Chronic fatigue syndrome Is a syndrome of unknown etiology and pathophysiology characterized by severe, chronic, debilitating fatigue as main symptom and numerous additional symptoms such as joint and muscle pain, headache, sleep disturbance. According to recent researches, it was suggested that chronic fatigue syndrome was developed by disturbance of interaction between neuropsychiatric system and immune system due to environmental factors and stress. Many patients experience gradual improvement but complete recovery from disorderd state is rare. There was no research elucidating the exact pathogenetic mechanism of chronic fatigue syndrome, so there was no established treatment. Several controlled studies about treatment was reported, but its results was not effective in all patients with chronic fatigue syndrome. For chronic fatigue syndrome, a comprehensive approach to physical, psychological, and social aspects is needed.

This study was undertaken to explore the antecedent factors and process of the treatment-seeking behaviors of medical and alternative treatments in patients with arthritis using methodological triangulation. The data were collected from 995 arthritic patients who were registered either in a center of rheumatology for medical treatment or residents of community having no treatment to classify different treatment patterns. Sixteen patients with various types of treatment only, alternative treatment only, and no treatment were selected among the total samples to identify the antecedent factors through in-depth interview. The quantitative data were analyzed by percentile, t-test, chi-square test and discrimant analysis using SAS PC program, while the qualitative data were analyzed by means of grounded theory methodology. Treatment-seeking behaviors of patients change from the early stage to the sick-role stage. At the early stage, initial characteristics of pain and acculturation of medical professionalism affect the choice of treatment patterns. The acculturation of medical professionalism is affected by health care accessibility, level of education, duration of sickness and lay referral system. At the sick-role stage, lay referral system and acculturation of medical professionalism affect the choice of treatment patterns. The acculturation of medical professionalism is affected by characteristics of symtoms, perceived treatment effects, perceived causes of diseases and socio-economic status as well as health care accessibility, level of education and lay referral system. In conclusion, different factors as well as common factors are influencing the treatment-seeking behaviors depending on the disease and treatment stages. More detailed further studies are required to explore the value system or medical acculturation of patients which is one of the most important factors in decision-making about treatment modalities.

The lack of a comprehensive theory describing the mechanism of adaptation scientifically has been one of the limiting factors for the development of nursing intervention of patients with chronic illness. Since Roy's theory provides the general conceptual framework depicting adaptation process with structural stimuli and control mechanism, it is appropriate to understand the process of adaptation. But in Roy's theory, the propositions about cognator and regulator as control mechanisms are not clearly defined. For this reason, most of the previous researches applying the Roy's theory have disregarded the study of cognator and regulator. For the patients with chronic illness such as rheumatoid arthritis, it was reported that adaptation states were different for the same stimuli due to the difference of the control mechanism. Moreover in nursing it is important to identify the control mechanism which can be and must be intervened by nurses. It was the Lazarus and Folkman's theory that proposed the control mechanism. They suggested that individual differences in the reaction against the perceived stress are due to the difference in appraisal and coping. Therefore, the synthesis of Roy's and Lazarus and Folkman's propositions might help to clearly understand the mechanism of adaptation. From this point, a theoretical framework has been developed and tested. The subjects were the 297 patients who had been diagnosed rheumatoid arthritis and attended the outpatient clinic. A hypothetical prediction model of adaptation was tested by the covariance structure analysis with PC-LISREL 7.13. As a result, the overall fit was good($x^2$=78.83, p=0.00 ; GFI=0.96 : AGFI=0.90 ; RMR=0.04) for the hypothetical model. In the final model added GA(5, 1), the overall fit was increased ($x^2$=57.82, p=0.003 ; GFI=0.97 ; AGFI=0.93 : RMR=0.036). Except the fact that illness symptoms affected physical adaptation directly, it was supported that focal and contextual stimuli affected physical and psychosocial adaptation through appraisal and coping. Therefore, it was asserted that the synthesis of two theory's propositions was appropriate. So this model would be useful for the theoretical framework in the nursing practice. And this study synthesizing and testing the theory might contribute to establish nursing's scientific base.

In an attempt to measure effects of the Programmed Resistance Exercise on the daily performance of patients with rheumatoid arthritis, a quasi-experiment ; non-synchronised control group pre-post-test, was carried out for 8 weeks : from June 3 to November 29, 1996. 25 for the experimental group and 26 for the control group were conveniently sampled among registered out-patients on rheumatoid arthritis clinic of Anam Hospital, Korea University Medical Center. The programmed experimental resistance exercises were carried out by the experimental group five times a week for eight weeks. Before and after experiments, level of functional task performance, functional disability, joint mobility, ESR, CRP, self-efficacy and family support were measured and statistically analysed. The results of the analysis of the effects on the Programmed Resistance Exercise are as follows : 1. A statistically significant post-test effects on functional task performance were revealed : 1) the experimental group climbed up and down the 10 steps of the stairs significantly faster than the control group(P=0.0001). 2) the experimental group walked 100 m significantly faster than the control group (P=0.0000). 3) After the experiment, the experimental group could sit down and get up from chairs with no armrest as low as 30cm, 40cm, 50cm on their on, with no assistance as opposed to the control group who could not sit down and get up from such low chairs (P=0.0084). 4) the experimental group lifted 0-15 kg object up to their own heights with no specific strain than the control group (P=0.0000). 2. A significant reduction in the functional disabilities was revealed in the experimental group(P=0.0017). 3. A notable incresement of the joint mobility was revealed in the experimental group. 4. A decrease in the ESR in both the experimental and the control groups was noticed, however, the difference was not statistically significant (P=0.9546). 5. The CRP of both the experimental and control groups decreased with no significant difference (P=0.6022). 6. The self-efficacy increased significantly in the experimental group(P=0.0042), however, no significant effect of self-efficacy on the actual practice of the program was noticed. 7. The family support revealed to be significantly higher in the experimental group (P=0.0013), however, the effect of the family support on actual practice of the program revealed not significant. Judging from the results of these experiments, the resistance exercise program not only improves the functional capacity of rheumatoid arthritis, but also diminishes their functional disabilities and has a great influence on increasing their joint mobility, self-efficacy, and family support. Concluding, in promoting the daily performance of rheumatoid arthritis, the resistance exercise program would be an appropriate nursing intervention.

This study was conducted to identify the characteristics of uncertainty in patients having rheumatoid arthritis. Subjects of the study constituted 528 patients who visited outpatient clinics of two university hospitals and one general hospital in Seoul. A self report questionnaire was used to measure the uncertainty. Reliability coefficients of this instrument was found Cronbach's ${\alpha}=.84$. In data analysis, SPSS PC 6.0 computer program was utilized for descriptive statistics and factor analysis. Three factors were appointed on the basis of literature review for the principal component factor analysis method and Varimax Orthogonal Rotation. The results of factor analysis were as follows ; 1) Three factors for uncertainty were identified through the principal component analysis and varimax rotation, and these contributed 37.4% of the valiance in the total score. Twenty six items among the whole items in the scale loaded above .39 on one of 3 factors. 2) The naming of each factor was as follows : Factor 1 was 'ambiguity' and has 12 items, factor 2 was 'lack of information' and has 8 items, factor 3 was 'unpredictability' and has 7 items. 3) Cronbach's alpha for internal consistency was .84 for the total items and .81, .80, .50 for each of three subscales in that order.

The purpose of this study was to explore the effect of short term selp-help education on pain, depression, self-efficacy, and quality of life in patients having chronic arthritis. This program was carried out 3 hrs per week for 4 weeks by 3 small groups among 10 patients. Research design was a quasi-experimental study of nonequivalent control group pretest-posttest design. The subject of this study were 10 of experimental group and 10 of control group. Before and after 4 weeks program, quality of life, self-efficacy, depression, pain, ADL were measured. As a result, it was confirmed the self-help education was effective to increase quality of life, but self-efficacy, depression, pain, ADL were not improved. This suggests the replicate study to examine the effect of self-help education with the large samples of subjects having chronic arthritis.

The purposes of this study are 1) to modify a self-help program for patients having fibromyalgia, 2) to revise instruments to measure the self-efficacy and impact of fibromyalgia; and 3) to test the effects of the program in terms of self-efficacy, physical activities, and clinical symptoms. The subjects of this study were persons diagnosed as fibromyalgia at a university hospital. For the first two purposes, six patients were selected. Twenty three subjects for the third purpose were selected and assigned to experimental and control group on the base of their residence. Thirteen were assigned to the experimental group, while 10 to the control group. Instruments selected for revision were self-efficacy scale and fibromyalgia impact profile. On the basis of the text developed by Arthritis Foundation, a program for patients with fibromyalgia was tentatively developed. Instruments for measurement of self-efficacy and impact of fibromyalgia were revised to show high reliabilities. Results obtained by utilization of the program were as follows : 1) There were no increase of self-efficacy and physical activities. 2) There were no improvement of the number of tender points and pain. 3) There were improvement of depression, fatigue and sleep impairment. These findings indicate the needs for modification of the program with emphasis of exercise for relaxation of tender points, increases of enactive action and vicarious learning.

This study was conducted to investigate the influencing factors on the appraisal of uncertainty in patients having rheumatoid arthritis. Subjects of the study constituted 528 patients who visited outpatient clinics of two university hospitals and one general hospital in Seoul. Self report questionnaires were used to measure the variables influencing the appraisal of uncertainty. Reliability coefficients of these instruments were found Cronbach's Alpha=$.70{\sim}.96$. In data analysis, SPSS PC 6.0 program was utilized for descriptive statistics, Pearson's correlation, logistic and multiple regression analysis. The results of logistic and multiple regression analysis were as follows 1) Among the independent variables, significant factors to explain the appraisal of uncertainty in patients were uncertainty(p<.001), severity of illness(p<.05), educational level (p<.05) and age (p<.05). 2) When patients appraised uncertainty as "Danger", significant factors to explain the appraisal of uncertainty were uncertainty(p<.0001), age(p<.0005), severity of illness(p<.001), educational level (p<.05). 3) When patients appraised uncertainty as "Opportunity", significant factors to predict the appraisal of uncertainty were uncertainty(p<.0005), social support(p<.0005), severity of illness(p<.005), credible authority(p<.05), age(p<.05) and educational level (p<.05).