PURPOSE:To synthesize published qualitative studies concerning the lived experience of rheumatoid arthritis (RA). To compare the conceptual features of qualitative studies covering two different time periods. METHODS:In 2002, 24 items published 1975-2001 were identified in comprehensive literature searches and assessed by multiple reviewers. In 2010, the first author found 28 articles published 2002-2009 in a simple search of the Medline database and synthesized them alone. Articles were synthesized using meta-ethnography. RESULTS:Both syntheses found that the main symptoms of RA are variable and unpredictable. However, in the first synthesis a sociological model dominated where RA was seen as an assault on self-identity with devastating social consequences. The main concepts were biographical disruption, role incompetence and the dread of dependency on others. In the second synthesis, the findings produced a model for health care practitioners tied to perceptions of control and incorporating a career-adaptation model of the experience of RA. CONCLUSIONS:We recommend that future synthesizers and primary qualitative health researchers focus more on non-hospital based populations and non-English language articles or study participants. The implications for rehabilitation follow from reflecting the findings of the synthesis against existing psychological models of coping and adaptation in RA. Implications for Rehabilitation Coping and adaptation are biographical processes, although the relative importance of active "disease mastery" versus more passive "getting used to it" is unclear. The uncertainty and fluctuating nature of symptoms and disease course presents existential challenges for people with RA in relation to maintaining physical functioning and social roles. Within a social model of disability, these findings point to potential intervention sites in society and relationships that would benefit people living with RA.

译文

目的:综合有关风湿性关节炎(RA)生活经验的已发表的定性研究。比较涵盖两个不同时间段的定性研究的概念特征。
方法:在2002年,通过全面的文献检索确定了1975-2001年发表的24项内容,并由多位审阅者进行了评估。在2010年,第一作者在Medline数据库的简单搜索中找到了2002-2009年发表的28篇文章,并单独对其进行了合成。使用元民族志对文章进行了综合。
结果:两种合成方法均发现RA的主要症状多变且不可预测。但是,在第一个综合中,社会学模型占主导地位,其中RA被视为对自我认同的攻击,具有毁灭性的社会后果。主要概念是个人传记的破坏,角色的无能和对他人依赖的恐惧。在第二个综合报告中,研究结果为卫生保健从业人员提供了一个模型,该模型与对控制的认识联系在一起,并纳入了RA经历的职业适应模型。
结论:我们建议未来的合成器和主要的定性健康研究人员更多地关注非医院人群和非英语文章或研究参与者。康复的意义是通过反映针对RA中现有的应对和适应心理模型的综合发现得出的。康复应对和适应的含义是传记过程,尽管尚不清楚主动“掌握疾病”相对于更被动“习惯”的相对重要性。症状和疾病进程的不确定性和波动性质为RA患者在维持身体机能和社会角色方面提出了生存挑战。在残疾的社会模型中,这些发现指出了可能有益于RA患者的社会和关系中潜在的干预场所。

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