| Both how people think and what people do appear to be critically important for how the adjust to common chronic pain conditions including osteoarthritis(OA) and rheumatoid arthritis(RA). This thesis includes independent studies designed to underscore the roles of specific cognitive influences(i.e., beliefs about pain and the self)and objectively measured physical activity on adjustment within these groups.Numerous theories have implicated beliefs about pain, health or illness as key influences on adjustment to arthritis but associations have been somewhat inconsistent within this literature. In Study 1, a meta-analysis was performed to evaluate overall associations of beliefs about pain, health, illness, and self(i.e., beliefs about pain as a source of fear, threat or harm, health/pain locus of control beliefs, pain catastrophizing,self-efficacy, and helplessness beliefs) with specific facets of adjustment(i.e.,functional impairment, affective distress, pain severity) in OA and RA samples.Moderating effects of methodological factors and sample characteristics on these associations were also assessed in attempting to explain variable effect sizes between studies.In sum, based on a review of 106 studies, data from 111 samples(N=17,365patients) met all inclusion criteria for analysis. Overall effect sizes for associations between pain beliefs and each outcome were medium in strength and highly significant.However, heterogeneity was elevated across aspects of adjustment. Pain belief content emerged as a significant moderator of belief-adjustment associations; effect sizes were comparatively stronger for studies that assessed pain catastrophizing, helplessness,and/or self-efficacy beliefs than those examining locus of control and fear/threat/harm beliefs. In contrast, belief-adjustment effect sizes were not moderated by arthritis subtype, gender, or age. Analyses of longitudinal study subsets indicated relationsbetween baseline pain beliefs and follow-up adjustment were significant, even when controlling baseline responses, supporting the status of pain beliefs, not only as correlates of, but also as risk/protective factors for later functioning among people with OA and RA. In sum, the meta-analysis indicated that beliefs related to personal effectiveness in managing pain(self-efficacy, helplessness, catastrophizing) tended to have stronger associations with adjustment to arthritis compared to beliefs about pain and health itself.In study 2, we compared objectively-measured physical activity(PA) and sleep as well as self-reported PA, sleep, and adjustment in an arthritis sample(N=40) and gender-matched controls without arthritis(N=40). All participants were required to wear a Sense Wear Physical Activity Questionnaire Short Form-Chinese(IPAQ-SF-C),Baecke Physical Activity Questionnaire(BPAQ), Pittsburgh Sleep Diary(PSD) and12-item Short-Form Health Survey Questionnaire version 2(SF-12v2).Demographically, the sample was 54.55 years of age on average, and a majority of participants were married(78.8%) and had an education of high school completion or lower(83.75%). Within the arthritis group, 40% had been diagnosed with OA and 60%had RA. The mean duration of arthritis was 6.40 years.Analyses of between groups differences indicated that the two samples did not differ on any of the basic demographic measures. On self-report measures, the arthritis group and non-arthritis group reported no differences on either PA measure, most self-reported sleep indices, or SF-12 mental health adjustment. However, the arthritis sample reported a slower sleep onset, less alertness while awake, and poorer overall functioning on the SF-12 physical health adjustment subscale. In contrast to the complete absence of group differences in self-reported PA, the arthritis sample was unambiguously and significantly less physical active on most SWA parameters(i.e.,less vigorous activity, shorter physical activity duration, lower active energy expenditure, less overall PA level, fewer steps, more sedentary activity), and had marginally lower levels of light and moderate activity as well. SWA sleep data also indicated arthritis patients had comparatively more waking periods during sleep and lower overall sleep efficiency compared to controls.A mediation analysis was performed to evaluate the extent to which the highly significant group difference in overall physical adjustment might be explained by group differences on objectively-measured physical activity and sleep. The analysis indicated that, after controlling for the impact of significant SWA physical activity and sleepindices, the difference in overall reported physical functioning between arthritis and comparison samples was substantially attenuated compared to the initial value but remained highly significant. As such, the group difference in overall reported physical adjustment were partially explained by objective PA and sleep indicators.In sum, findings from Study 2 underscored how objective measures of PA and sleep are far more sensitive than self-report responses in identifying differences between people with arthritis and demographically-similar non-arthritic controls.Furthermore, SWA indices had at least some utility in explaining why people with arthritis experienced a significantly lower level of overall physical adjustment than non-arthritic controls while responses on self-report PA measures had no such value.Consequently, whenever possible, researchers evaluating samples with ongoing pain conditions should incorporate objective measures of physical activity and sleep within assessment protocols to facilitate accuracy in the measurement of activity levels.Together, the studies indicate that assessment of both cognitive factors such as beliefs about pain, and subjective self-reports and objectively-measured physical activity have potential utility in understanding adjustment in OA and RA groups. |
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