Instructing patients in physiotherapy: an example using three methods

Physical and exercise therapy for treatment of the rheumatoid hand

OBJECTIVE

To study the short-term effects of physical therapy (ice massage or wax packs, thermal baths, and faradic hand baths) and exercise therapy on the rheumatoid hand.

METHODS

The effect of individual physical therapy and exercise therapy programs was evaluated in 50 randomly selected rheumatoid arthritis inpatients (38 women and 12 men). Mean patient age (+/- SD) was 47.94 +/- 11.22 years, and mean disease duration was 5.04 +/- 4.80 years. The control group consisted of 50 randomly selected rheumatoid arthritis outpatients (37 women and 13 men; mean age 48.46 +/- 10.65 years, mean duration of disease 5.23 +/- 4.89 years) who at the time of the investigation were not receiving any physical or exercise therapy. The clinical indices used for evaluation of inflammation included erythrocyte sedimentation rate (ESR), pain intensity, proximal interphalangeal (PIP) joint size, and Ritchie articular index. Hand grip strength, palmar tip-to-tip and key pinch finger strength, finger range of motion, and activities of daily living (ADL) were the parameters used to assess the functional hand status. The study was single-blinded and of 3 weeks duration.

RESULTS

In the physical therapy treated group, there was an improvement for most of the observed indices from baseline parameters that achieved statistical significance (P < 0.01 and P < 0.005) after the 3-week study period. ESR and PIP joint size improved clinically but failed to reach statistical significance. Patients had a more significant improvement in hand pain, joint tenderness, and ADL score (P < 0.005) than in range of motion (P < 0.01). All parameters in the control group slightly deteriorated over the study period.

CONCLUSION

At least in the short term, physical and, particularly, exercise therapy produce a favorable improvement in the functional status of the rheumatoid hand.

Effect of active hand exercise and wax bath treatment in rheumatoid arthritis patients

The effect of active hand exercise and warm wax treatment was evaluated in 52 rheumatoid arthritis patients randomized into four groups: (1) both exercise and wax bath, (2) exercise only, (3) wax bath only, and (4) controls. Treatment was given three times a week for 4 weeks. Deficits in flexion and extension in digits II-V bilaterally, grip function, grip strength, pain, and stiffness were measured before and after the treatment period. The control group was measured at corresponding times. Wax bath treatment followed by active hand exercise resulted in significant improvements of range of motion (ROM) and grip function. Active hand exercise alone reduced stiffness and pain with nonresisted motion and increased ROM. Wax bath alone had no significant effect.

Health education in rheumatology

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Arthritis patient education: a review of the literature

Arthritis is one of the most prevalent chronic diseases and the number one disabler of the elderly. Even though arthritis is a major cause of morbidity and a contributor to early mortality, relatively few studies have been undertaken to examine effects of arthritis patient education. This review was undertaken to (1) provide a summary of arthritis patient education studies, (2) summarize the effectiveness of arthritis patient education in changing knowledge, behavior, psychological status, and health status, (3) address critical issues/problems in arthritis patient education study methodology, and (4) suggest guidelines for future design, implementation, and evaluation of arthritis patient education programs. In addition, we discuss implications of past studies for future practice.

Effectiveness of self-instruction for arthritis patient education

Self-instruction is one means of providing patient education, allowing the health professional to teach a larger number of persons than with one-to-one or group instruction and at a lower cost. The purpose of this study was to examine the effects of self-instruction on learning, satisfaction with the teaching approach, and health status of persons with rheumatoid arthritis (RA). A control-group pretest-posttest design was used. Thirty subjects receiving care at a rheumatology clinic who met study criteria were randomly assigned to two groups: self-instruction and control. One-way analysis of covariance on posttest Rheumatoid Arthritis Knowledge Inventory (RAKI) scores, with the pretest as covariate, was used to examine the difference in learning between the self-instruction and control groups. There was a significant difference between the groups (P = 0.01). Participants who completed the self-instructional program had improved scores on the posttest as compared to the control. Subjects rated self-instruction as an effective teaching strategy in terms of promoting learning about RA and patient acceptability. t-Test demonstrated no significant difference between the groups in health status. Significant correlations were found between subjects' test scores and selected variables.

How long should we talk to patients? A study in doctor-patient communication

The 13 questions to which 173 rheumatic outpatients most frequently wished to know the answer were made the basis of a structured interview. Two lengths of interview were conducted in a controlled trial (short being of 2 minutes' duration, long ranging from 4 to 11 minutes). Sixty patients referred directly from their general practitioners, and not being in any of the remedial professions, were randomly assigned to one of the 2 groups. They were tested by an independent observer immediately after interview, and one month later at their return appointment, by means of a questionnaire that covered the 13 items of information given to all the patients. The longer interview resulted in significantly more information being retained. Of individual questions only 3 scored significantly better with the longer interview--that about the reasons for x-rays immediately after interview, and the role of heredity and the place of rest at delayed recall.