Skip to main content
SpringerLink
Log in

Contribution of the self-regulation model to understanding the health related quality of life of rheumatoid arthritis patients

Quality of Life Research Aims and scope Submit manuscript

Cite this article

Abstract

Purpose

This study examined a comprehensive model that integrates the interrelationships among health-related-quality-of-life (HRQoL), disease duration, disease severity, illness representations, and coping resources regarding patients with Rheumatoid arthritis (RA), based on the Self-regulation model.

Method

A convenience sample of 164 patients with RA completed measures of disease’s characteristics (disease duration, disease status), illness representations (timeline, consequences, self-control, treatment control, symptom burden, concern about RA, understanding RA, emotional representations), coping resources (resilience, social support), HRQoL, and socio-demographic questionnaires. The research model was assessed through path analysis.

Results

Perceptions of higher treatment control, lower consequences of RA and lower symptom burden were directly related to HRQoL. The perceptions of higher self-control, higher treatment control, less concern about RA, and lower emotional representations were associated with higher resilience, which in turn was associated with higher HRQoL. The perceptions of higher treatment control, greater understanding of RA, and lower emotional representations were associated with higher perceived social support; however, social support was not associated with HRQoL.

Conclusions

This study contributes to a better understanding of the determinants of HRQoL among RA patients. The findings indicate that clinical interventions targeting RA patients’ illness representations and resilience may assist patients with RA to improve their HRQoL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Gibofsky, A. (2012). Comparative effectiveness of current treatments for rheumatoid arthritis. The American Journal of Managed Care,18(13 Suppl), S303–S314.

    PubMed  Google Scholar 

  2. Scott, D. L., Wolfe, F., & Huizinga, T. W. (2010). Rheumatoid arthritis. Lancet,376, 1094–1108.

    Article  PubMed  Google Scholar 

  3. Cho, S. K., Kim, D., Jun, J. B., Bae, S. C., & Sung, Y. K. (2013). Factors influencing quality of life (QOL) for Korean patients with rheumatoid arthritis (RA). Rheumatology International,33(1), 93–102.

    Article  PubMed  Google Scholar 

  4. Matcham, F., Scott, I. C., Rayner, L., Hotopf, M., Kingsley, G. H., Norton, S., et al. (2014). The impact of rheumatoid arthritis on quality-of-life assessed using the SF-36: A systematic review and meta-analysis. WB Saunders: In Seminars in arthritis and rheumatism.

    Google Scholar 

  5. Rumsfeld, J. S., Alexander, K. P., Goff, D. C., Jr., Graham, M. M., Ho, P. M., Masoudi, F. A., et al. (2013). Cardiovascular health: the importance of measuring patient-reported health status: A scientific statement from the American Heart Association. Circulation,127(22), 2233–2249.

    Article  PubMed  Google Scholar 

  6. Sobota, A., Yamashita, R., Xu, Y., Trachtenberg, F., Kohlbry, P., Kleinert, D. A., et al. (2011). Quality of life in thalassemia: A comparison of SF-36 results from the thalassemia longitudinal cohort to reported literature and the US norms. American Journal of Hematology,86(1), 92–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Liu, L., Xu, X., Xu, N., & Wang, L. (2017). Disease activity, resilience and health-related quality of life in Chinese patients with rheumatoid arthritis: A multi-center, cross-sectional study. Health & Quality of Life Outcomes,15(1), 149–159.

    Article  Google Scholar 

  8. Senra, H., Rogers, H., Leibach, G., Altamar, M. L., Plaza, S. L., Perrin, P., et al. (2014). Health-related quality of life and depression in a sample of Latin American adults with rheumatoid arthritis. International Journal of Rheumatic Diseases,20(11), 1684–1693.

    Article  PubMed  Google Scholar 

  9. Cruz-Castillo, Y., Montero, N., Salazar-Ponce, R., & Villacís-Tamayo, R. (2017). Quality of life in Ecuadorian patients with rheumatoid arthritis: A cross-sectional study. Reumatologia Clinica. https://doi.org/10.1016/j.reuma.2017.08.012.

    Article  PubMed  Google Scholar 

  10. Stockl, K. M., Shin, J. S., Lew, H. C., Zakharyan, A., Harada, A. S., Solow, B. K., et al. (2010). Outcomes of a rheumatoid arthritis disease therapy management program focusing on medication adherence. Journal of Managed Care Pharmacy,16(8), 593–604.

    Article  PubMed  Google Scholar 

  11. Strand, V., Burmester, G. R., Ogale, S., Devenport, J., John, A., & Emery, P. (2012). Improvements in health-related quality of life after treatment with tocilizumab in patients with rheumatoid arthritis refractory to tumour necrosis factor inhibitors: Results from the 24-week randomized controlled RADIATE study. Rheumatology,51(10), 1860–1869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Wan, S. W., He, H. G., Mak, A., Lahiri, M., Luo, N., Cheung, P. P., et al. (2016). Health-related quality of life and its predictors among patients with rheumatoid arthritis. Applied Nursing Research,30, 176–183.

    Article  PubMed  Google Scholar 

  13. Ma, M. H. Y., Ibrahim, F., Kingsley, G. H., Cope, A., & Scott, D. L. (2018). Variable impacts of different remission states on health-related quality of life in rheumatoid arthritis. Clinical and Experimental Rheumatology,36(2), 203–209.

    PubMed  Google Scholar 

  14. Michelsen, B., Uhlig, T., Sexton, J., van der Heijde, D., Hammer, H. B., Kristianslund, E. K., et al. (2018). Health-related quality of life in patients with psoriatic and rheumatoid arthritis: data from the prospective multicentre NOR-DMARD study compared with Norwegian general population controls. Annals of the Rheumatic Diseases,77(9), 1290–1294.

    Article  PubMed  Google Scholar 

  15. Berner, C., Erlacher, L., Fenzl, K. H., & Dorner, T. E. (2018). A cross-sectional study on self-reported physical and mental health-related quality of life in rheumatoid arthritis and the role of illness perception. Health & Quality of Life Outcomes,16(1), 238.

    Article  Google Scholar 

  16. Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense representation of illness danger. Contributions to Medical Psychology,2, 7–30.

    Google Scholar 

  17. Moss-Morris, R., Weinman, J., Petrie, K. J., Horne, R., Cameron, L., & Buick, D. (2002). The revised illness perception questionnaire (IPQ-R). Psychology and Health,17(1), 1–16.

    Article  Google Scholar 

  18. Hyphantis, T., Kotsis, K., Tsifetaki, N., Creed, F., Drosos, A. A., Carvalho, A. F., et al. (2013). The relationship between depressive symptoms, illness perceptions and quality of life in ankylosing spondylitis in comparison to rheumatoid arthritis. Clinical Rheumatology,32(5), 635–644.

    Article  PubMed  Google Scholar 

  19. Kotsis, K., Voulgari, P. V., Tsifetaki, N., Drosos, A. A., Carvalho, A. F., & Hyphantis, T. (2014). Illness perceptions and psychological distress associated with physical health-related quality of life in primary Sjögren’s syndrome compared to systemic lupus erythematosus and rheumatoid arthritis. Rheumatology International,34(12), 1671–1681.

    Article  CAS  PubMed  Google Scholar 

  20. Jopson, N. M., & Moss-Morris, R. (2003). The role of illness severity and illness representations in adjusting to multiple sclerosis. Journal of Psychosomatic Research,54(6), 503–511.

    Article  PubMed  Google Scholar 

  21. Hallas, C. N., Wray, J., Andreou, P., & Banner, N. R. (2011). Depression and perceptions about heart failure predict quality of life in patients with advanced heart failure. Heart and Lung,40(2), 111–121.

    Article  PubMed  Google Scholar 

  22. Fan, S. Y., Eiser, C., Ho, M. C., & Lin, C. Y. (2013). Health-related-quality-of-life in patients with hepatocellular carcinoma: The mediation effects of illness perceptions and coping. Psycho-Oncology,22(6), 1353–1360.

    Article  PubMed  Google Scholar 

  23. Graham, C. D., Weinman, J., Sadjadi, R., Chalder, T., Petty, R., Hanna, M. G., et al. (2014). A multicentre postal survey investigating the contribution of illness perceptions, coping and optimism to quality of life and mood in adults with muscle disease. Clinical Rehabilitation,28(5), 508–519.

    Article  PubMed  Google Scholar 

  24. Tiggelman, D., van de Ven, M. O., van Schayck, O. C., Kleinjan, M., & Engels, R. C. (2014). The Common Sense Model in early adolescents with asthma: Longitudinal relations between illness perceptions, asthma control and emotional problems mediated by coping. Journal of Psychosomatic Research,77(4), 309–315.

    Article  PubMed  Google Scholar 

  25. Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology,3, 377–401.

    Article  PubMed  Google Scholar 

  26. Minnock, P., Fitzgerald, O., & Bresnihan, B. (2003). Quality of life, social support, and knowledge of disease in women with rheumatoid arthritis. Arthritis & Rheumatism-Arthritis Care & Research,49(2), 221–227.

    Article  Google Scholar 

  27. Sanyal, N., Fernandes, T., Fathi, M., & Khatoon, S. (2017). Illness perception, medication adherence, resilience and quality of life among COPD and arthritis patients. Indian Journal of Health & Wellbeing,8(1), 18–28.

    Google Scholar 

  28. Windle, G. (2011). What is resilience? A review and concept analysis. Reviews in Clinical Gerontology,21(2), 152–169.

    Article  Google Scholar 

  29. Grünberg, J., Verocay, C., Rébori, A., & Amaral, C. (2005). The promotion of patient resilience in a pediatric dialysis unit: a case report. Humane Medicine [Internet], 5(2), 1–5.

    Google Scholar 

  30. Hajmohammadi, R., & Shirazi, M. (2017). Predicting resilience via social support and illness perceptions among patients undergoing Hemodialysis. Jundishapur Journal of Chronic Disease Care,6(3), 14427.

    Article  Google Scholar 

  31. Sarason, I. G., Levine, H. M., Basham, R. B., & Sarason, B. R. (1983). Assessing social support: The social support questionnaire. Journal of Personality and Social Psychology,44(1), 127–139.

    Article  Google Scholar 

  32. Davidson, L. M., & Demaray, M. K. (2007). Social support as a moderator between victimization and internalizing-externalizing distress from bullying. School Psychology Review,36(3), 383–405.

    Google Scholar 

  33. Kelly, M. A., Sereika, S. M., Battista, D. R., & Brown, C. (2007). The relationship between beliefs about depression and coping strategies: Gender differences. British Journal of Clinical Psychology,46(3), 315–332.

    Article  PubMed  Google Scholar 

  34. Edwards, S., Tinning, L., Brown, J. S., Boardman, J., & Weinman, J. (2007). Reluctance to seek help and the perception of anxiety and depression in the United Kingdom: a pilot vignette study. The Journal of Nervous and Mental Disease,195(3), 258–261.

    Article  PubMed  Google Scholar 

  35. Leventhal, H., Leventhal, E. A., & Contrada, R. J. (1998). Self-regulation, health, and behavior: A perceptual-cognitive approach. Psychology & Health,13(4), 717–733.

    Article  Google Scholar 

  36. Gong, G., & Mao, J. (2016). Health-related quality of life among Chinese patients with rheumatoid arthritis: The predictive roles of fatigue, functional disability, self-efficacy, and social support. Nursing Research,65(1), 55–67.

    Article  PubMed  Google Scholar 

  37. Ware, J. E., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care,34, 220–233.

    Article  PubMed  Google Scholar 

  38. Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research,60(6), 631–637.

    Article  PubMed  Google Scholar 

  39. Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the connor–davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies,20(6), 1019–1028.

    Article  Google Scholar 

  40. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment,52(1), 30–41.

    Article  Google Scholar 

  41. Selig, J. P., & Preacher, K. J. (2008). Monte Carlo method for assessing mediation: An interactive tool for creating confidence intervals for indirect effects [Computer software]. Retrieved April 1st from http://quantpsy.org/medmc/medmc.htm.

  42. Michaud, K., Messer, J., Choi, H. K., & Wolfe, F. (2003). Direct medical costs and their predictors in patients with rheumatoid arthritis: A three-year study of 7,527 patients. Arthritis and Rheumatism,48(10), 2750–2762.

    Article  PubMed  Google Scholar 

  43. Chaigne, B., Finckh, A., Alpizar-Rodriguez, D., Courvoisier, D., Ribi, C., Chizzolini, C., et al. (2017). Differential impact of systemic lupus erythematosus and rheumatoid arthritis on health-related quality of life. Quality of Life Research,26(7), 1767–1775.

    Article  PubMed  Google Scholar 

  44. Hagger, M. S., & Orbell, S. (2003). A meta-analytic review of the common-sense model of illness representations. Psychology and Health,18(2), 141–184.

    Article  Google Scholar 

  45. Helmreich, I., Kunzler, A., Chmitorz, A., König, J., Binder, H., Wessa, M., et al. (2017). Psychological interventions for resilience enhancement in adults. Cochrane Database of Systematic Reviews,2017(2), CD012527.

    PubMed Central  Google Scholar 

  46. Bonsaksen, T., Haukeland-Parker, S., Lerdal, A., & Fagermoen, M. S. (2014). A 1-year follow-up study exploring the associations between perception of illness and health-related quality of life in persons with chronic obstructive pulmonary disease. International Journal of Chronic Obstructive Pulmonary Disease,9, 41.

    PubMed  Google Scholar 

  47. Chung, M. L., Moser, D. K., Lennie, T. A., & Frazier, S. K. (2013). Perceived social support predicted quality of life in patients with heart failure, but the effect is mediated by depressive symptoms. Quality of Life Research,22(7), 1555–1563.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, 52900, Ramat-Gan, Israel

    Shiri Shinan-Altman & Shiran Afuta-Goldstein

Authors
  1. Shiri Shinan-Altman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shiran Afuta-Goldstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shiri Shinan-Altman.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shinan-Altman, S., Afuta-Goldstein, S. Contribution of the self-regulation model to understanding the health related quality of life of rheumatoid arthritis patients. Qual Life Res 29, 403–412 (2020). https://doi.org/10.1007/s11136-019-02315-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-019-02315-5

Keywords

search

Navigation