Participation in work in early rheumatoid arthritis: a qualitative interview study interpreted in terms of the ICF

Abstract

Purpose. To explore what work related dilemmas are experienced by patients with early rheumatoid arthritis (RA), according to their own descriptions, and to interpret this in terms of participation categories of the International Classification of Functioning, Disability and Health (ICF).Method. In 48 patients with early RA, qualitative interviews were analyzed, followed by linking of concepts to the activity/participation component of the ICF and interpretation of general themes.Results. Work related dilemmas represented different societal perspectives on work related to acquiring, keeping, and terminating a job, self-employment, part-time, full-time, and nonremunerative employment. Dilemmas also represented participation priorities in economic self-sufficiency, self-care such as health care, and avoiding social relationships and recreation in favour of work. Leisure time was influenced because efforts of working took energy and time of day-to-day procedures. Embedded actions in work related dilemmas were carrying out daily routine, mobility including using transportation, self-care, domestic life, and social interaction. Conclusion.The general themes societal perspectives, participation priorities and embedded actions, with the included ICF categories that are described in detail according to the experiences of the patients, can support clinical reasoning and research on quantitative relations to disease activity, body functions, ability and contextual factors.

Emotions related to participation restrictions as experienced by patients with early rheumatoid arthritis: a qualitative interview study (the Swedish TIRA project)

“…The CIT is a semi-qualitative method of collecting data that has been used in several studies [22][23][24][25][26], as is content analysis [29]. Moreover, the analysis was made in cooperation with several researchers in identifying emotions and dilemmas, and classifying the dilemmas with respect to ICF codes.…”

“…CIT has been applied in research on patients with different medical conditions [22][23][24], and in research on emotional experiences [25] and emotional work [26] in patients and professionals. Data were collected through semi-structured individual face-to-face interviews.…”

“…Participants for this study were recruited from the 522 patients that were included in the second cohort (TIRA-2) of the prospective multi-centre early arthritis project with the Swedish acronym TIRA [5,22] during 2006-2009. At inclusion, at 3, 6 and 12 months after inclusion in the TIRA study, and thereafter yearly, information concerning disease activity, disability, genetics, and on going disease modifying anti-rheumatic drugs were recorded.…”

“…In critical incident studies, information on dilemmas, consequences, and strategies for handling situations are usually collected. RA patient-experienced dilemmas have previously been described in relation to work [22]. However, emotions corresponding to RArelated participation restrictions have not yet been described.…”

Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project)

“…Though it is known that even basic daily activities are affected in today´s patients with early RA [3] and that more complex aspects, so-called valued life activities, are important for the psychological well-being of populations with long term RA [12], there is a clinical need to explore the patterns of disability in more detail in order to support the early intervention strategy of today [13]. One problem is that studies on these issues refer to quite different underlying theories and terminologies.…”