Improving self-efficacy and life activities of arthritis patients: A quasy-experiment study

Oroh, Cindi Teri Marni; Suprapti, Fitriana; Susilo, Wilhelmus Hary
doi:10.1016/j.enfcli.2020.07.006
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Arthritis is a disease which attacks the joints and found in the elderly&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> The World Health Organization &#40;WHO&#41;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> estimates that there are 165 million people in the world with arthritis&#46; Board of Health Research and Development Ministry of Health of the Republic of Indonesia<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> presented data on arthritis patients in Indonesia with 11&#46;9&#37; diagnosed while those identified with arthritis were 24&#46;7&#37;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Furthermore&#44; arthritis infiltrates the joints of the upper and lower extremities causing limitations in carrying out Activities Daily Living &#40;ADL&#41; and affect psychological aspects such as self-efficacy&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Fontaine<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> suggests that arthritis patients complain more about the presence of physical and social activities&#46; Arthritis leads patients to experiencing difficulties in improving their desired life&#46; If this condition worsens&#44; arthritis sufferers incline to have insufficient quality of life&#46; Complaints arising from arthritis impacts on a patient&#39;s confidence in managing situations associated to this illness as well as inducing physical limitation which affects one&#39;s ability to care for oneself&#46; This is fully discussed with the theory of self-care deficits proposed by Orem which states the inability of individuals to look after themselves continuously&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The National Institute of Arthritis and Musculoskeletal and Skin Disease<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> explains that professional nurses as educators are appropriate to apply treatment on arthritis patients&#44; where nurses provide special assistance to patients who discuss the problems they encounter and plan their assistance&#46; Thus&#44; patients&#8217; quality of life is developed&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0020" class="elsevierStylePara elsevierViewall">This research is a quantitative study with a quasy-experiment design&#46; The research design is non-equivalent control group pre&#8211;post test design&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> This research was conducted in April&#8211;June 2018 in the Community Health Center Paniki Bawah and Wawonasa&#44; Manado&#46; This study employed three groups&#44; namely the group of Arthritis Self-Care Management Education &#40;ASCME&#41; intervention groups&#44; Home-Based Exercise &#40;HBE&#41; intervention groups and the control group&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The population in this study were all arthritis patients in the Community Health Center Paniki Bawah &#40;255 participants&#41; and Wawonasa &#40;238 participants&#41;&#46; The sampling technique used was simple random sampling technique&#44; 189 obtained samples were divided into 80 respondents for the ASCME intervention group&#44; 79 respondents for the HBE intervention group and 30 respondents for the control group&#46; The inclusion criteria for respondents&#44; who were diagnosed with arthritis by doctor &#40;rheumatoid arthritis or osteoarthritis or gout arthritis&#41;&#44; aged &#8805;45 years&#44; were willing to become respondents&#46; The exclusion criteria for respondents were musculoskeletal disorders&#44; contraindications to physical activity&#44; active physiotherapy programs&#44; history of knee replacement surgery&#44; and cognitive impairment&#46; This research was conducted in the Community Health Center Paniki Bawah and Wawonasa&#44; Manado&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The data collection tool employed was a demographic data questionnaire covering age&#44; sex&#44; current education level and duration of arthritis&#46; The self-efficacy questionnaire consists of two items which are pain scale items &#40;5 questions&#41; and other symptom scale items &#40;6 questions&#41;&#46; This questionnaire is to determine the level of respondents&#8217; ability to control pain and other symptoms&#46; Barthel index is used to measure ADL by means of interviews&#46; These questionnaires have been tested for validity and reliability on 30 respondents who met the inclusion criteria&#44; declared valid with r results &#62; r table&#46; The pain self-efficacy questionnaire has a Cronbach alpha value of 0&#46;945&#46; Another symptom self-efficacy questionnaire has a Cronbach alpha value of 0&#46;896&#46; Barthel index with Cronbach alpha value 0&#46;879&#46; Thus the three questionnaires have met the validity and reliability requirements&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This study has passed the ethical test from the Ethics Committee of Nursing Research Institute of Health Science Sint Carolus&#46; Moreover&#44; this research acquired a recommendation from the Political National Unity Agency and the Public Protection of the Manado City Government to be carried out in the Community Health Center Paniki Bawah and Wawonasa&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Pre-test using pain and other symptom self-efficacy questionnaire and Barthel index were conducted on respodents who fulfilled the inclusion criteria and signed an informed consent&#46; Later&#44; these participants were given the intervention&#44; and a post-test was executed using the similar questionnaire as during the pre test&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the ASCME group&#44; respondents were collected in small groups &#40;15&#8211;20 people&#41;&#46; Respondents were distributed with knowledge and skills related to arthritis self-care management &#40;pain management&#44; daily activity management&#44; fatigue management and emotional management&#41; for 6 weeks&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">In the HBE group&#44; respondents were visited in their homes&#46; Respondents and families were given knowledge and skills related to home-based training consisting of joint flexibility exercises and muscle strengthening exercises&#46; Leaflets and observation sheets were handed out&#46; Subsequent respondents for 5 weeks are contacted by telephone to evaluate their progress&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the control group&#44; respondents were observed at home&#46; Intervention was not conducted because participants mainly performed normal activities only&#46; On the sixth week&#44; a post test was measured using questionnaires&#44; such as during the pre test&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The data analysis used was paired <span class="elsevierStyleItalic">t</span>-test&#44; Wilcoxon test&#44; independent <span class="elsevierStyleItalic">t</span>-test&#44; Mann&#8211;Whitney test&#44; multiple linear regression and ordinal regression&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">The univariate test results for variables age&#44; sex&#44; education and duration of arthritis discovered the following results of respondents in this study which are mostly 45&#8211;59 years old &#40;56&#46;6&#37;&#41; with female &#40;63&#46;7&#37;&#41; and high school diploma &#40;34&#46;4&#37;&#41;&#46; Most respondents suffered from arthritis for 1 year&#44; and there were also respondents who suffered from arthritis for 28 years&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Distintinctive test results of each independent variable &#40;ASCME and HBE&#41; on each of the dependent variables before and after change can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> displays that there are significant differences&#44; each in self-efficacy of pain&#44; other symptoms and ADL after being given the ASCME and HBE intervention&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Dissimilar test results of each independent variable &#40;ASCME and HBE&#41; between the intervention group and the control group&#44; can be observed in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> gives information that there are significant disparateness&#44; respectively in self-efficacy of pain&#44; other symptoms and ADL in the ASCME intervention group and HBE intervention groups compared with the control group&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The results of the influence test describe the partial and simultaneous influence of ASCME intervention group or HBE intervention groups&#44; age&#44; sex&#44; education and duration of arthritis suffering from self-efficacy of pain&#44; other symptoms and ADL&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the ASCME intervention group&#44; only the ASCME and duration of arthritis significantly affected the self-efficacy of pain and other symptoms&#46; On the contrary&#44; the factors of age&#44; sex and education did not have a compelling influence on the self-efficacy of pain and other symptoms&#46; Meanwhile in the ADL&#44; the most influential is the educational background of the respondents&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In the HBE intervention group&#44; HBE interventions generated a considerable effect on the self-efficacy of pain and other symptoms while the factors of age&#44; sex&#44; education and duration of arthritis did not&#46; Meanwhile&#44; the most influential activity of daily life is male&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The findings of the influence test describe the simultaneous impact of each interventions in ASCME as well as HBE interventions&#44; age&#44; sex&#44; education and duration of arthritis suffering from self-efficacy of pain&#44; other symptoms and ADL&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0110" class="elsevierStylePara elsevierViewall">The study findings indicated that the age characteristics of arthritis patients with the highest percentage were 45&#8211;59 years old&#44; more female compared to male&#44; more high school graduates&#44; and longer in suffering from arthritis &#40;1 year&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The Arthritis Foundation<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> suggests that arthritis affects many elderly people&#46; According WHO&#44; elderly people are classified from 45 to 59 years of age&#46; Lewis<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> addresses that although most arthritis patients are at the age of &#62;65 actual cartilage destruction as one of the originators of arthritis begins to occur from the age of 20&#8211;30 and mostly occurs at the age of 40&#46; Hence&#44; it is possible that at the age of 50&#8211;60 can be diagnosed with arthritis&#46; Besides being due to changes in cartilage because of the level&#44; genetic factors also affect the incidence of arthritis&#46; Ignatavicius and Workman<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> suggest that one of the triggering factors for osteoarthritis is genetic factor&#46; The people of Manado have long been diagnosed with arthritis&#44; as evidence by 10&#46;3&#37; of the total arthritis sufferers in Indonesia in North Sulawesi&#44; including Manado&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Ignatavicius and Workman<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> state that arthritis sufferers are more experienced by women than men&#46; This is possible because of the role of the hormone estrogen which is closely related to autoimmune as the trigger for rheumatoid arthritis&#46; Similarly&#44; Vollehovven<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> explains that more women suffer from arthritis&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Maryam and Hartini<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> suggest that the level of education is closely related to cognitive function&#46; People with a high level of education have good cognitive functions&#44; where their nerve functions work well&#46; Therefore&#44; the higher the level of education&#44; the more able someone is to maintain their health&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The age characteristics of the majority of respondents were in the age group of 40&#8211;59 years&#44; which was followed by long suffering of mostly 1 year or &#60;5 years while the respondents in the age group of 75&#8211;90 years were not too many that the duration of arthritis &#62;20 years tended to be lesser&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Alterations in self-efficacy of pain in respondents who received ASCME interventions were in line with the research conducted by Dave Parise and Ann O&#8217;Hanlon&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> His research on 85 respondents found that education related to self-management of arthritis given for 6 weeks could improve the respondent&#39;s self-efficacy&#46; Research conducted by Unsal and Kasicki<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a> suggested the results of his research&#44; namely that there were groups who were distributed ASCME interventions experiencing increased self-efficacy of pain&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Moreover&#44; self-efficacy of other symptoms changed significantly in respondents who obtained ASCME intervention&#46; The results of this study&#44; in line with the research conducted by Lorig et al&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> in 855 arthritis patients by providing an arthritis self-management education program for 6 weeks&#44; found that other symptoms of self-efficacy increased&#46; Brekke&#44; Hjortdahl and Kvein<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> address that mental aspects&#44; psychology is strongly influenced by arthritis&#44; leading to a few arthritis sufferers to experience instant anger&#44; irritation&#44; and experience of physical and psychological fatigues&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">For respondents who were supplied with HBE intervention&#44; there was an improvement in self-efficacy of pain&#46; The results of this study are supported by research conducted by Yip et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> in 120 arthritis patients who were provided with stretching exercises stating that the discovery of their study showed an increase in pain self-efficacy for arthritis sufferers&#46; Crowley<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> suggests that HBE does not only rise muscle strength but also the self-confidence of respondents to be able to handle self-complaints due to arthritis&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">In addition&#44; HBE increases self-efficacy of other symptoms&#46; Evcik and Sonel<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> provided home-based training interventions in his study of 30 arthritis sufferers&#46; The results of his research signify that HBE possesses an effective effect on treating arthritis symptoms&#46; The research carried out by Yip et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a> seems to embody a notable difference in the level of self-efficacy of other symptoms in the group that participated intervention with exercise compared to the control group which only implemented routine activities&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">The daily activities of arthritis patients are increasing after engaging in ASCME interventions and HBE interventions&#46; Warsi et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> analyze 17 research journals on the provision of ASCME&#44; it is identified that these interventions could reduce pain and record muscle tone&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="par0160" class="elsevierStylePara elsevierViewall">This research points out that ASCME and HBE occupy a positive impact on self-efficacy and ADL for arthritis patients&#46; ASCME can be provided by professional nurses to small groups of arthritis patients while HBE is also taught by professional nurses with the assistance of other relatives and family members&#46; The implementation of ASCME and HBE for 6 weeks escalated the confidence of arthritis patients that pain and other symptoms caused arthritis are manageable&#44; and improve patients&#8217; abilities to carry out activities daily living&#46; Thus&#44; people with arthritis can develop their quality of life without being limited by complaints that arise due to arthritis&#46; It is therefore important to apply ASCME and HBE interventions to arthritis patients as independent nurse interventions by evidence-based&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Acknowledgements</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors express gratitude to all respondents involved in this study along with researcher assistants who provide assistances with the data collection process&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conflict of interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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          "titulo" => "Conclusions"
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        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Acknowledgements"
        ]
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          "identificador" => "sec0035"
          "titulo" => "Conflict of interest"
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          "titulo" => "References"
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      ]
    ]
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    "fechaRecibido" => "2020-05-12"
    "fechaAceptado" => "2020-07-15"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1315171"
          "palabras" => array:4 [
            0 => "Arthritis Self-Care Management Education"
            1 => "Home-Based Exercise"
            2 => "Self-efficacy"
            3 => "Activity Daily Living"
          ]
        ]
      ]
    ]
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Arthritis can cause physical and psychological complaints which affect patients&#8217; quality of life&#46; This study aims to determine the effect of Arthritis Self-Care Management Education &#40;ASCME&#41; and Home-Based Exercise &#40;HBE&#41; to self-efficacy and Activities of Daily Living &#40;ADL&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This research utilized quasy-experimental research design&#44; using pre-test and post-test on non-randomized control group&#46; The samples in this study were 198 arthritis patients divided into 3 groups&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The findings of the research indicated that there were differences of self-efficacy as well as ADL before and after intervention with <span class="elsevierStyleItalic">p</span>-value of 0&#46;000 on each intervention group respectively&#46; The results of the analysis found that both the ASCME and HBE had a significant influence to self-efficacy and ADL with <span class="elsevierStyleItalic">p</span>-value of 0&#46;000&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">It is concluded that ASCME and HBE are significant to increase self-efficacy and also improve ADL&#46; Nurses are suggested to function these interventions as part of independent nursing intervention and also for improving arthritis self-care for patients and the family&#46;</p></span>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Pain self-efficacy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;000&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                          "autores" => array:1 [
                            0 => "C&#46; Eliopoulos"
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                        "fecha" => "2014"
                        "editorial" => "Lipincott Williams &#38; Wilkins"
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                        "fecha" => "2017"
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                        "editorialLocalizacion" => "Geneva"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Riset Kesehatan Dasar"
                    ]
                  ]
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                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2013"
                        "editorial" => "Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan RI"
                        "editorialLocalizacion" => "Jakarta"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Self-efficacy and health status in rheumatoid arthritis&#58; a two-year longitudinal observational study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Brekke"
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                            2 => "T&#46;K&#46; Kvien"
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                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Br Soc Rheumatol"
                        "fecha" => "2001"
                        "paginaInicial" => "387"
                        "paginaFinal" => "392"
                      ]
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                      "titulo" => "ACR Diagnosis Guidelines"
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                        "editorial" => "John Hopkins Arthritis Center"
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