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A challenge with the aggressive new care model for patients with rheumatoid arthritis has been determining which measures to use to assess disease activity and response to therapy. With an observed functional assessment based on the Multidimensional Health Assessment Questionnaire domains, both the physician and the patient can gain important insights into function during a standard office visit. The presence of impairments in strength, joint range of motion, pain, and coordination--including balance and dexterity--can affect patients' ability to perform functional activities. This assessment allows a physician to observe the impact of these impairments on function. It may help identify patients with significant changes in function who can benefit from effective intervention. (J Musculoskel Med. 2012;29:102-105), Treatment of patients with rheumatoid arthritis (RA) has undergone tremendous advances related to greater understanding of its pathophysiology and the introduction of effective disease-modifying medications. New management strategies for RA [...]

Knowing how rheumatoid arthritis (RA) symptoms are affecting patients' everyday activities enhances your ability to provide best 'treat to target' practice interventions. Impairments can result in activity limitations and participation restrictions. An important impairment in RA is structural joint deformities; others are pain, fatigue, and adverse emotional reactions. Persons with RA often make some type of adaptation to their activities. Activity performance may be assessed by patient self-report with directed questions and by direct observation. Knowledge about RA and perspectives on what constitutes a particular activity differ greatly among patients. A challenge during an office visit is to make an accurate assessment of patients' functional activities. Identifying problems is easier if attention is focused on specific body areas that are likely to be problematic. (J Musculoskel Med. 2012;29:78-81), Assessing function in patients with rheumatoid arthritis (RA) is a challenging but important part of the rheumatology office visit. Knowing how the symptoms of RA are affecting patients' everyday activities [...]

The reasons why patients go to physicians to seek help for musculoskeletal problems, such as pain, difficulty in climbing stairs, and reduced work time, all are aspects of human function but refer to different aspects of function. In 2001, the World Health Organization published a classification to describe the health components of functioning and disability. Included is the entirety of a person's health rather than just the consequences of his or her disease. Patient self-report measures, used in conjunction with routine office visits, provide a practical and feasible way of obtaining information about functional health. The Health Assessment Questionnaire, a frequently used tool, has played a major role in broadening the perspective of chronic disease management from biomedical measurements to include measurement of functional health. (J Musculoskel Med. 2012;29:41-43), Musculoskeletal problems are some of the main reasons why patients go to physicians or other health care professionals. The reasons for seeking help are quite variable. For example, a person [...]

Joint pain and joint damage resulting from rheumatoid arthritis (RA) lead to functional limitations that reduce patients' quality of life and make activities of daily living difficult. Recent guidelines have emphasized treat to target strategies for minimizing joint destruction in patients with RA and maximizing their functional well-being, but these strategies have not been tested in usual-care settings and have not focused on the functional improvements that occur when disease activity is reduced by medication. The Routine Assessment of Patient Index Data 3, a composite of patient self-reported measures, includes a multidimensional HAQ (MDHAQ). The MDHAQ provides questions to determine patients' ability to perform activities related to function. Additional treatment strategies that focus on directly addressing functional disabilities may be needed. (J Musculoskel Med. 2012;29:10-12), Rheumatoid arthritis (RA), which affects an estimated 1.3 million Americans, is a complex inflammatory disorder associated with synovitis and joint destruction. (1-3) Both joint pain and joint damage resulting from [...]

Introduces the September 2003 issue of the journal "Quality of Life Research." Nature of health related issues that need to be taken care during chronic illness; Topics covered in this issue; Importance of exercise to maintain a healthy life.

Pain treatment begins with a nurse’s assessment, which relies on effective assessment skills. Hospital settings have implemented pain assessment education, but there is limited evidence in pediatric transitional care settings. The purpose of this quality improvement (QI) initiative was to develop, implement, and evaluate an evidence-based pain education session with 20 nurses in a pediatric specialty hospital that provides transitional care. Specific aims were to assess nurses’ knowledge and attitudes of pain, and evaluate assessment skills based on nurses’ documentation. A prospective pre-post design with three assessments (baseline, post-intervention, and one-month follow-up) was used. The Shriner’s Pediatric Nurses’ Knowledge and Attitudes Regarding Pain questionnaire and an electronic health record review were completed at each assessment. There was significant improvement in nurses’ knowledge and attitudes of pain after the education session (F[2,6] = 50.281, p < 0.0001) from baseline to post-intervention (p < 0.0001), which was maintained at follow-up (p = 0.009). Pain assessment frequency by nurses significantly increased from 43.1% at baseline to 64.8% at post-intervention, and 67.7% at follow-up (χ²[2] = 20.55, p < 0.0001). Developmentally appropriate pain scale usage increased significantly, from 13.1% at baseline to 77.4% at post-intervention, and 81.8% at follow-up (χ²[2] = 169.19, p < 0.0001). Nursing interventions for pain increased significantly, from 33.3% at baseline to 84.0% at post-intervention, and stabilized at 80.0% at follow-up (χ²[2] = 8.91, p = 0.012). Frequency of pain reassessments did not show a statistically significant change, decreasing from 77.8% at baseline to 44.0% at post-intervention and 40.0% at follow-up (χ²[2]= 3.538, p = 0.171). Nurses’ pain knowledge and documentation of assessment skills were improved in this QI initiative.

Objectives: To describe lung transplant recipients (LTRs') acceptance and use of mobile technology for health self-monitoring during the first year post-transplantation, and explore correlates of the use of technology in the 0 to 2, >2 to ≤6, >6 to ≤12, and 0 to 12 months., Methods: Secondary analysis of data from 96 LTR assigned to use Pocket PATH(®), a smartphone application, for daily health self-monitoring in a randomized controlled trial. Use of Pocket PATH was categorized as low, moderate, and high use. Proportional odds models for ordinal logistic regression were employed to explore correlates of use of technology., Results: LTR reported high acceptance of Pocket PATH at baseline. However, acceptance was not associated with actual use over the 12 months (p=0.45~0.96). Actual use decreased across time intervals (p<0.001). Increased self-care agency was associated with the increased odds of higher use in women (p=0.03) and those less satisfied with technology training (p=0.02) in the first 2 months. Higher use from >2 to ≤6 months was associated with greater satisfaction with technology training (OR=3.37, p=0.01) and shorter length of hospital stay (OR=0.98, p=0.02). Higher use from >6 to ≤12 months was associated with older age (OR=1.05, p=0.02), lower psychological distress (OR=0.43, p=0.02), and better physical functioning (OR=1.09, p=0.01). Higher use over 12 months was also associated with older age (OR=1.05, p=0.007), better physical functioning (OR=1.13, p=0.001), and greater satisfaction with technology training (OR=3.05, p=0.02)., Conclusions: Correlates were different for short- and long-term use of mobile technology for health self-monitoring in the first year post-transplantation. It is important to follow up with LTR with longer hospital stay, poor physical functioning, and psychological distress, providing ongoing education to improve their long-term use of technology for health self-monitoring.