| ObjectiveFirst,this study aimed to culturally adapt and test the psychometric properties of the Chinese version of the eight-item Arthritis Self-Efficacy Scale(ASES-8)among patients with rheumatoid arthritis(RA).Second,to verified the reliability and validity of the Bristol Rheumatoid Arthritis Fatigue scales(BRAFs).Then,to investigate fatigue in RA patients and explore indicators which influence fatigue.Methods1.We achieved the Chinese version of ASES-8 after a forward-back-translation procedure.Validation survey was then carried out in Tianjin Medical University General Hospital,which is the largest comprehensive medical center in Tianjin from November to December 2015.A convenience sample of 109 patients with RA was recruited from department of rheumatology.Patients' demographic information and disease characteristics were collected by a set of questionnaires,including socio-demographic questionnaire,pain-Visual Analog Scale(VAS),the Chinese version of ASES-8,the physical functioning(PF)subscale of Short Form 36-Item Health Survey(SF-36),the Functional Assessment of Chronic Illness TherapyFatigue(FACIT-F),and the Hospital Anxiety AND Depression Scale(HADS).Validity was assessed by exploratory factor analysis(CFA)and Pearson's correlation analysis.Reliability was assessed using the Cronbach's alpha and intraclass correlation coefficient(ICC).2.A cross-sectional study was conducted in Tianjin Medical University between November 2015 to March 2016,208 RA patients were enrolled using convenience sampling.A set of questionnaires comprised socio-demographic questionnaire,pain-VAS,SF-36 PF,FACIT-F,HADS,and Chinese version of BRAFs(BRAF-MDQ & BRAF-NRS)were used to collect data.The construct validity of BRAF-MDQ was assessed by confirmatory factor analysis(CFA),and criterion validity was tested by calculating the Spearman's correlation coefficient between pain-VAS,FACIT-F,SF-36 PF and HADS.Internal consistency of the scale was tested by Cronbach's alpha coefficient,test-retest reliability was examined by calculating the ICC.The validity of BRAF-NRS was assessed by Spearman's correlation analysis,and test-retest reliability was assessed by ICC.3.The study sample included 243 RA patients selected by a convenience sampling method from Tianjin Medical University General Hospital between April to October 2016.Each participant was asked to administer a set of questionnaires consisting of a socio-demographic questionnaire,pain-VAS,SF-36 PF,ASES-8,HADS,BRAF-MDQ,the Pittsburgh Sleep Quality Index(PSQI)and the Perceived Social Support Scale(PSSS).Using univariate analysis to compare the fatigue in different groups and the spearman's correlation coefficient with the continuous variables.Multiple linear regression analysis was used to test the association between fatigue and each of the independent variables.Results1.EFA extracted one dimension that explained of the 70.66% variation.Factor loadings for each item were above 0.730.Significant positive correlations were found between the ASES-8 and SF-36 PF,FACIT-F scores,while negative correlations were found between the ASES-8 and HADS-D,HADS-A,pain-VAS scores.Excellent internal consistency(Cronbach's alpha = 0.939)and test-retest reliability(ICC = 0.986)were demonstrated.2.CFA verified that the BRAF-MDQ was organized into four factors,and the fit of the 4-factor model was acceptable according to the ?2/df(2.88),NFI(0.91),TLI(0.92),CFI(0.94),IFI(0.94),RMSEA(0.095)fit indices.Standardized factor loadings for each item were above 0.652.The Chinese BRAF-MDQ,its subscales and the BRAF-NRS Severity and Effect showed significant correlations with FACIT-F(-0.786 ~-0.906),SF-36 PF(-0.400 ~-0.629),HADS-A(0.551 ~ 0.610),HADS-D(0.461 ~ 0.563)and pain-VAS(0.401 ~ 0.550).The BRAF-NRS Coping had lower correlations with those scales.The BRAF-MDQ showed a good internal consistency(Cronbach's alpha = 0.958)and individual Cronbach's alpha of four subscales,i.e.physical fatigue,living with fatigue,cognition fatigue,and emotional fatigue,was 0.881,0.967,0.937 and 0.913,respectively.The ICC of the BRAF-MDQ was 0.965,and 0.971 for physical domain,0.946 for living domain,0.939 for cognition domain,0.952 for emotional domain.Except the BRAF-NRS Coping,the correlations between BRAF-NRS and the four subscales of BRAF-MDQ were good,which showed a good internal consistency.The ICC of the BRAF-NRS Severity,Effect and Coping item was 0.974,0.982 and 0.988,respectively.3.The score of BRAF-MDQ was(28.25±16.37).In the univariate analysis,fatigue was significantly associated with different education level,residence condition,exercise habit,disease duration,morning stiffness,joint function,CRP and DAS28(P < 0.05).Bivariate correlation analysis revealed that BRAF-MDQ was associated with pain-VAS,HADS-A,HADS-D,PSQI,SF-36 PH,ASES-8 and PSSS(P < 0.01).Multiple linear regression analysis indicated that self-efficacy(? =-0.239),physical function(? =-0.212),pain(? = 0.206),depression(? = 0.171),morning stiffness(? = 0.151)and anxiety(? = 0.150)were significant influencing factors of fatigue which explained 59.5% of the variance.Conclusions1.The Chinese version of the ASES-8 had statistically acceptable levels of reliability and validity for assessing self-efficacy in patients with RA.This disease-specific scale has concise items and easy to be understood which is particularly valuable for use among patients with RA from the Chinese population.2.The Chinese version of the BRAFs are reliable and valid instruments for measuring fatigue of patients with RA.The CFA showed that the subscales of BRAF-MDQ can adequately reflect the measured traits.The scales can be used to explain the influence of fatigue as a multi-dimensional evaluation index on the daily life of RA patients,which is helpful for clinical assessment and intervention.3.The fatigue was in the medium level among Chinese patients with RA.Self-efficacy,physical function,pain,morning stiffness,depression,and anxiety are the main influencing factors of fatigue.Therefore,doctors and nurses should be aware of the fatigue problem in RA patients and take effective measures to improve the self-efficacy of them,help them for disease self-management,so as to relieve the fatigue level,improve the physical function and quality of life. |
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