Examining the Efficacy of Personalized Lifestyle Intervention in Individuals With Rheumatoid Arthritis

Disease Activity Score (DAS-28), which includes 28 joints, is used to monitor objective and subjective measures of disease activity in individuals with RA [33, 34]. The DAS-28 has been shown to have good validity and internal consistency reliability for monitoring this patient population [35] and is able to distinguish between patients with high and low disease activity [33]. Objective measures for rheumatoid arthritis are the number of swollen joints and the level of inflammation (erythrocyte sedimentation rate or C-reactive protein); subjective measures are the number of tender joints and the patient's overall health assessment. Disease activity scores range from 0 (not completely active) to 9.4 (very active). It is classified as ≤ 3.2 = mild, >3.2 to ≤5.1 = moderate, and >5.1 = severe [36].

Evaluate how an individual's health status affects their physical function. It consists of eight subsections containing 20 activities (dressing and preparation, sitting-standing, eating, walking, hygiene, reaching, grip strength, and other activities) and each subsection contains two or three questions. All questions are rated on a four-point likert (0=I can do it easily), and (3=I can't do it at all). Eight subdivision scores are added up and divided by eight. A high score indicates poor health [37]. The Turkish validity and reliability of the test was established [38].

The hospital anxiety and depression scale was developed by Zigmond and Snaith in 1983 [39]. In our country, the validity and reliability study was carried out by Aydemir[15] in 1997 [40]. The scale is used to determine the risk of anxiety and depression in the patient, to measure its level and change in severity.

The General Self-Efficacy Scale - Turkish form is a valid and reliable tool for measuring the general self-efficacy of people aged 18 years and older who are at least primary school graduates. The scale consists of 17 items and a 5-point likert structure. Bandura argues that the perception of self-efficacy is one of the main determinants of human behavior and behavioral changes [43]. The use of the concept of self-efficacy in the formation and change of patients' health-related behaviors seems to be beneficial in the field of health. The Turkish validity and reliability study of the scale was carried out by Yıldırım and İlhan in 2010 [44].

It is a disease-specific scale developed for patients with Rheumatoid arthritis and evaluates the quality of life multi-dimensionally. It consists of 30 questions prepared to be answered as yes/no. Scores range from 0 to 30, and high scores indicate poor quality of life [45]. The Turkish version of the RAQoL was used in this study [46].

It was developed to evaluate the effect of fatigue in different dimensions in RA patients. In the questionnaire, 4 questions (questions 1-4) evaluate physical fatigue, 7 questions evaluate fatigue in activities of daily living (ADL), 5 questions evaluate cognitive fatigue (questions 12-16), and 4 evaluate emotional fatigue. There are 20 questions in total (questions 17-20). All questions except the first 3 questions are asked to be answered according to the 4-point Likert system (none, a little, a lot, and a lot). The questionnaire completed by the patient evaluates the last seven days. The patient can leave a total of 3 questions blank. But it should answer questions 1 and 2. The patient scores between 0-70. A high score indicates high fatigue [41]. A Turkish validity and reliability study was conducted [42].