014 Nov 1;15:364. doi: 10.1186/1471-2474-15-364.
Previous studies have not addressed rheumatoid arthritis (RA) patients' help-seeking behaviours for RA flares, and only one small qualitative study has addressed how patients experience daily life on current treatment regimes. Thus, this study aims to identify clusters of opinion related to RA patients' experiences of daily life on current treatments, and their help-seeking behaviours for RA flares.
Using Q-methodology (a methodology using qualitative and quantitative methods to sort people according to subjective experience), two separate studies were conducted with the same sample of RA patients (mean age 55, 73% female). Thirty participants sorted 39 statements about daily life (Q-study 1) and 29 participants separately sorted 23 statements about flare help-seeking (Q-study 2). Data were examined using Q-factor analysis.
Daily life with RA (Q-study 1): Three factors relating to the experience of living with RA were extracted and explained. Patients belonging to Factor A (mean age 62, 86% female) use effective self-management techniques to control the daily impact of RA. Those in Factor B (mean age 55, 75% male) struggle to self-manage and cope. Whilst patients in Factor C (mean age 42, 100% female) prioritise life responsibilities over their RA, reporting less impact.Flare help-seeking (Q-study 2): Two factors explaining the experience of flare help-seeking (unrelated to the factors from Q-study 1) were extracted and explained. Factor X (68.8% on biologics) reported seeking help quickly, believing the medical team is there to help. Factor Y (0% on biologics) delay help-seeking, concerned about wasting the rheumatologist's time, believing they should manage alone. All participants agreed they sought help due to intense pain and persistent, unmanageable symptoms.
Patients with different characteristics appear to manage RA life in different ways and men may struggle more than women. Whilst all patients are prompted to seek help by persistent, unmanageable symptoms, some delay help-seeking. Further research is needed to quantify the severity of daily symptoms, the level of symptoms needed for patients to define themselves as in flare and to understand the support needs of RA men.
既往研究未涉及类风湿关节炎（RA）患者在病情复发时的求助行为，仅有一项小型定性研究探讨了患者在当前治疗方案下的日常生活体验。因此，本研究旨在确定与RA患者在当前治疗下的日常生活体验及其病情复发时求助行为相关的意见类别。
采用Q方法（一种运用定性和定量方法根据主观体验对人群进行分类的方法），对同一组RA患者样本（平均年龄55岁，73%为女性）进行了两项独立研究。30名参与者对39条关于日常生活的陈述进行了分类（Q研究1），29名参与者分别对23条关于病情复发求助的陈述进行了分类（Q研究2）。使用Q因子分析对数据进行检验。
RA患者的日常生活（Q研究1）：提取并解释了与RA生活体验相关的三个因素。属于A因子的患者（平均年龄62岁，86%为女性）采用有效的自我管理技巧来控制RA对日常生活的影响。B因子的患者（平均年龄55岁，75%为男性）在自我管理和应对方面存在困难。而C因子的患者（平均年龄42岁，100%为女性）将生活责任置于RA之上，称其影响较小。病情复发时的求助行为（Q研究2）：提取并解释了两个解释病情复发求助体验的因素（与Q研究1中的因素无关）。X因子（68.8%使用生物制剂）报告称会迅速寻求帮助，相信医疗团队会提供帮助。Y因子（0%使用生物制剂）会延迟求助，担心浪费风湿病专家的时间，认为自己应该独自应对。所有参与者都同意，他们是由于剧痛和持续、难以控制的症状而寻求帮助的。
具有不同特征的患者似乎以不同方式应对RA生活，男性可能比女性更困难。虽然所有患者都会因持续、难以控制的症状而寻求帮助，但有些患者会延迟求助。需要进一步研究以量化日常症状的严重程度、患者将自身定义为病情复发所需的症状水平，并了解RA男性患者的支持需求。
