Psychosocial factors in rehabilitation of the chronic rheumatoid arthritic.

For the past two years we have engaged in a research project devoted to the problems of rehabilitation among chronically disabled rheumatoid arthritis patients. To be admitted to the study, patients had to be severely disabled, and their disease process had to be still in an active phase. Our objective was to determine the feasibility of a combined programme of hormone therapy and physical medicine rehabilitation procedures. Previous papers (Rusk and Lowman, 1953; Lowman and Lee, 1953; Lowman, 1953) have reported the factors considered most important in establishing and attaining goals with such chronic arthritis patients; among these, the psycho-social aspects of the problem were prominent. Many writers support the hypothesis that the psychological status of the rheumatoid arthritic warrants consideration as specific to this disease. Some investigators have proposed that this "rheumatoid personality" is a stigma which antecedes the disease and predisposes psychosomatically to its development as a clinical entity (Johnson and others, 1947; Rome, 1949; Halliday, 1944; Ludwig, 1952, 1954). We have looked out for any personality structure characteristic of arthritics and its influence on the possibilities of rehabilitation. We have also tried to distinguish the motivated from the nonmotivated patient, since rehabilitation is a protracted and expensive treatment. We have previously reported the high incidence of passivity and dependence in the chronic rheumatoid group, and in analysing our patients from a psycho-social standpoint, we have looked for characteristics among the successful and unsuccessful groups of rehabilitees which could be used as yardsticks in selecting those patients for rehabilitation who will be most likely to derive benefit from the treatment.