The purpose of this study was to identify influencing factors adherence and dropout of aquatic exercise in patients who had been diagnosed chronic arthritis. Subjects were 54 patients with rheumatoid arthritis and osteoarthritis who had participated in the 6-week aquatic exercise program in Taejon metropolitan city. Data was collected from march 25 to April 25, 1999 through face to face and telephone interview. Result are as follows. Fourteen subjects(26.0%) were adherer who was keeping aquatic exercise. The reasons of aquatic exercise adherence were improvements of physical and affectional factors. And the major reasons of dropout was an environment factors(65.8%) and second reasons was physical factors(34.2%). Participants of friends(r=.34, p=.014) was significantly associated with the total duration of an aquatic exercise adherence. For these results, the nurse who care to patients with arthritis have to encourage to maintain aquatic exercise within six month after they begin aquatic exercise.

Muscle stiffness, pain and discomfort in dally activities are cardinal symtoms on arthritis. To reduce these symtoms, a nonequivalent one-group pre & posttest experiment was carried out at a rural community health post area in Chonbuk province during eight weeks (from 25th of January to 20th of March, 1999). The subjects were sixteen rural old women(65-89yrs) with osteoarthritis. And to reduce the level of pain, discomfort in daily living and to increase that of life satisfaction, 30 minutes of flexibility exercise followed by $15{\sim}20\;minutes$ of local heat therapy were done three times a week. Pain scale from Arthritis Impact Measurement Scales developed by Meenan(1980) for pain, Jette's Daily Activity Discomfort Scales revised by Lee(1988) for discomfort and Life Satisfaction Scales developed by Youn(1982) for life satisfaction were used as research instruments. The data were collected by face-to-face interviews with Investigator and the experiments were done under demonstration and supervision of investigator in community health post. The data were analyzed in percentage and Wilcoxon sign rank sum test by SPSS/PC+ program. The result could be summarized as follows ; 1. The scores of experiment group who were applied hot bag followed by flexibility exercise were tended to be significant lower in the level of pain statistically(Z=4.949, P=0.0001). 2. The scores of experiment group who was applied hot bag followed by flexibility exercise were tended to be significant lower in the level of discomfort in daily living statistically(Z=2.7226, P=0.0279). 3. The scores of experiment group who was applied hot bag followed by flexibility exercise were tended to be higher in the level of life satisfaction, but there was no significant statistical difference(Z=-1.2087, P=0.2171). In conclusion, flexibility exercise with local heat therapy could be identified as an effective therapy to reduce pain and discomfort in daily living of the rural elderly with osteoarthritis. And as a community health practitioner, the investigator concluded that this exercise with local heat therapy could be developed as a health promotion program for the rural aged people.

This descriptive correlational study was carried to identify the relationship among social support, compliance, and psychosocial adjustment of patients with rheumatoid arthritis. The study was done with 100 rheumatoid arthritic patients who were visited in Outpatient clinic of university hospital in Taegu, Korea from the 23rd of February to the 20th of March in 1998. The Data were collected through person to person interviews which were performed by five researchers. The instruments used for this study were Yu's social support scale(1996), Cho's compliance scale(1987), and Kim's psychosocial adjustment scale(1997). The data was analyzed by using a t-test, Pearson correlation coefficient, ANOVA, and Tukey test with the SAS Program. The results of this study were as follows ; 1. The mean score of social support was 2.76 for 4 full marks, compliance was 3.20 for 5 full marks, and psychosocial adjustment was 2.26 for 4 full marks. 2. Hypothesis 1 : "The higher the social support degree, the higher the compliance degree of the rheumatoid arthritis patient". It was supported(r=0.54, p<0.001). Hypothesis 2 : "The higher the compliance degree, the higher the psychosocial adjustment degree of the rheumatoid arthritis patient". It was supported(r=0.34, p<0.001). Hypothesis 3 : "The higher the social support degree, the higher the psychosocial adjustment degree of the rheumatoid arthritis patient". It was supported(r=0.24, p<0.05). 3. In general, the spouse group compared to other groups was demonstrated as the most dependable group for patients to trust and expect support. And the sons and daughters group was shown higher than other groups in terms of social support(F=4.19, p=0.01). There was no difference in terms of compliance in degree. In the degree of psychosocial adjustment the highly educated group(more than high school) is a little higher than the lowly educated group(F=3.08, p=0.03). In the costs of medical care, the group that could afford was significant higher than the group which could not afford results in terms of the psychosocial adjustment degree(F=3.99, p=0.01). The outcome of this study is that the social support that related rheumatoid arthritic patients had an effect on the following compliance, and the following compliance helps psychosocial adjustment of patients. It also shows that social support related psychosocial adjustment. Therefore, to increase the level of psychosocial adjustment of rheumatoid arthritic patients, it will be effective in supportive nursing intervention to improve social support and compliance.

This study was undertaken to find out the causal perception of rheumatoid arthritis patients, and to understand the typology. The Q-population consisted of 236 statements of causal perception were collected. Thirty eight Q-samples of causal perception were selected. The P-sample for this study were made up of 28 first visiting female rheumatoid arthritis patients from a rheumatoid arthritis specialty hospital. Each respondent responded Q-set of causal perception according to 9-point scale. The result of Q-sorting were coded and analyzed using QUANL PC program. 1) Typological Observation on Causal Perception (1) Physical Fatigue Type : Type 1 perceived that the illness occurred due to excessive work requiring physical labor or strain that had occurred from not resting after excessive physical labor, therefore, thinking the origin of the illness was from physical strain. (2) Physical origin Type : Type 2 perceived that the major cause for the illness is not only excessive physical labour but also fecundity and old age. (3) Causality to Environment Type : Type 3 perceived that rheumatoid arthritis occurred from injury to the joints or bad and humid weather. (4) Conscience of Guilty Type : Type 4 consisted of people with guilty conscience for lack of religious commitment. They perceived that the illness was a punishment from God for not praying or because of bad luck. (5) Rationally Perceiving Type : People who belong in type 5 perceived the cause of illness in light of scientific facts such as genetics, unbalanced diet or lack of exercise. (6) Psychological Stress Type : People who belong in type 6 believed that excessive stress was the cause of the illness. 2) Emotions of Rheumatoid arthritis patients Rheumatoid arthritis patients' positive emotions included determination, courage, coping, acceptance, hope, and adoption ; and their negative emotions were prostration, worry, stupor, conflicts, grievance, giving-up, resignation, depression, loss, solitariness, fear, anxiety, avoidance, anger and loneliness. Rheumatoid arthritis patients experience different level of emotions from their suffering experience from the severe pains. Rheumatoid arthritis patients also experience negative emotions when they could not perform self-care and lose their self-esteem from painful suffering ; however, they regain positive emotions when they recover from pain with the use of drugs, physical therapy or exercise. Their emotional states are closely connected to level of and presence of pain.

The purpose of this study was to explore self management of pain by folk remedies in patient with chronic arthritis. The participant of this study were 90 volunteers who were visit C hospital and who want to counsel with researcher for their pain control by convenient sampling method. The results of this study were summarized as follows : The subjects were the 90 patients who had been diagnosed rehumatoid arthritis(52.5%)and osteoarthritis(47.8). 93.3% of participants were women. Mean age of participants was 53.7 and duration of arthritis was 7 years. Mean pain score was 5.5cm. Eighty five kinds of folk remedies were used for pain management. The mean cost for folk remedies was 3,723,207 won and the patients with rheumatoid arthritis paid to folk remedies as much as 3 times. The perceived effect score of pain management by folk remedies was 2.932(the range of perceived effect score were 0-10cm). Percentage of discontinue to use folk remedies was 82.8% and the major reason of discontinue to use folk remedies was no effect to pain control(50.4%). Some participants(30.5%) were experienced side effect such as exacerbation of pain(50.5%). In conculusion, chronic arthritis patients have been experienced various kind of folk remedies for the management of their pain. But the effect of pain control was very low. The important weakness of folk remedies were economical waste and loss of opportunity to treatment for arthritis. The nurse who care for arthritis should be teach about weakness of folk remedies for their pain control to the patients with arthritis.

Patients with chronic disease have various treatment patterns because it shows a progressive degenerative feature. Especially various physical and emotional problems of the rheumatoid arthritis patients leave them shopping around various types of treatment. According to previous studies, over 70% of patients with arthritis experienced the traditional oriental medicine or folk remedies simultaneously with medical treatment within one year after the onset of disease. The purposes of this study are 1) to compare the patterns of treatment-seeking behaviors between Korean arthritis patients and Americans ; and 2) test two models of treatment-seeking behaviors by path analysis, one for early treatment-seeking behavior model(ETBM) and the other is chronic treatment-seeking behavior model (CTBM) in Korean sample. The interview survey was performed to 133 RA patients with structured questionnaire at out-patient clinic or public health center. Patients characteristics such as age, duration of disease were similar in two countries except higher educational background in Americans. There were no patients using only alternative therapies or no medical treatment in the US. Most of the American patients have chosen both medical treatment and alternative therapy, while the Koreans less than American. In Korea, combined treatment group usually consists of the people who are younger, more educated and higher economic status than the characters of other groups in early or chronic stages. In early stage, they tend to have strong belief of curing from the disease, satisfy the relationship with their physicians and comply with direction of the medical professional. The paths of two models were explained by 70% in ETBM and 33% in CTBM. When the models were modified, almost all paths of the CTBM were the same as the previous one, but direct determinant factor was changed from the relationship with physicians to the lay referral system in chronic model. These two models' explanation powers became 94% and 88%, respectively. The attitude or perception of disease, lay referral system and the relationship with medical personnel are the main determinants of treatment-seeking behaviors.

The PACE (People nth Arthritis Can Exercise) is an exercise program developed by the Arthritis Foundation to improve muscle strength and joint flexibility for patients with arthritis. The purpose of this study was to explore the effects of PACE program on self-efficacy, pain, and joint function in the Korean immigrant elderly. The PACE program was held twice a week for 6 weeks for Korean immigrant elderly who had osteoarthritis. Twenty four subjects completed the program, who were recruited in two places : 10 elderly in a senior residential apartment, and 14 elderly in a senior center supported by Congregated Meal Program for Korean Elderly. Self-efficacy(Sherer et al., 1982), pain severity(by using Visual Analogue Scale), and number of painful joints were measured before and after the PACE program. To examine the joint flexibility and strengthening, the followings were measured : the extent of the upward arm reach in both sides(flexibility of shoulder), the ability to touch fingertips of the both hands in back pat and rub(flexibility of arm), the degree of range of motion(ROM) of both ankles in their dorsiflexion(flexibility of ankle) and plantarflexion with standing with toe(strengthening of ankle), and the degree of knee extension. Wilcoxon signed rank test was used for data analysis and the significance of the differences in the variables was examined to compare the data obtained before and after the PACE program. After the PACE, followings were found : 1. Self-efficacy was significantly increased. 2. Pain severity and number of painful Joints was significantly decreased. 3. The flexibility of both shoulders and arms were significantly improved, but the flexibility of knee was not changed. 4. The flexibility and strengthening of both ankle was significantly improved. In conclusion, PACE was clearly proved to be an effective exercise program to promote self-efficacy, to reduce pain, and to enhance joint function in the elderly with osteoarthritis. It is suggested that the PACE program should be recommended as one of the useful and appropriate nursing interventions for elderly with osteoarthritis.

This study was done to Identify the relations between psychosocial factors and symptoms of patient with rheumatoid arthritis. Its subjects were 150 outpatients selected at H. Rheumatism clinic from July to August in 1998. Data were collected by means of questionnaires using interview. Those data were analyzed by Frequency, t-test, ANOVA, pearson's correlation using SPSS window 8.0. The results were as follows : 1) The level of family support was relatively high and the level of self-efficacy and performance of daily living activities were average. Among their symptoms, fatigue and pain were frequent problems. 2) Family support was different by educational level, self-efficacy and physical, psychological symptoms were different by performance of regular exercise. 3) The family support was inversely related to physical symptoms especially ADL, while it was not related to psychological symptoms except a reverse correlation between depression and anxiety, and family support. Self-efficacy held a reverse correlation with both physical and psychological symptoms. And there was a close relationship between symptoms. In conclusion it was found that the promotion of family support, self-efficacy and exercise-performance holds a key post in reducing symptoms of rheumatoid arthritis.

The purpose of this study is to analyze the knowledge and attitude of applicants on self-help teacher's program for arthritis patients. Subjects of the study constituted 407 applicants who attended the self-help teacher's program for arthritis patients. Self report questionnaires were used to measure the knowledge about arthritis and the attitude toward self-help education. In data analysis, SPSS PC 9.0 Program was utilized for descriptive statistics and one-way anova analysis. The results were as follows : Average age of the participants were 37, while 62% married, 62% had 4-year or above education, and 32.7% had experience of community health nursing. The mean score of knowledge about arthritis was 17.99/28 ; the mean score of applicants' appraisal on the arthritis patients' ability of self-help was 31.66/40 ; the mean score of applicants' attitude toward self-help education for arthritis patients was 35.64/56. According to regions of education for applicants' self-help program, there were not significant differences in applicants' knowledge and appraisal and attitude on self-help program.

The purpose of this study was to identify the relationship between self-efficacy and adherence of aquatic exercise in patients with chronic arthritis. Subjects were 54 patients with rheumatoid arthritis and osteoarthritis who had participated in the 6-week aquatic exercise program. The results indicated that the relationship between self-efficacy and aquatic exercise adherence in patients with chronic arthritis was statistically significant. A significant difference of self-efficacy was found between adherers and non-adherers and self-efficacy of adherer was higher than that of non-adherer(t=5.21, p=.000). Self-efficacy was significantly associated with the total duration of an aquatic exercise adherence(r=.44, p=.001). Based on these results, self-efficacy was the important factor which affect adherence of aquatic exercise in patients with chronic arthritis. Further study was suggested to identify the relationships among self-efficacy, exercise barrier and other possible factors.