The paper reviewed here is a 2008 paper purpose in life in patients with rheumatoid arthritis by verduin and colleagues and freely available here. Purpose in life while intuitively obvious is slightly trickier to define explicitly relating to the much broader category of meaning in life. This is reflected in the introduction where the authors discuss the similar usage of purpose in life and meaning. They also recognise that both terms relate to motivation, the moral self as well as the move towards achieving aims which transcend the self. In this cross sectional study, the researchers use two measures of purpose in life. These are the
1. The purpose in life test. This is based on the work of victor frankl the existential psychotherapist. This is a 20 item instrument using a 7 point likert scale. The questions focus for example on goals, aims, meaning and purpose. A high score on the test indicates a high sense of purpose.
2. The purpose in life susbscale of the psychological wellbeing scale. There are 20 questions which look for instance at making plans for the future and consideration of whether daily activities are trivial.
The researchers wanted to investigate the role of purpose in life in rheumatoid arthritis. In the previous literature they have reviewed they argue that coping mechanisms have not been evaluated as an important confounder. The researchers have recruited 300 people with Rheumatoid arthritis randomly from the rheumatology outpatient department. This may suggest that the sample group had a more severe form of rheumatoid arthritis if they were not being managed solely in primary care. The rating scales had been translated into Dutch although it wasnt clear on whether the Dutch version had been validated. The researchers used the Health Assessment Questionnaire, the RAND 36 questionnaire (a measure of quality of life) and visual analogue ratings of disease activity, pain and fatigue. They also used a measure of coping in life.
The researchers sent out questionnaires to all 300 participants and received 52 percent of them back. The average age of participants was 60 with an average disease duration of 10 years. Encouragingly there was a good correlation between the purpose in life questionnaire results (spearmanns r = 0.62 p less than 0.001). Table 3 in the paper shows the relationship between the two purpose in life scales amd a number of sociodemographic factors. Interestingly the purpose in life outcome measure is related to leisure or social activities suggesting a concrete example of behaviours that correlate with the scale construct. In table 4, rather disappointingly there is no significant relationship between the purpose in life scale results and the main physical outcome measures although there is a significant relationship with the RAND summary scale mental health outcome measures in the expected direction. This makes it difficult to interpret the findings of a relationship between purpose and reduced pain and fatigue as they might properly be considered part of the secondary analysis in which case a correction for muliple comparisons may be needed. This is also a cross-sectional study which precludes the establishment of causality.
In conclusion, in the primary analysis there isn’t a relationship between the Purpose in Life outcome measures and the main physical outcome measures although there is a relationship with the mental health outcome measures. The secondary analysis suggests that subjective pain anf functioning may be correlated with purpose in life measures but this occurs in the context of the negative result in the primary analysis. A large randomised longitudinal study would be helpful in investigating this further.
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