A. W. M. Evers^1
1Medical Psychology, Rheumatology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands

Abstract: Rheumatological conditions usually impose a great impact on the quality of life, resulting in limitations in daily activities, substantial changes of life goals and requiring long-term adjustment processes of living with a chronic condition. These changes challenge the coping capacities of patients and require a new balance between the demands of the environment and the capacities of the individual to respond to these demands. As a consequence, the individual’s self-image is threatened and has to change. Self-image means the individual’s perception of his or her physical, psychological and social roles, capacities and demands in relation to the environment and circumstances, e.g. such as a chronic disease. Personal coping capacities largely determine to what extent a patient can adjust to the new situation and is able to develop an adjusted self-image. Although the majority of patients usually adjust well to these changes in the longer term, there is large individual variability between patients to what extent they are able to adjust to the new situation of being chronically ill and to find a new balance with regard to the demands and capacities.

Support by health professionals has to take this individual variability of patients into account in order to fulfil the needs of patients in a balanced way. This can be optimally realized by stepwise care programs. Stepwise care means that patients are screened as shortly as possible after the diagnoses with regard to their needs by different disciplines (e.g. physical therapy, medical-psychological support). Depending on the results of the screening, the need for further care can be determined together with the rheumatologist or the rheumatology nurse consultant, usually starting with basic education and support (e.g. education for all patients, support groups) to more complex care by health professionals (e.g. exercise training, cognitive-behavioral therapy). Depending on the specific screening profile and needs of patients, the interventions can be directed to the development of new coping facilities that in turn can contribute to an adjusted, positive self-image. New technologies of E-health care, e.g. internet therapy, can largely support and facilitate the applicability, user friendliness and effectiveness of this care approach. In the presentation, innovative stepwise care approaches will be outlined by recent developments at our rheumatology department, including E-health medical-psychological screening and treatments for patients with rheumatology conditions.


References: Evers, A.W.M., Kraaimaat, F.W., van Riel, P.L.C.M., de Jong, A.J.L. (2002). Tailored cognitive-behavioral therapy in early rheumatoid arthritis for patients at risk: A randomized, controlled trial. Pain, 100, 141-153.