title: Self-efficacy as an outcome measure and its association with physical disease-related variables in persons with rheumatoid arthritis: a literature review.
abstract: BACKGROUND
  Studies have demonstrated a positive impact of patient education on self-efficacy in persons with rheumatoid arthritis (RA). However, the relationship between self-efficacy, physical disease-related variables and educational interventions has not yet been reviewed.
  
  
  OBJECTIVE
  The aims of this study, in relation to persons with RA, were: 1) to provide an overview of the existing research into the association between self-efficacy and physical disease-related variables and, with this knowledge, 2) to provide an overview of the existing research on the effect of different types of educational interventions on self-efficacy.
  
  
  METHODS
  A systematic literature search was performed using eight databases, based on the terms 'rheumatoid arthritis' AND 'self-efficacy'. In total, 74 studies reporting associations between self-efficacy and physical disease-related variables and using self-efficacy as an outcome measure in educational interventions were included.
  
  
  RESULTS
  The scores obtained by the most commonly used questionnaire, the Arthritis Self-Efficacy Scale (ASES), was highly associated with physical disability, pain, fatigue and disease duration. If educational activities had a positive impact on self-efficacy, disease-related variables usually improved as well. Evidence is scarce as to whether disease-related variables affect patients' self-efficacy or vice versa and whether individual consultations can affect patients' self-efficacy.
  
  
  CONCLUSIONS
  The scores attained by the ASES is highly associated with physical disease-related variables. This relationship requires further research using a specific study design to restrict bias when evaluating the impact of interventions on self-efficacy in persons with RA. Research is needed on whether individual consultations can affect patients' self-efficacy. Disease-related variables do not affect the Rheumatoid Arthritis Self-Efficacy (RASE) questionnaire but this needs further exploration.
authors.affiliation: Institute of Regional Health Services Research, University of Southern Denmark, Odense C, Denmark and King Christian X's Hospital for Rheumatic Diseases, Graasten, Denmark. jprimdahl@gigtforeningen.dk.
authors.forename: J
authors.initials: J
authors.lastname: Primdahl
authors.forename: L
authors.initials: L
authors.lastname: Wagner
authors.forename: Kim
authors.initials: K
authors.lastname: Hørslev-Petersen
mesh_terms: D001172:Arthritis, Rheumatoid / Q000628:therapy*; D004185:Disability Evaluation; D006801:Humans; D010353:Patient Education as Topic; D020377:Self Efficacy