Influencia de la autoeficacia sobre la capacidad funcional de pacientes reumatológicos con dolor crónico

Abstract

ABSTRACT Background and justification Rheumatic diseases are considered a broad group of disorders that share some common symptoms such as pain, physical disability, functional limitations in activities of daily living, and psychological problems. There are different types of rheumatic diseases, however, rheumatoid arthritis and osteoarthritis of the hand are the two main diseases associated with functional challenges. This is due to the impact that is generated in the joints of the upper extremities, causing in turn a disability of the hands. The presence of psychological problems associated with these rheumatic diseases indicates the need to design and promote effective therapeutic interventions to improve hand disability. These strategies could be aimed at improving your levels of self-efficacy while helping to manage the symptoms related to your rheumatic disease. For this, it is necessary to adapt evaluation instruments such as the Arthritis Self-Efficacy Scale —ASES—, a self-report scale for the evaluation of self-efficacy in patients with rheumatoid arthritis. In addition to the possible association of psychological problems regarding hand function in the population with rheumatic diseases, it appears to be other possible associated factors. For these reasons, knowledge about the possible influence of self-efficacy and other clinical variables such as pain intensity, the evolution of the disease, among others, could increase the knowledge of the relevant factors in the independence of these patients. Objectives The objectives of this thesis are: 1) to validate the original version of the ASES scale in Spanish to obtain an instrument in our context that serves to assess perceived self-efficacy in patients with rheumatic disease; 2) to evaluate whether there is a relationship between certain demographic, psychosocial (perceived self-efficacy) and clinical factors regarding functional disability of the hand in patients with rheumatic disease. Methods For the execution of the objectives, in the present thesis, two multicenter cross-sectional observational studies were carried out. A total of 275 individuals were included in the first study and 335 in the second study. In the first study, the translation/back translation procedure was performed by two bilingual translators. Internal consistency was estimated using the Omega coefficient, test-retest reliability was measured using a 2-way mixed intraclass correlation coefficient (absolute agreement) and the estimated limits of agreement using a Bland-Altman plot. Convergent validity was examined using Pearson's correlations between the rheumatic disease self-efficacy scale —RDS-ES— and the Duruöz Hand Index, the visual analogue scale, and the Quick-Disability of the Arm, Shoulder and Hand questionnaire. In the second study, the total sample consisted of people with rheumatic disease. To analyze the possible relationships of functional disability of the hand in activities of daily living and possible associated factors, the Duruöz Hand Index, the general perceived self-efficacy scale, the RDS-ES scale, the visual analogue scale for the intensity of pain and the meantime of evolution of the disease in years. Results In the first study, the resulting instrument after validation into Spanish of the original version of the ASES scale was called the RDS-ES. The reliability of the RDS-ES scale in the sample of patients with rheumatic diseases was high for the pain, function and other symptoms subscales with Omega coefficients of .96, .97 and .97, respectively. The RDS-ES also showed satisfactory reliability through a test-retest analysis within a two-week period that showed intraclass correlation coefficients that varied between .87 and .98, and through a Bland-Altman graph. It does not reveal systematic trends. On the other hand, in the second study, statistically significant differences were observed between the sample of patients with a rheumatic disease and the non-rheumatic ones in the scores obtained on the general self-efficacy scale, the RDS-ES scale and the visual analogue scale for the intensity of the pain (p <0.001). The results of the multiple regression showed that age, the general self-efficacy scale, the RDS-ES, the scores of the visual analogue scale for pain and the duration of the disease (or the combination of some of these variables) explained the 68% of the explained variance of functional handicap in the kitchen, 44% in clothing, 46% in hygiene and other activities, and 47% in work activities. Conclusions The main conclusions were, first, that the translated version of the ASES scale, renamed RDS-ES, is valid and reliable for use in Spanish-speaking patients with rheumatic diseases. Second, that age, general and domain-specific self-efficacy, pain intensity, and disease duration are predictors of the dimensions of hand function in patients with rheumatic disease. Therefore, early evaluation of these components can help in the proper management of hand disability caused by rheumatic disease from an interdisciplinary approach.