Fatigue and Pain
Rheumatoid arthritis (RA) is known to be a systemic, inflammatory, autoimmune condition which causes disability, pain, and also psychological distress. Fatigue also is experienced by almost 90% of the patients with rheumatoid arthritis and the causalities are likely to be multidimensional.
This fatigue has wide consequences on the lives of these patients and this fatigue is also known to be a significant outcome for most of the patients although currently it is not classified among the seven globally agreed core outcome actions in rheumatoid arthritis clinical trials. However, the OMERACT (Outcome Measures in Rheumatology Clinical Trials) group has in the recent past been discussing the significance of this fatigue as a major outcome. As a result, this group has been given this mandate to further pursue work on choosing the valid measures (Pray, 2006).Fatigue needs to be assessed accurately using the available scales with enough validation properties of accuracy, reliability, sensitivity to change, comprehensiveness, and biologic sense if at all appropriate treatments for the fatigue are to be tested and developed. There is a subjective element o the rheumatoid arthritis fatigue which is beyond the mere physiologic muscle fatigue.
The qualitative studies that have been carried out suggest that the rheumatoid fatigue incorporates the physical, emotional and cognitive elements. This fatigue in rheumatoid patients is different from the fatigue experienced in other long-term circumstances. Therefore as a result, it was important to start the usual application of the generic scales or also the creation of the new scales without even the patient participation and it also had limited validity.The generic scales have items that in the rheumatoid arthritis could reflect the inflammatory disability or disease rather than usual fatigue which is visible in most of the generic depression scales. The usage of invalidated or inappropriate scales for the outcomes could even result in misleading or unreliable results.
There was evidence of the construct validity which was supported if there were any moderate associations with the appropriate variables such as mood and pain. Any strong correlations would reflect the incapability of the scale to distinguish between all other variables and fatigue. The criterion validity was used and also assessed when there was some comparison with other measures of the rheumatoid arthritis fatigue. Research ProblemUntil recently, patients’ fatigue had been assessed with non-specific scales. Providers maintain that without an accurate way to measure fatigue levels, it is difficult to develop a treatment plan that includes managing fatigue.
Currently a rheumatoid fatigue scale is being developed by Joanna Nicklin, a Nursing Research Fellow at the Rheumatology Unit at the University of the West of England.Research PurposeThe purpose of my study is to use the newly developed fatigue scale and a pain scale to determine if there is a correlation between pain and fatigue in rheumatoid arthritis patients. My study will be one of the first to use the scale, and my results will be reported to the developer of the scale to further validate her data.Theoretical FrameworkThe theoretical model being used for this study is Pender’s Health Promotion Model. In her model, Nora Pender emphasizes that health promotion and disease prevention should be the primary focus in health care.
If these fail to prevent problems, care in illness becomes the priority. She defines illness prevention as the desire to actively avoid illness, detect it early, or maintain functioning within the constraints of illness. Detecting illness early and maintaining functions are key nursing interventions in rheumatoid arthritis patients. To apply these principles to this to this study, it is essential to recognize the importance of identifying and properly treating fatigue is crucial in maintaining daily function.Limitation of the studyThe fatigue scales were limited whenever the evidence of validation could be recognized.
On the systematic assessment of the data that is available for the validation data to measure the fatigue in rheumatoid arthritis. A good measure of the fatigue hours was sensitive to alterations in the randomized trial of the NSAIDs (non-steroidal anti-inflammatory drugs) but the research did not describe all the questions and also did not provide reliable or validity data.There is also the CFI (Chronic Fatigue Index) which was developed from the interviews of the patients with rheumatoid arthritis and also the chronic diseases. There is also the current PROMs (patient reported outcome measures) of the fatigue in RA (Rheumatoid arthritis) which has limitations, providing only an international perspective. This research brought about the BRAF-MDO and the short BRAF numerical rating scales (NRS) and the VAS (Visual Analogue scale) for ability, effect, and severity in coping with fatigue and therefore evaluated foe equal validity. Validity of the studyThe twenty-item BRAF-MDQ had a very recommendable internal consistency with Cronbach’s alpha 0.
932, the criterion validity which has a correlation with various fatigue scales r being equal to 0.643 to almost 0.813 and also the construct validity which has the correlations with mood, disability, pain, helplessness with r being equal to 0.340 to almost 0.627.
The factor analysis demonstrated four different dimensions which include living with fatigue, emotional fatigue, physical fatigue and cognition fatigue that also correlated very well with the rheumatoid arthritis MAF with r being equal to 0.548 to almost 0.834. We can therefore conclude that the BRAF instruments are rheumatoid arthritis specific which are inclusive of standardized NRS and the VAS for effect, severity, and coping, and also have verification to support the so called validity.Significance of the studyThis study would show whether the fatigue instruments correlate very strongly with the BRAF short scales. This report would also help to show whether these instruments correlate moderately with the related constructs of mood, disability and pain using the construct validity.
The other aim would be to identify the more appropriate items to form an internally and coherent consistent final questionnaires in order to explore it for distinct, robust and also consistent fatigue dimensions, and also then estimate the construct and its criterion validity. Expected results and findingsIn the research that was carried out, the ethics of the research by committee approval, the consecutive patients from all out-patients clinic of the big teaching hospital that were invited to participate if they had a confirmed diagnosis of rheumatoid arthritis, and were aged 18 years and over and also had English as their first initial language and also had a score of over 5 on the 10cm fatigue VAS where there is no fatigue to the extreme fatigue. The participants had to give an informed consent and they also had to complete the short scales of BRAF, and also complete the four existing comparator fatigue instruments and also the draft 45 item questionnaire. These used the MAF, POMS, FACIT (F), and SF36 Vitality.The variables which were potentially connected with rheumatoid arthritis fatigue which were used to evaluate the construct validity. These included the disability which used the HAQ (Health Assessment Questionnaire), HAD (Hospital Anxiety and Depression Scale), AHI (Arthritis Helplessness Index, and pain which used the 10cm VAS.
The data was then analyzed using the SPSS of both versions 14 and 15 because they were not distributed normally; the correlations by Spearman were utilized. There were different iterative rounds for the analyses in the usage and compiling of the draft questionnaires which now allowed for the removal of less informative items and also the retention of the more informative items. The Cronbach’s alpha was used as a measure of the internal repeated and consistency factor analyses for the whole identification. There are various opinions regarding the strength of all the correlation coefficient. This means that when r is equal or more than 0.7 is referred to as strong; when r is between 0.
7 and 0.5 as moderate; and also when r is less than 0.5 it was to be regarded as weak. There were 428 rheumatoid arthritis patients who were invited to complete this screening for VAS, and among these 59 declined the offer and 95 scored
The mean NRS and VAS scores for the fatigue severity, effect and coping are well elaborated. For every VAS and NRS versions, the correlation is at a level of r which is 0.784 for severity, 0.777 for effect and 0.684 for coping.
The NRS version also gave a slightly advanced mean score, and the differences among the two scales were not very important and also there was no prejudice on the Bland-Altman plots. The effect scale and the BRAF Severity scales correlated with one another, but the correlations among the two were weak and this helped to support the notion that the coping with rheumatoid arthritis fatigue is a new construct.The research also demonstrated that BRAF severity scale was correlated very strongly with the FACIT (F), POMS and the MAF fatigue instruments, which supported the criterion validity and also the moderate with the SF36 vitality subscale. The research showed that there was only weak correlations with disability, pain, helplessness and depression, which suggested that the scale of BRAF severity was connected with but not measuring directly these constructs and hence support construct validity. There was no known correlation that would be said to be strong between inflammation and BRAF severity.
The POMS and MAF correlated very strongly with BRAF Effect scale and very moderately with SF36 vitality and FACIT (F), and this supported the criterion validity (Rheum, 2008).There were very weak correlations with mood, pain, disability, helplessness, supporting construct validity. For the case of BRAF coping scale there were only very weak correlation with the current fatigue scales, and further supporting the notion that coping with rheumatoid arthritis fatigue is a construct that is not encompassed within the main scales.The individuals who suffer from the rheumatoid arthritis often referred to as RA always consider fatigue to be a very important cognitive and physical symptom, which is uncontrollable, overwhelming, unpredictable, and also unearned and affects all aspects of the patient’s life. This is experienced by nearly 98% of the patients of rheumatoid arthritis.
The fatigue that they go through is tough and feel is multi-casual and complex with such components as stress, pain, depression, stress, disability, and inflammation which contribute in different degrees at various times. A global consensus has already recommended that the fatigue brought about by rheumatoid arthritis should be measured using an instrument used to measure the rheumatoid arthritis patients.Realizing the emphasis rheumatoid arthritis patients place on fatigue is important in treating all aspects of their disease process. In order to effectively manage their disease process, specific scales must be used to accurately evaluate fatigue and pain to facilitate successful treatment.