Investigating the relationship between disability status and self-care ability in rheumatoid arthritis patients referred to Razi Medical Training Center in Rasht in 1391-92

Dissertation to receive a master's degree in nursing education

(internal orientation - surgery)

Abstract

Introduction: Chronic diseases are one of the main health issues in modern societies. Rheumatoid arthritis as a chronic disease may lead to a severe decline in functional status and reduced life expectancy. Rheumatoid arthritis patients suffer from physical dysfunction and disability due to pain, fatigue, limitation of movement and daily activity.  Since self-care is one of the most important factors to control disability and disease, this study was conducted with the aim of determining the relationship between disability status and self-care ability in people with rheumatoid arthritis. Materials and methods: In this descriptive-analytical cross-sectional study, 326 patients with rheumatoid arthritis who were They were referred to the Rheumatology Clinic of Razi Medical Training Center in Rasht, and were examined. The method of data collection was an interview using the Health Assessment Questionnaire tool to determine the level of disability and the Self-Care Inventory tool to determine the level of self-care ability. The data was analyzed using SPSS version 16 software and descriptive and analytical tests (Spearman, Mann-Whitney and Kruskal-Wallis correlation coefficients as well as regression analysis). Results: The average self-care ability of the patients was 57.65 ± 2.32 and at a good level. The relationship between disability status and self-care ability in rheumatoid arthritis patients was statistically significant. (r=0.324; p<0.0001) so that as disability increases, self-care ability decreases and vice versa. Also, disability (P < 0.0001), patient's age (P < 0.0001), education level (p < 0.004) and disease duration (p < 0.013) were found to be related factors predicting self-care ability.

Conclusion: According to the research results that indicate the effect of related factors in the control of rheumatoid arthritis, it is necessary for nurses to examine arthritis patients Rheumatoid patients, in addition to determining the level of disability and self-care needs, taking into account relevant influencing factors, formulate and implement the necessary educational plans to promote the empowerment of patients.

Key words: self-care, disability assessment, rheumatoid arthritis

Introduction:

Today, the medical world is facing the growth of "chronic diseases" (1). In 1995, about 99 million people in America were suffering from chronic diseases. It is predicted that this number will reach 167 million people by 2050. Chronic diseases are seen in all countries of the world, both developed and developing, in all social and economic groups and in all ages (2). In addition, with the increase in the incidence of chronic diseases, the costs associated with these diseases (such as hospital costs, tools and equipment, drugs and services) also increase. The long course of chronic diseases, due to disability, makes it difficult for the sufferers to control it, and some of them cause many changes in the life process as a crisis (1 and 2). Chronic diseases affect routine and daily life activities (3). Chronic disease causes tension in the patient and the family, because it causes life-long changes in the roles or way of life, and frequent hospitalizations cause economic problems and reduced social interactions (4).

Rheumatoid arthritis [1] is considered one of the types of chronic diseases and the spread of this disease can cause joint destruction and disability in adulthood (5). Rheumatoid arthritis is a disease. Chronic progressive autoimmune inflammation with variable clinical symptoms. Rheumatoid arthritis has a negative impact on the life dimensions of affected people and is characterized by mild to severe inflammation of the synovial joints, which can lead to joint pain, dryness and destruction along with physical deformities and subsequent disabilities. This disease can be a main cause of disability and death. This disease is seen in every region and race with different frequency. Generally, it affects 1% of the world population.In general, it affects 1% of the world's population. Its prevalence in Canada and America is approximately 1%, and its frequency in women is three to four times higher than the frequency observed in men. Its frequency is reported as 0.36% in Mediterranean countries (6). In 1998, the prevalence of this disease was between 2 and 4 people per 100,000 people (7). The prevalence of this disease has increased significantly in recent years.  Statistics showed that in 2008, more than 2 million Americans are suffering from this disease (8). In Iran, during a population study based on the COPCORD project ([2]) in 2018, the prevalence of rheumatoid arthritis was 0.19% (9). Socially, the ability to participate in social activities and emotional problems can lead to physical deformities (6). Patients with rheumatoid arthritis may suffer from physical dysfunction and "disability" (10). They have defined it as a multifaceted and complex experience that blends with a person's life. The intensity of disability in a person's life is influenced by three factors affecting disability, including the effects of the condition that causes disability, other perceptions of disability and the level of the person's need to use resources. It is estimated that there are 54 to 60 million disabled people in the United States of America. It is expected that the number of these people will increase due to the increase in the survival rate of patients with chronic diseases, people with disabilities in the first stages of life and people who have suffered severe injuries (2). The disability was caused by this disease. Studies have shown that "self-care [4]" is one of the methods of controlling the complications of chronic diseases (such as rheumatoid arthritis) and the resulting disability (1, 11). Also, since chronic disease requires chronic care, in this regard, many believe that in order to organize these patients and facilitate work, the care should be done by the people themselves (12). The concept of "self-care" was first proposed by Orem and published in 1959 (6). According to Orem's definition, self-care is the learned behavior that a person performs to maintain or promote life, health and well-being, prevention and treatment. (13 and 14). Self-care includes dealing with basic human needs and maintaining activities related to health and maintaining life. Self-care is purposeful and contributes to the structural integrity of man, his function and evolution (14, 15, 16). Self-care is an important component of disease control and is a relative process that brings purposeful behaviors and choices and reflects the attitude and knowledge of each person (17). In chronic diseases, self-care refers to examining and controlling the symptoms of the disease, adopting a therapeutic regimen, maintaining a healthy lifestyle, and controlling the impact of the disease on daily functioning, emotions, and social relationships. The most important principle in self-care is the patient's participation and acceptance of responsibility (11). The strongest dimension of Orem's nursing theory is to provide self-care as a priority for people at various levels of health, and the patient actively participates in his or her self-care.

Introduction: Chronic diseases are the major health care issues in modern societies. Rheumatoid arthritis as a chronic disease may lead to a sharp decline in the performance condition and life expectancy. Patients with rheumatoid arthritis suffer from impaired physical function and disability due to pain, fatigue, daily activity and movement restrictions disability and disease.