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REFERENCE LINKING PLATFORM OF KOREA S&T JOURNALS
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Journal of muscle and joint health
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Journal DOI :
Korean Society of Muscle and Joint Health
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Volume & Issues
Volume 5, Issue 2 - Nov 1998
Volume 5, Issue 1 - Apr 1998
Selecting the target year
Model Construction of Perceived Uncertainty in Rheumatoid Arthritis Patients
Yoo, Kyung-Hee ; Lee, Eun-Ok ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 7~25
Rheumatoid arthritis, unlike other chronic diseases, causes the patients to experience uncertainty in their daily lives and thus to feel threat on their emotional comfort because of inconsistent and unpredictable symptoms such as pain. Therefore, a theoretical framework is needed for explanation of uncertainty in patients having rheumatoid arthritis. A hypothetical model was constructed on the basis of Mishel's Uncertainty Theory and other literature review. The model included 9 theoretical concepts and 19 paths. Subjects of the study constituted 330 partients who visited outpatient clinics of two university hospitals and one general hospital in Seoul. Self report questionnaires were used to measure the variables affecting uncertainty. Reliability coefficients of these instruments were found Cronbach's Alpha=
. In data analysis, SAS program and PC-LISREL 8.03 computer program were utilized for descriptive statistics and covariance structure analysis. The results of covariance structure analysis for model fitness were as follows : 1) Hypothetical model showed a good fit to the empirical data : Chi-square(
)=41.81 (df=11, P=.000), Goodness of Fit Index=.974, Root Mean Square Residual=.049, Normed Fit Index=.928, Non Normed Fit Index=.814. 2) For the validity and the parcimony of model, a modified model was constructed by appending 2 paths and deleting 5 paths according to the criteria of statistical significance and meaningfulness. 3) The results of hypothesis testing were as follows : (1) Educational level, event familiarity and severity of illness had a direct effect on uncertainty : Event congruency had both direct and indirect effect on uncertainty : Credible authority and symptom consistency had a nonsignificant direct effect on uncertainty, (2) Illness duration, symptom consistency, and event congruency had a direct effect on severity of illness ; Credible authority had a both direct and indirect effect on severity of illness ; Event congruency had the greatest effect on severity of illness, and event familiarity had a nonsignificant direct effect on severity of illness.
Effects of Coping on Physical and Psychosocial Adaptation by Illness Duration in Patients with Rheumatoid Arthritis
Kim, In-Ja ; Suh, Moon-Ja ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 26~38
The effects of coping on physical and psychosocial adaptation in the 297 patients with rheumatoid arthritis were investigated. The coping methods were divided into compliance of medical regimens, self-control activities, and cognitive control. The effects of these coping methods was analyzed with stepwise regression. The physical adaptation is found to be significantly affected by cognitive control, self-control activities, and compliance of medical regimens in order Compliance of the medical regimens affects negatively the physical adaptation. And psychosocial adaptation is significantly affected by the cognitive control. The analysis of these results by illness duration showed the distinct differences. That is in the patients who experienced the disease less than 48 months, the physical and the psychosocial adaptation were significantly affected only by the cognitive control. But in the patients who experienced the disease more than 96 months, the physical and the psychosocial adaptation were significantly affected by self-control activities. Based upon these results, it is recommended that the nurses who care the newly diagnosed patients emphasize on the positive side of the state. And the patients who are diagnosed long ago need the nursing programs which teach and promote self-control activities. Also it is suggested that the results of compliance must be considered rather than as the result variable.
Effects of a Self-Help Program including Stretching Exercise on Reduction of Symptom in Patients with Fibromyalgia
Han, Sang-Sook ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 39~56
This study was an quasi-experimental study, done to identify factors Influencing the reduction of symptoms in patients with fibromyalgia. The primary purpose of the study was to develop a Self-Help Program suitable for patients with fibromyalgia in Korea. The secondary purpose was to identify the effects of a Self-Help Program which included stretching exercise. This study was carried out between Feb. 24 and July 8, 1997 and patients in the study Included out patient diagnosed with fibromyalgia based on the criteria developed by the American College of Rheumatology(1990) and H, University which is a tertiary patient care clinic for Rheumatism. The experimental group included 38 patients who were residents of Seoul or Kyungi province, and a control group of 38 patients who were residents of other areas. The control patients were matched to the experimental group patients and they were selected considering the number of tender points on the Fibromyalgia Impact Questionnaire score and a score of self-efficacy. The experimental group participated in a Self-Help Program based on the American Arthritis Foundation(1995) guidelines. The program participants participated in a small group which consisted of 12-15 members attending the program once a week, for 6 weeks with each program lasted two to two and a half hours. The stretching exercise was carried out in each patient's home every day following the video tape exercise provided by the researcher, and the researcher provided encouragement and concern to the patients by calling them once a week. The number times the exercise was performed was divided by the number of participants to calculate the percentage of performance and determine the amount of exercise. Self-efficacy was measured by the Self-Efficacy Scale developed by Lorig et al. (1989) for arthritis patients. The degree of pain was converted to scores based on the Visual Analog Scale, the number of tender points was converted to scores based on the criteria of the ACR(1990) and of Yunus. Depression was measured by CES-D and physical disability, sleep disturbance, fatigue, and anxiety of patients with fibromyalgia were measured by the Fibromyalgia Impact Questionnaire. The level of the exercise performance was converted to scores using the number of times the exercise was performed following the video tape prepared by Association of Rheumatology Health Professionals. Data were analyzed by SPSS windows and the results ire described below. 1. The experimental group which participated in the Self-Help Program showed higher efficacy scores than the control group when both groups were analyzed for depression and the number of tender points as common variables(F=9.146, p=.003). 2. The experimental group which participated in the Self-Help Program showed lower scores than the control group, for pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety. These symptoms of fibromyalgia can all be seen to have subsided(F=9.483, p=.003 : F=32.680, p=.001 ; F=11.104, p=.001, F=5.344 : p=.024, F=7.630 : P=.007, F=15.6512, p=.003 : F= 7.5412, p=.008). 3. In the experimental group, the self-efficacy score for the first three weeks showed a positive correlation with the exercise-performance score for four to six weeks (r=.387, p=.043). 4. In the experimental group, the relationship between the level of exercise-performance and the reduction of symptoms showed a significant correlation only to physical disability(r= -.500, p=.001). 5. In the experimental group, the relationship between the self-efficacy score and pain, the number of tender points, depression, physical disability, fatigue, sleep disturbance and anxiety score showed inverse correlations and thus, a reduction of symptoms occured when the self-efficacy score increased(r=-.325, p=.004 ; r= -.253, p=.027, r=-.452, p=.001 : r=-.434, p=.001 ; r=-.316, p=.005 ; r=-.460, p=.001 ; r=-.397, p=.014). Therefore, self-efficacy improved following the Self-Help Program including the stretching exercise. It was also found that physical symptoms (pain, number of tender points, level physical disability) and psychological symptoms (depression, fatigue, sleep disturbance, anxiety) were reduced. Moreover, It was found that the higher the self-efficacy, the the higher the degree of achievement of goals set for the stretching exercises. In addition, the level of exercise-performance influenced the level of physical disability, one of the symptoms of fibromyalgia. Accordingly, the conclusions from this study are that exercise-performance and the reduction of symptoms is achieved through promotion of self-efficacy. Therefore, it is proposed that are the Self-Help Program including stretching exercises is an appropriate nursing intervention for the reduction of symptoms of fibromyalgia.
A Study on Degree of Daily Living Activities among Women with Osteoarthritis
Yang, Kyeong-Ra ; Rhee, Seon-Ja ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 57~71
This study purports to examine sociodemographic characteristics and those factors associated with osteoarthritis in women experiencing the disease in order to make suggestions for the prevention and management of osteoarthritis in women. The subjects were 143 women who were diagnosed to have osteoarthritis and under follow-up care at an outpatient department of a university-affiliated hospital. The data were collected through personal interviews by using the structured questionnaire between October 6 and October 24, 1997. The degree of daily living activities was measured with 24 items, which were made based upon Katz Index, Barthel Index and Functional Status Index. Each item has 4 response categories : (1) being able to do alone with any difficulty, (2) being able to do alone with some difficulty, (3) being able to do alone with the help of a person or an instrument, (4) not being able to do at all. The data was analyzed with correlation analysis, t-test, ANOVA, and regression analysis. The results are summarized as follows : 1. As for the age of the subjects, 59.4% were between 45 and 64 years, while 28% were 65 years and above. The subjects having religion were 71.7% and 44.1% of the subjects were protestants. The educational level was low : 31.5% graduated from elementary school, while 30.1% had no formal education. Those married subjects were 72%. Fifty nine percent of the subjects evaluated their economic status as middle class. 2. Those people from whom the subjects currently receive some help were spouses in 35.8% of the subjects. Likewise, 50% of the subjects indicated spouse as the people from whom they want to receive help. 3. The score of the ability of daily living activities ranged between 48 and 96, with the mean of 78.94. Those means of physical activity, ADL(activities of daily living) and IADL(instrumental activities of daily living) were 14.89, 13.97 and 50.09, respectively. Except for the items of carrying heavy stuff and of washing clothes in the sitting position the subjects showed independence in more than 90% of the items, where Independence is defined as being able to do alone or with the help of a person or an instrument. 4. The increase in age was a significant predictor of the decrease in the ability of daily living activities. Those graduated from middle school and above showed a significantly higher degree in the ability of daily living activities than those with less educational level. The married women revealed significantly higher scores in physical activity, ADL, and IADL than the unmarried ones. The ability of daily living activities was not significantly related to having religion, economic status and living with family. 5. The average duration of experiencing osteoarthritis was 4 years and 7 months. Regarding the site of the onset, 65% of the subjects indicated knees. The women with osteoarthritis for less than 3 years were 65%. The ability of daily living activities was significantly different by the duration of illness : the longer the duration of illness, the less the ability of activities. The above findings suggest the need for developing those programs for prevention disabilities in performing daily living activities and for managing diseases targeting the women of middle and old age, with low educational level, and with unmarried status. In addition, there should be developed an instrument for measuring the ability of daily living activities which reflects daily lives of Korean women with osteoarthritis in order to examine comprehensive effects of osteoarthritis on women's daily lives in this country.
Functional Impairment and Psychological Status in Patients with Chronic Arthritis
Lim, Nan-Young ; Lee, Eun-Young ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 72~82
The purpose of this study was to identify functional impairment and psychological status and to analyze their relationships in patients with chronic arthritis. The sample was consisted of 75 arthritic patients who visited H hospital and S welfare center. Functional impairment was measured by ADL, pain, and the number of painful joint. Psychological status was measured by depression, self-efficacy, and quality of life. Data was analyzed by frequency, mean
, Pearson's correlation coefficient, and Stepwise multiple regression. The results of this study were as follows : 1. In functional Impairment, ADL was below average which means somewhat difficult, pain was above average, and the number of painful joint was 9.20. 2. In psychological status, scores of quality of life was 97.89, depression was 41.28, self-efficacy was 895.35. 3. Pain was negatively correlated to self-efficacy, ADL and quality of life, and positively correlated to depression. 4. Self efficacy and depression explained 45% of the variance in quality of life. Therefore, it is suggested that nursing intervention improving psychological status would be useful for patients with chronic arthritis. Especially, it is very important to implement nursing intervention focused on increasing self-efficacy and decreasing depression.
Prediction Model for Reduced Bone mass in Women using Individual Characteristics & Life Style Factors
Lee, Eun-Nam ; Lee, Eun-Ok ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 83~109
This study was carried out to identify the Important modifiable risk factors for reduced bone mass and to construct prediction model which can classify women with either low or high bone mass. Through the literature review, individual characteristics such as age, body weight, height, education level, family history, age of menarche, postmenopausal period, gravity, parity, menopausal status, and breast feeding period were identified and factors of life style such as past milk consumption, past physical activity, present daily activity, present calcium intake, alcohol intake, cigarette smoking, coffee consumption were identified as influencing factors of reduced bone mass in women. Four hundred and eighty women aged between 28 and 76 who had given measurement bone mineral density by dual energy x-ray absortiometry in lumbar vertebrae and femur from July to October, 1997 at 4 general hospitals in Seoul and Pusan were selected for this study. Women were excluded if they had a history of any chronic illness such as rheumatoid arthritis, diabetes mellitus, hyperthroidism, & gastrointestinal disorder and any medication such as calcium supplements, calcitonin, estrogen, thyroxine, antacids, & corticosteroids known affect bone. As a result of these exclusion criteria, four hundred and seventeen women were used for analysis. Multiple logistic regression model was developed for estimating the likelihood of the presence or absence of reduced bone mass. A SAS procedure was used to estimate risk factor coefficient. The results are as follows For lumbar spine, the variables significant were age, body weight, menopause status, daily activity, past milk consumption, and past physical activity(p<0.01), while for femoral Ward's triangle, age, body weight, level of education, past milk consumption, past physical activity(p<0.001). Past physical activity, present daily activity and past milk consumption are the most powerful modifiable predictors in vertebrae and femur among the predictors. When the model performance was evaluated by comparing the observed outcome with predicted outcome, the model correctly identified 74.1% of persons with reduced bone mass and 84.5% of persons with normal bone mass in the lumbar vertebrae and 82.9% of persons with reduced bone mass and 75.0% of persons with normal bone mass in the femoral Ward's triangle. On the basis of these results, a number of recommendations for the management of reduced bone mass may be made : First, those woman who are classified as high risk group of the reduced bone mass in the prediction model should examine the bone mineral density to further examine the usefulness of this model. Second, the optimal amount of milk consumption and a regular weight bearing exercise in childhood, adolescence, and early adult should be ensured.
Rheumatoid Arthritis and Exercise
Kim, Eun-Hee ; Lim, Nan-Young ; Lee, Eun-Ok ;
Journal of muscle and joint health, volume 5, issue 1, 1998, Pages 110~119
In an effort to obtain preventive, diagnostic and therpeutic medical and exercise training information of rheumatoid arthritis as well as to provide pertinent data to be used in development of exercise program for the management of rheumatoid arthritis, this study was conducted by using literature review. Because RA is a disease that involves both joints and muscles, its activity in the different functional classes influences the patient's ability to exercise. A patient in Functional Class 1 may perform any type of exercise because the disease involvement has not yet reached major importance. Exceptions may include hard physical exercise, running, and individual racket sports. In almost all cases, bicycle exercise is possible. Patients in Functional Class 2 and a few in Class 3 can perform most types of exercise (especially cycling, walking, heated pool exercise and even jogging) in low activity phases of RA. Although a few patients in Functional Class 3 can walk, jog, and perform similar types of exercise, most persons in this class can swim or exercise on a bicycle if the type of exercise, its intensity, and its range of motion are modified according to the patient's anatomic and pathologic conditions. Most patients in Functional Class 4 are not able to carry out complicated movements. We conclude that physical training for persons with RA has physical, psychological, and social consequences that are clearly beneficial. We recommend training be one part of the many involved in the complicated treatment of RA.