title: "Stiffness has different meanings, I think, to everyone": examining stiffness from the perspective of people living with rheumatoid arthritis.
abstract: OBJECTIVE
  Stiffness is a well-recognized symptom of rheumatoid arthritis (RA). It is frequently queried during clinic visits as an indicator of disease activity and was included in the 1961 and 1987 RA classification criteria. Little is known about how people with RA experience stiffness and its impact on their lives.
  
  
  METHODS
  We conducted 4 focus groups including 20 people with RA (4-6 participants per group) from 1 academic clinical practice and 1 private practice to generate accounts of stiffness experiences. Qualitative inductive thematic data analysis was conducted.
  
  
  RESULTS
  Five overarching themes were identified: relationship of stiffness with other symptoms, exacerbating or alleviating factors and self-management, stiffness timing and location, individual meanings of stiffness experiences, and impact of stiffness on daily life.
  
  
  CONCLUSIONS
  Focus group discussions revealed individual stiffness experiences as diverse and complex. Several stiffness features were endorsed by a majority of participants, but few, if any, were universally experienced; thus, the significance of stiffness as an expression of the disease varied widely. Discussions yielded descriptions of how individual limits imposed by RA in general and stiffness in particular may change over time and were intertwined with adaptations to preserve participation in valued life activities. These results concerning the diversity of the stiffness experience, consequential adaptations, and its impact suggest that a more individualized approach to stiffness measurement may be needed to improve stiffness assessments.
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ana-Maria
authors.initials: AM
authors.lastname: Orbai
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Smith
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Bartlett
authors.forename: Elaine
authors.initials: E
authors.lastname: De Leon
authors.forename: Clifton O
authors.initials: CO
authors.lastname: Bingham
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D017144:Focus Groups; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular / Q000502:physiology*; D012649:Self Concept; D057566:Self Report; D012720:Severity of Illness Index; D009626:Terminology as Topic