Relationship Between Illness Uncertainty And Quality Of Life In Patients With Rheumatoid Arthritis: Analysis Of Mediating Effects With Regulation

Purpose:To understand the current status of illness uncertainty,,sense of coherence,perceived social support and quality of life in patients with rheumatoid arthritis.To investigate the factors influencing illness uncertainty,sense of coherence,perceived social support and quality of life.To explore the underlying relationships and path of action of illness uncertainty,sense of coherence,perceived social support and quality of life in patients with rheumatoid arthritis.Methods:A consecutive sampling method was used to select 260 patients with rheumatoid arthritis who attended the rheumatology departments of three tertiary-level general hospitals in Chengdu from January to November 2022 as the study population.Questionnaires were administered using the General Information Questionnaire,the Mishel Uncertainty in Illness Scale,the Quality of Life in Rheumatoid Arthritis Patients Scale,the Sense of Coherence Scale,and the Perceived Social Support Scale.Data analysis using SPSS 26.0 software,statistical methods using descriptive statistical analysis,independent samples t-test,one-way ANOVA,Pearson’s correlation analysis,multi-factor analysis;using Process V3.3 plug-in for mediating and moderating effect analysis.Result:1.Patients with rheumatoid arthritis had a illness uncertainty score of(87.11±13.94).The difference in illness uncertainty score was statistically significant(P<0.05)in terms of age,education level,average monthly household income,occupation,usual place of residence,mode of payment for health care,number of rheumatoid arthritis-related drugs currently taken and joint function classification grouping.2.The sense of coherence score of patients with rheumatoid arthritis was(60.27±9.57).The difference in the sense of coherence score was statistically significant(P<0.05)in terms of age,education level,average monthly household income,occupation,usual place of residence,mode of payment of medical expenses,number of types of rheumatoid arthritis-related medications currently taken,and joint function classification grouping.3.The perceived social support score of patients with rheumatoid arthritis was(54.40±12.13),with statistically significant differences(P<0.05)by age,education level,mean monthly household income,occupation,usual place of residence,mode of payment of medical expenses,family history,number of rheumatoid arthritis-related drugs currently taken and joint function classification group.4.The quality of life score for patients with rheumatoid arthritis was(70.75±12.86),with statistically significant differences(P<0.05)between patients of different genders,ages,education levels,average monthly household income,occupations,usual place of residence,mode of payment for health care,duration of morning stiffness,number of types of rheumatoid arthritis-related drugs currently taken and joint function classification.5.The results of multiple stepwise linear regression analysis showed that four variables,namely,age,occupation,mode of medical payment and joint functional class,jointly explained 27.6% of the total variance in illness uncertainty score;four variables,namely,age,occupation,number of rheumatoid arthritis-related medications currently taken and joint functional class,jointly explained 26.4% of the total variance in sense of coherence score;the four variables of age,education,residence and family history jointly explained 30.0% of the total variance in the perceived social support score;The six variables of sense of coherence,gender,number of rheumatoid arthritis-related medications currently taken,education,occupation and joint functional class together explained 49.3% of the total variance in quality of life scores.6.The quality of life score(reverse scale)of patients with rheumatoid arthritis was positively correlated with illness uncertainty(r=0.455,P<0.01)and negatively correlated with sense of coherence and perceived social support(r=-0.636,P<0.01;r=-0.419,P<0.01);illness uncertainty was negatively correlated with sense of coherence and perceived social support(r=-0.523,P<0.01;r=-0.500,P<0.01);sense of coherence was positively associated with perceived social support(r=0.475,P<0.01).7.Analysis of the mediating effect showed that the total effect of illness uncertainty on quality of life was 0.288,of which the direct effect was 0.111 and the mediation effect of sense of coherence was 0.177,with the mediation effect accounting for 61.4% of the total effect.8.Analysis of the moderating effect showed that perceived social support has a moderating effect in the first half of the pathway in the mediating effect.Perceived social support can attenuate the negative impact of illness uncertainty on sense of coherence.The threshold value for the moderating effect of perceived social support was 13.7481(after standardization of the data).When the value of perceived social support was below 13.7481,the association between illness uncertainty and sense of coherence increased gradually with increasing perceived social support;when the value of perceived social support was above 13.7481,the association between illness uncertainty and sense of coherence disappeared.The moderating effect of perceived social support was not significant on either the second half of the mediated pathway or the direct pathway.Conclusion:1.People with rheumatoid arthritis have a moderate level of illness uncertainty;a low level of sense of coherence;and a moderate level of perceived social support;a poor level of quality of life.2.Age,occupation,health care payment method and joint functional class were factors influencing the perception of illness uncertainty in rheumatoid arthritis patients;age,occupation,number of rheumatoid arthritis-related drugs currently taken and joint functional class were factors influencing the perception of sense of coherence;and a moderate level of perceived social support.;age,education,usual place of residence and family history were factors influencing the perceived social support;sense of coherence,gender,number of rheumatoid arthritis-related drugs currently taken,education,occupation and joint functional class were factors influencing the perception of quality of life.3.The higher the sense of illness uncertainty,the lower the sense of sense of coherence and the lower the perceived social support of people with rheumatoid arthritis,the poorer their quality of life.4.Sense of coherence partially mediated the relationship between illness uncertainty and quality of life,with perceived social support moderating the first half of the mediating pathway and not significantly moderating the second half of the mediating pathway and the direct pathway.This study examines the intrinsic relationships and pathways of action between illness uncertainty,sense of coherence,perceived social support and quality of life in patients with rheumatoid arthritis,and provides a reference for the development of interventions to improve the quality of life of patients with rheumatoid arthritis.