Sexual health in Rheumatoid Arthritis - a physiotherapeutic approach

Sammanfattning: The overall aim of this thesis was to study how persons experience the influence of Rheumatoid Arthritis (RA) on their sexual health and their experiences of communication about sexual health, in order to improve physiotherapy within the field of rheumatology. Sexual health is an integrated part of life, and persons with Rheumatoid Arthritis, RA, often experience a decreased sexual health, which can affect their overall quality of life. RA is a chronic systematic inflammatory disease with physical, social and psychological impact on the functioning of the patient. Common symptoms of RA are pain, fatigue, morning stiffness, reduced physical capacity, and joint swelling. Symptoms during flares are complex and experienced in different ways. They can be described as multilayered symptoms affecting the whole body experience. Physiotherapy for persons with RA is usually directed towards improving activities of daily living, dealing with specific symptoms, such as pain or limited joint mobility, and it is important to widen this context to also include sexual relations. The thesis has a mixed paradigm design in a fixed multiphase model, including qualitative, quantitative and psychometric methods, in order to respond to the research question and the aims of the thesis. The first study explored the views of persons living with RA concerning sexual health in relation to physiotherapy, and covered how the body and the total life situation affected sexual health. The impact of RA was experienced as multidimensional. The findings consisted of three themes: 1) Sexual health – physical and psychological dimensions, 2) Impacts of RA and 3) Possibilities of increasing sexual health – does physiotherapy make a difference? The findings from the first study were used as a base for the questionnaire used in the second study in order to further investigate views and experiences of the impact of RA on sexual health, experiences and needs of physiotherapy in this context, as well as communication between patients and health professionals concerning sexual health. The results of the second study clarified the need to improve communication and interaction between healthcare professionals and persons with RA concerning sexual health. This was investigated in the fourth study, where the question of whether decreased sexual health can be detected with a standard outcome measurement tool was explored. In order to perform the fourth study, the Multi Dimensional Health Assessment Questionnaire had to be validated and tested for reliability in a Swedish context, which was performed in the third psychometric study. To conclude, sexual health is affected in different ways for persons with RA, and there is a lack of communication concerning sexual health between health professionals and persons with RA. Physiotherapists can play an active role in improving sexual health for persons with RA by being aware that pain, fatigue, decreased mobility, and level of physical capacity can affect sexual health negatively. Improvement of communication concerning sexual health between persons with RA and their partners, as well as with health professionals, may improve sexual health among persons with RA. The Swedish version of the Multi Dimensional Health Assessment Questionnaire (MDHAQ-S) was found to have acceptable reliability and validity, and can be used as a base for sexual health communication since it correlates significantly with results of the Questionnaire of Sexual Health in persons with RA. The MDHAQ-S covers issues concerning sexual health in a multiple way to deepen the prerequisites for sexual health communication, but to uncover sexual health difficulties, an in-depth clinical interview or a more specific sexual health questionnaire is needed.