title: Dilemmas of participation in everyday life in early rheumatoid arthritis: a qualitative interview study (The Swedish TIRA Project).
abstract: OBJECTIVE
  To explore the experiences of today's patients with early rheumatoid arthritis (RA) with respect to dilemmas of everyday life, especially regarding patterns of participation restrictions in valued life activities.
  
  
  METHODS
  A total of 48 patients, aged 20-63, three years post-RA diagnosis were interviewed using the Critical Incident Technique. Transcribed interviews were condensed into meaningful units describing actions/situations. These descriptions were linked to ICF participation codes according to the International Classification of Functioning, Disability and Health (ICF) linking rules.
  
  
  RESULTS
  Dilemmas in everyday life were experienced in domestic life, interpersonal interactions and relationships, community, social and civic life. Most dilemmas were experienced in domestic life, including participation restrictions in, e.g. gardening, repairing houses, shovelling snow, watering pot plants, sewing or walking the dog. Also many dilemmas were experienced related to recreation and leisure within the domain community, social and civic life. The different dilemmas were often related to each other. For instance, dilemmas related to community life were combined with dilemmas within mobility, such as lifting and carrying objects.
  
  
  CONCLUSIONS
  Participation restrictions in today's RA patients are complex. Our results underline that the health care needs to be aware of the patients' own preferences and goals to support the early multi-professional interventions in clinical practice. Implications of Rehabilitation Today's rheumatoid arthritis (RA) patients experience participation restrictions in activities not included in International Classification of Functioning, Disability and Health (ICF) core set for RA or in traditionally questionnaires with predefined activities. The health care need to be aware of the patients' own preferences and goals to meet the individual needs and optimize the rehabilitation in early RA in clinical practice.
authors.affiliation: Department of Rehabilitation and Department of Medical and Health Sciences, Linköping University , Linköping , Sweden .
authors.forename: Annette
authors.initials: A
authors.lastname: Sverker
authors.forename: Gunnel
authors.initials: G
authors.lastname: Östlund
authors.forename: Mikael
authors.initials: M
authors.lastname: Thyberg
authors.forename: Ingrid
authors.initials: I
authors.lastname: Thyberg
authors.forename: Eva
authors.initials: E
authors.lastname: Valtersson
authors.forename: Mathilda
authors.initials: M
authors.lastname: Björk
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001172:Arthritis, Rheumatoid / Q000534:rehabilitation*; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D007398:Interpersonal Relations; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011446:Prospective Studies; D036301:Qualitative Research; D012111:Residence Characteristics; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult
keywords: Activity limitations; critical incident technique; patient perspective; rehabilitation