title: Stiffness is more than just duration and severity: a qualitative exploration in people with rheumatoid arthritis.
abstract: OBJECTIVE
  Stiffness is internationally recognized as an important indicator of inflammatory activity in RA but is poorly understood and difficult to measure. The aim of this study was to explore the experience of stiffness from the patient perspective.
  
  
  METHODS
  Semi-structured interviews conducted with 16 RA patients were analysed independently by researchers and pat.ient partners using inductive thematic analysis.
  
  
  RESULTS
  Six themes were identified. Part of having RA identified stiffness as a normal consequence of RA, perceived as associated with disease-related aspects such as fluctuating disease activity, other RA symptoms and disease duration. Local and widespread highlighted stiffness occurring not only in joints, but also over the whole body, being more widespread during the morning or flare. Linked to behaviour and environment illustrated factors that influence stiffness, including movement, medications and weather. Highly variable captured the fluctuating nature of stiffness within and between patients and in relation to temporality, duration and intensity. Impacts on daily life emphasized the effect of stiffness on a range of domains, including physical function, quality of life, psychological well-being, activities of daily living and participation in work and leisure activities. Requires self-management detailed self-management strategies targeting both the symptom and its consequences.
  
  
  CONCLUSIONS
  Patients' experiences of stiffness were varied, complex and not exclusive to the morning period. Importantly, stiffness was reported in terms of impact rather than the traditional measurement concepts of severity or duration. Based on these findings, further research is needed to develop a patient-centred measure that adequately reflects inflammatory activity.
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK. Serena.halls@uwe.ac.uk.
authors.forename: Serena
authors.initials: S
authors.lastname: Halls
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Dures
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK.
authors.forename: John
authors.initials: J
authors.lastname: Kirwan
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Pollock
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Gill
authors.initials: G
authors.lastname: Baker
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Avis
authors.initials: A
authors.lastname: Edmunds
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, School of Clinical Sciences, University of Bristol and Rheumatology Department, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hewlett
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009127:Muscle Rigidity / Q000188:drug therapy / Q000503:physiopathology*; D036301:Qualitative Research; D012648:Self Care; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D018501:Antirheumatic Agents
keywords: patient experience; qualitative; rheumatoid arthritis; stiffness