Difficulty and Accommodations with Relevant Recreational Activity are Associated with Physical Function, Pain, and Fatigue in Adults with Rheumatoid Arthritis

Author: Sarah Novroski, SPT
Advisor: Louise Thoma, PT, DPT, PhD
Committee Members: Chris Lane, PT, PT and Joshua Torrey, PT, DPT

 

Background

During my 3rd year in UNC’s DPT program, I had the desire to further explore the world of research as I felt it is an important way to progress the field of physical therapy (PT) and would also make me a better clinician. In Fall 2022 I had the opportunity to participate in a research elective with Dr. Thoma on research regarding patients with rheumatoid arthritis (RA). Throughout this time, I have learned about the disease progression of RA, the benefits physical activity can provide to this population as well as how uncommon it is for patients to use PT solely due to RA symptoms. Due to this gain of knowledge, I have developed an interest in the RA population and believe there is a strong need for PTs to be educated on the benefits of being active and ways to treat this population. Since working with Dr. Thoma I have received a preceptorship through the American College of Rheumatology which has allowed me to attend a rheumatology conference and continue to expand my knowledge in the realm of RA. By completing my Capstone and focusing on the RA population, I have been able to become more of an expert on this unique population and can apply this information in the clinical setting.

 

Statement of Need

Rheumatoid arthritis (RA) is a chronic autoimmune and inflammatory disease that attacks multiple systems within the body and leads to individuals experiencing fatigue, pain, and joint stiffness among other symptoms. These symptoms can lead to limitations in recreational activities which are considered a type of physical activity that are done for personal enjoyment during leisure time³. Minimal research has been done to understand recreational activity participation in adults with RA however, participating can provide a sense of normalcy to the individual and lead to an overall improvement in quality of life and function⁴. The difficulty and use of accommodations to complete tasks are also important components of recreational activity assessment as identifying these variables could provide key information in indicating early signs of disability.

 

Purpose

The purpose of my Capstone Project was to address the needs mentioned above. The purpose of my manuscript was to first describe the distribution of the relevance, difficulty, and accommodation for recreational activities and identify the recreational item that is most relevant and difficult to the population. The second purpose was to examine the association of the Short-Valued Life Activities Questionnaire (SVLA) recreational activity response that was the most relevant and difficult with physical function, fatigue, and pain. Lastly, the purpose of my handout was to provide a basic education to patients with RA on the benefits of physical activity.

 

Products

The main portion of my Capstone, the manuscript, is attached below.

Manuscript

 

As part of the health literacy portion of my Capstone, attached below is my handout on physical activity which was intended for patients with RA.

PA and RA Handout

 

Evaluation and Self Reflection

Overall, I feel that my Capstone project went well and I was able to complete my goals and objectives. I learned a lot during this time as coming into the project I honestly was very uncertain what was required in order to write a manuscript. I felt at times not sure what I was doing, however once I figured out a step I felt extremely accomplished. Dr. Thoma was an amazing guide for me throughout the journey and was there whenever I had questions or needed a meeting to discuss my next steps or provide feedback. The entire process taught me to be flexible, as sometimes things were not able to be completed on the expected timeline and some of my initial focuses for the manuscript needed to be slightly shifted. However, I enjoyed the fluidity of the project and seeing it all come together in the end. I feel I have really progressed in my scientific writing skills since the beginning of the semester and that I will continue to hone my skills as I edit my manuscript. In the future I plan to submit my research to various conferences and work towards publishing my manuscript.

 

For the evaluation of my project, I relied on multiple rounds of feedback from my committee. Dr. Thoma and I had almost weekly meetings to discuss progress of my project which allowed me to stop and evaluate to better understand what my next steps were. My committee provided crucial feedback on the best way to enhance readability and flow of my manuscript as well as any important content that could better support my arguments. My committee was extremely helpful and played a key role in guiding my manuscript.

 

Acknowledgements

To Louise Thoma, PT, DPT, PhD: Thank you for being my primary advisor and preceptor. I am extremely grateful for all the feedback and guidance you have provided me throughout the project and year. Your expertise in research has shaped my manuscript and has provided me with an invaluable research experience.

To Chris Lane, PT, DPT: Thank you for agreeing to be on my Capstone committee and volunteering your time and all your feedback. I have appreciated getting to work with you in lab meetings and wish you the best of luck as you complete your PhD.

To Joshua Torrey, PT, DPT: I appreciate you volunteering your time to help me with my Capstone. I am very grateful for the feedback and input you have provided me throughout the semester.

 

References

1. Rheumatoid Arthritis 2021 December 2021; Available from: https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Rheumatoid-Arthritis.
2. Thomas, R., et al., Keeping physically active with rheumatoid arthritis: semi-structured interviews to explore patient perspectives, experiences and strategies. Physiotherapy, 2019. 105(3): p. 378-384.
3. Ball, J.W., M.R. Bice, and T. Parry, Adults’ Motivation for Physical Activity: Differentiating Motives for Exercise, Sport, and Recreation. Recreational Sports Journal, 2014. 38(2): p. 130-142.
4. Piva, S.R., G.J. Almeida, and M.C. Wasko, Association of physical function and physical activity in women with rheumatoid arthritis. Arthritis Care Res (Hoboken), 2010. 62(8): p. 1144-51.
5. Liu, X., et al., Long-Term Physical Activity and Subsequent Risk for Rheumatoid Arthritis Among Women: A Prospective Cohort Study. Arthritis Rheumatol, 2019. 71(9): p. 1460-1471.
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13. Fried, L.P., et al., Preclinical mobility disability predicts incident mobility disability in older women. J Gerontol A Biol Sci Med Sci, 2000. 55(1): p. M43-52.
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16. Henry, T.A. Why 41% of patients have skipped care during COVID-19 pandemic. 2021; Available from: https://www.ama-assn.org/delivering-care/public-health/why-41-patients-have-skipped-care-during-covid-19-pandemic.