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Gavin JP, Rossiter L, Fenerty V, Leese J, Adams J, Hammond A, Davidson E, Backman CL. The Impact of Occupational Therapy on the Self-Management of Rheumatoid Arthritis: A Mixed Methods Systematic Review. ACR Open Rheumatol 2024; 6:214-249. [PMID: 38332322 PMCID: PMC11016568 DOI: 10.1002/acr2.11650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To determine the impact of occupational therapy (OT) on the self-management of function, pain, fatigue, and lived experience for people living with rheumatoid arthritis (RA). METHODS Five databases and gray literature were searched up to June 30, 2022. Three reviewers screened titles and abstracts, with two independently extracting and assessing full texts using the Cochrane risk of bias (quantitative) and Critical Appraisal Skills Programme (qualitative) tools to assess study quality. Studies were categorized into four intervention types. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) (quantitative) and GRADE- Confidence in Evidence from Reviews of Qualitative research (qualitative) were used to assess the quality of evidence for each intervention type. RESULTS Of 39 eligible papers, 29 were quantitative (n = 2,029), 4 qualitative (n = 50), and 6 mixed methods (n = 896). Good evidence supports patient education and behavior change programs for improving pain and function, particularly group sessions of joint protection education, but these do not translate to long-term improvements for RA (>24 months). Comprehensive OT had mixed evidence (limited to home OT and an arthritis gloves program), whereas limited evidence was available for qualitative insights, splints and assistive devices, and self-management for fatigue. CONCLUSION Although patient education is promising for self-managing RA, no strong evidence was found to support OT programs for self-managing fatigue or patient experience and long-term effectiveness. More research is required on lived experience, and the long-term efficacy of self-management approaches incorporating OT, particularly timing programs to meet the individual's conditional needs (i.e., early or established RA) to build on the few studies to date.
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Affiliation(s)
| | | | | | - Jenny Leese
- Arthritis Research Canada, Vancouver, British Columbia, University of OttawaOttawaOntarioCanada
| | - Jo Adams
- University of SouthamptonSouthamptonUnited Kingdom
| | | | | | - Catherine L. Backman
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
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Ghali A, Lacombe V, Ravaiau C, Delattre E, Ghali M, Urbanski G, Lavigne C. The relevance of pacing strategies in managing symptoms of post-COVID-19 syndrome. J Transl Med 2023; 21:375. [PMID: 37291581 PMCID: PMC10248991 DOI: 10.1186/s12967-023-04229-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Post-COVID-19 syndrome (PCS) shares many features with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). PCS represents a major health issue worldwide because it severely impacts patients' work activities and their quality of life. In the absence of treatment for both conditions and given the beneficial effect of pacing strategies in ME/CFS, we conducted this study to assess the effectiveness of pacing in PCS patients. METHODS We retrospectively included patients meeting the World Health Organization definition of PCS who attended the Internal Medicine Department of Angers University Hospital, France between June 2020 and June 2022, and were followed up until December 2022. Pacing strategies were systematically proposed for all patients. Their medical records were reviewed and data related to baseline and follow-up assessments were collected. This included epidemiological characteristics, COVID-19 symptoms and associated conditions, fatigue features, perceived health status, employment activity, and the degree of pacing adherence assessed by the engagement in pacing subscale (EPS). Recovery was defined as the ability to return to work, and improvement was regarded as the reduction of the number and severity of symptoms. RESULTS A total of 86 patients were included and followed-up for a median time of 10 [6-13] months. Recovery and improvement rates were 33.7% and 23.3%, respectively. The EPS score was the only variable significantly associated with recovery on multivariate analysis (OR 40.43 [95% CI 6.22-262.6], p < 0.001). Patients who better adhered to pacing (high EPS scores) experienced significantly higher recovery and improvement rates (60-33.3% respectively) than those with low (5.5-5.5% respectively), or moderate (4.3-17.4% respectively) scores. CONCLUSION Our findings demonstrated that pacing is effective in the management of patients with PCS, and that high levels of adherence to pacing are associated with better outcomes.
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Affiliation(s)
- Alaa Ghali
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France.
| | - Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Camille Ravaiau
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Estelle Delattre
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Maria Ghali
- Department of General Medicine, Faculty of Medicine of Angers, Angers, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 Rue Larrey, 49000, Angers, France
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Kim S, Xu Y, Dore K, Gewurtz R, Larivière N, Letts L. Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illn 2022; 18:441-457. [PMID: 34515530 PMCID: PMC9397391 DOI: 10.1177/17423953211039783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
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Affiliation(s)
- Sungha Kim
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Ying Xu
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Kelly Dore
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Rebecca Gewurtz
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Nadine Larivière
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Lori Letts
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
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(Re-)Defining ergonomics in hand therapy: Applications for the management of upper extremity osteoarthritis. J Hand Ther 2022; 35:400-412. [PMID: 35871881 DOI: 10.1016/j.jht.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/10/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Invited literature review BACKGROUND: Arthritis is the leading cause of disability in adults, and research shows that people living with arthritis experience work instability, loss of independence, financial difficulties, and overall decreased quality of life. Current nonpharmacological treatments can be beneficial for short term relief; however, the evidence on these long-term treatments is limited. Ergonomic modifications have been used in the workplace to address musculoskeletal conditions to ensure proper fit of one's environment, and research shows that these modifications can decrease pain and injury and increase work productivity. A broader perspective on ergonomic approaches may be important to supporting individuals with arthritis within hand therapy. PURPOSE OF THE STUDY This review proposes an expanded perspective on ergonomic approaches within hand therapy and explores published literature to identify potential benefits of applying ergonomic approaches for individuals with upper extremity arthritis. METHODS A systematic search and screening process was conducted to identify articles that implemented an ergonomic approach for the support of individuals with upper extremity osteoarthritis or rheumatoid arthritis. RESULTS A total of 34 articles described interventions that employed ergonomics including task-based or general ergonomics (n = 17), contextualized supports (n = 8), or holistic, lifestyle approaches (n = 9). Only one study focused solely on individuals with osteoarthritis, whereas interventions for individuals with rheumatoid arthritis showed positive outcomes across these categories. Situational learning, building of patient self-efficacy, and development of new habits and routines are vital for carryover and implementation to support performance in daily life. CONCLUSION There is an opportunity for hand therapists to extend the scope of interventions provided as part of an ergonomic approach to supporting patients. Specifically, therapists can consider use of emerging technologies and telehealth that promote contextualization and follow-up for long-term outcomes.
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Helle T, Joho T, Kaptain RJ, Kottorp A. Activity repertoires and time use in people living with chronic obstructive pulmonary disease. Scand J Occup Ther 2020; 28:564-570. [PMID: 32631116 DOI: 10.1080/11038128.2020.1782982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Understanding the dynamics and aspects of how activity choices impact health and well-being in people living with chronic obstructive pulmonary disease (COPD) is important to inform rehabilitation. AIM To describe, firstly, how much time people living with COPD spend on work, daily living tasks, recreation and rest; secondly, how this population perceived competence, importance and enjoyment related to these activities; thirdly, if differences in such perceptions and time use were associated with the living situation and COPD severity. MATERIAL AND METHODS This cross-sectional study involved 76 participants (+45 years, COPD, living in ordinary homes), who completed the Occupational Questionnaire (OQ). Descriptive statistics and group comparisons were performed. RESULTS Most of the participants' time were spent on daily living activities and recreational activities. Participants spent approx. 80% of their recorded time in OQ on activities they valued, enjoyed and in which they felt competent. Participants living alone scored significantly lower on enjoyment in restful activities than those living in couples (p < 0.05). No statistically significant difference in perceived competence, importance or enjoyment was found in relation to COPD severity. CONCLUSIONS AND SIGNIFICANCE Findings underscore the importance of targeting overall daily activity repertoires including compositions of activity types, time use and perceived competence, importance and enjoyment.
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Affiliation(s)
- Tina Helle
- Department of Occupational Therapy, University College North, Aalborg, Denmark.,Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden
| | - Tanja Joho
- Zurich Psychiatric University Hospital, Zurich, Switzerland.,Department of Occupational Therapy, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Rina Juel Kaptain
- Department of Occupational Therapy, University College North, Aalborg, Denmark.,Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden
| | - Anders Kottorp
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institute, Stockholm, Sweden.,Faculty of Health and Society, Malmö University, Malmö, Sweden
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Farragher JF, Jassal SV, McEwen S, Polatajko HJ. Energy management education and occupation-related outcomes in adults with chronic diseases: A scoping review. Br J Occup Ther 2020. [DOI: 10.1177/0308022620904327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Fatigue is a pervasive symptom of chronic disease that often interferes with occupational performance. Our objective was to describe what is known about energy management education and occupation-related outcomes in adults with chronic diseases. Methods Seven electronic databases were searched for relevant literature published before August 2019. Eligible articles were full-text, available in English, and studied energy management education in adults with a chronic disease. The first author assessed article eligibility with validation from a second reviewer, extracted characteristics of included studies, and described them using descriptive statistics. A narrative synthesis of findings was conducted for each chronic disease population. Results Forty-four studies addressed eight different chronic disease populations. The most common program delivery format was face-to-face in a group setting (42%), 39% of programs were informed by a learning theory, and their median cumulative length was 8 hours. Positive outcomes were associated with a specific, group-based energy management program in people with multiple sclerosis. The evidence on other energy management programs and in other chronic disease populations was more limited and inconclusive. Conclusions Further research is needed to understand the impact of energy management education in chronic disease populations beyond multiple sclerosis, and its impact on occupational performance.
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Affiliation(s)
- Janine F Farragher
- Department of Community Health Sciences, University of Calgary, AB, Canada
| | | | - Sara McEwen
- Department of Physiotherapy, University of Toronto, ON, Canada
| | - Helene J Polatajko
- Department of Occupational Science & Occupational Therapy, University of Toronto, ON, Canada
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Operant Learning Versus Energy Conservation Activity Pacing Treatments in a Sample of Patients With Fibromyalgia Syndrome: A Pilot Randomized Controlled Trial. THE JOURNAL OF PAIN 2018; 20:420-439. [PMID: 30326271 DOI: 10.1016/j.jpain.2018.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 07/23/2018] [Accepted: 09/07/2018] [Indexed: 12/26/2022]
Abstract
This study's aim was to assess the efficacy of 2 forms of activity pacing in patients with fibromyalgia syndrome (FMS). Treatment-related changes in activity management patterns were also examined. Patients with FMS (n = 178) were randomly assigned to an operant learning (OL; delayed [n = 36] or immediate [n = 54] groups) or an energy conservation (EC; delayed [n = 35] or immediate [n = 53] groups) treatment condition. Of these, 32 OL and 37 EC patients completed treatment. Forty-three patients were allocated to the delayed treatment condition (control group). Repeated measures analyses of variance were used to examine the effects of OL and EC treatments on primary (average pain and usual fatigue), secondary (pain and fatigue interference, physical and psychological function, sleep quality, depressive symptoms, and anxiety symptoms), and tertiary (pain-related activity patterns) outcomes. Neither treatment was effective in reducing average pain or usual fatigue symptoms. Relative to EC, OL patients showed greater improvements in depressive symptoms, whereas nonsignificant trends (P values ranging between .05 and .06) were observed for pain interference, fatigue interference, and psychological function. Both treatments were associated with improvements in sleep quality and physical function, increases in pacing, and decreases in overdoing activity patterns. Reductions in activity avoidance were only found in OL. These findings suggest that OL may be more beneficial than EC and that it could potentially be viewed as an effective stand-alone activity pacing treatment for patients with FMS. Research to determine the extent to which these preliminary findings replicate is warranted. PERSPECTIVE: This article examines the efficacy of 2 forms of activity pacing in patients with fibromyalgia syndrome. The results suggest the possibility that operant learning may be more beneficial than energy conservation and could potentially be viewed as an effective stand-alone activity pacing treatment for patients with fibromyalgia syndrome.
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Rice LA, Abou L, Denend TV, Peterson EW, Sosnoff JJ. Falls Among Wheelchair and Scooter Users with Multiple Sclerosis—A Review. ACTA ACUST UNITED AC 2018. [DOI: 10.17925/usn.2018.14.2.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Falls are increasingly recognized as a threat to the safety, health and well-being of people with multiple sclerosis (MS), and emerging evidence suggests that full time wheelchair and scooter users with MS have unique fall prevention needs. This review is comprised of three parts. Part 1 summarizes findings describing influences on falls among full time wheelchair and scooter users with MS and associated clinical implications. Although further studies are needed, early findings regarding influences on fall risk operating in this specific population highlight the importance of addressing falls that occur during activities of daily living, the high frequency of falls occurring in the bathroom, and both extrinsic (e.g., wet/slippery surfaces) and intrinsic (e.g., muscle spasticity/weakness) contributors to falls. Part 2 of this review describes available evidence regarding interventions to prevent falls in full time wheelchair and scooter users with MS. Because intervention work in this area is limited to one pilot study, Part 3 presents priorities for future research and identifies the need for randomized trials evaluating fall prevention programs that address diverse fall risk factors and allow for development and attainment of individualized fall prevention goals.
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Abstract
This literature review considers the evidence to support or disclaim the efficacy of joint protection principles in the treatment of rheumatoid arthritis. The principles used in the occupational therapy department of the Guest Hospital, Dudley, are examined and appraised individually. The application of these principles is then discussed in the context of overall patient care.
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Abstract
Joint protection (JP) education is a standard part of rheumatology occupational therapy services. This survey was conducted to identify the duration, teaching methods and content of JP education. Over half of therapists responding (55%, n=86) provided education for less than one hour during one treatment session. Eighty-six per cent supported education with written information; 66% demonstrated JP methods to patients, commonly methods for opening Jars, chair transfers and tap turning; and 50% also asked patients to practise these under supervision. The SPIRE arthritis education programme seemed a common influence on the JP education provided. Previous research suggests that educational-behavioural approach based patient education programmes (of 8–12 hours' duration) facilitate health behavioural change. It would appear that much of the current JP education provided in the United Kingdom may not be achieving this goal.
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Henderson SE, McMillan IR. Pain and Function: Occupational Therapists' Use of Orthotics in Rheumatoid Arthritis. Br J Occup Ther 2016. [DOI: 10.1177/030802260206500403] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of orthotics in the management of rheumatoid arthritis appears to be relatively commonplace within occupational therapy departments. The aim of this study was to identify the frequency of orthotic use by occupational therapists, their beliefs about the efficacy of orthotic use, what they aimed to achieve by orthotic provision and any outcome measures used. The total membership of the British Association of Hand Therapists who were both occupational therapists and self-identified as working and/or having an interest in rheumatology (n = 132) were surveyed through a postal questionnaire. Of the responses received (n = 89, 67%), all the respondents (100%) were regular users of orthotics in the management of rheumatoid arthritis. The results showed that the most highly rated reasons for orthotic provision were to decrease hand and wrist pain and to improve hand function. Subjective comments from the respondents provided evidence of positive beliefs about the efficacy of orthotic use, despite a lack of objective outcome measures to support such comment. Given the complexity of the intervening variables that occur with orthotic use, perhaps there is no easy answer; however, with the expectation of evidence-based practice and intervention, it is suggested that an increased use of standardised outcome measures may provide additional strength in presenting, often subjective, evidence.
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Bhasin CA, Goodman GD. The Use of OT FACT Categories to Analyze Activity Configurations of Individuals with Multiple Sclerosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153944929201200201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Open-ended responses on activity configurations of 25 patients with multiple sclerosis were coded using categories from the Occupational Therapy Functional Assessment Compilation Tool (OT FACT), Level II— Functional Activities of Performance (Smith, 1989, 1990). The inter-rater reliability for the five occupational therapists who coded the responses was .89. When the same categories were used by patients to code responses, there was complete agreement between therapist and patient in 94% of the activities coded. In a separate study of eight patients, 86% of the OT FACT categories reported on a “typical day” were also reported 10 days later when an “actual day” was recorded. These findings indicate that the OT FACT categories were a reliable and valid tool for coding activity configurations of patients with multiple sclerosis.
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Abstract
BACKGROUND Activity pacing (AP) is a concept that is central to many chronic pain theories and treatments, yet there remains confusion regarding its definition and effects. OBJECTIVE To review the current knowledge concerning AP and integrate this knowledge in a manner that allows for a clear definition and useful directions for future research. METHODS A narrative review of the major theoretical approaches to AP and of the empirical evidence regarding the effects of AP interventions, followed by an integrative discussion. RESULTS The concept of AP is derived from 2 main traditions: operant and energy conservation. Although there are common elements across these traditions, significant conceptual and practical differences exist, which has led to confusion. Little empirical evidence exists concerning the efficacy of AP as a treatment for chronic pain. DISCUSSION Future research on AP should be based on a clear theoretical foundation, consider the context in which the AP behavior occurs and the type of pacing problem ("underactivity" vs. "overactivity"), and should examine the impact of AP treatment on multiple clinical outcomes. We provide a provisional definition of AP and specific recommendations that we believe will move the field forward.
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Cramp F, Hewlett S, Almeida C, Kirwan JR, Choy EHS, Chalder T, Pollock J, Christensen R. Non-pharmacological interventions for fatigue in rheumatoid arthritis. Cochrane Database Syst Rev 2013:CD008322. [PMID: 23975674 DOI: 10.1002/14651858.cd008322.pub2] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fatigue is a common and potentially distressing symptom for people with rheumatoid arthritis with no accepted evidence based management guidelines. Non-pharmacological interventions, such as physical activity and psychosocial interventions, have been shown to help people with a range of other long-term conditions to manage subjective fatigue. OBJECTIVES To evaluate the benefit and harm of non-pharmacological interventions for the management of fatigue in people with rheumatoid arthritis. This included any intervention that was not classified as pharmacological in accordance with European Union (EU) Directive 2001/83/EEC. SEARCH METHODS The following electronic databases were searched up to October 2012, Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; AMED; CINAHL; PsycINFO; Social Science Citation Index; Web of Science; Dissertation Abstracts International; Current Controlled Trials Register; The National Research Register Archive; The UKCRN Portfolio Database. In addition, reference lists of articles identified for inclusion were checked for additional studies and key authors were contacted. SELECTION CRITERIA Randomised controlled trials were included if they evaluated a non-pharmacological intervention in people with rheumatoid arthritis with self-reported fatigue as an outcome measure. DATA COLLECTION AND ANALYSIS Two review authors selected relevant trials, assessed risk of bias and extracted data. Where appropriate, data were pooled using meta-analysis with a random-effects model. MAIN RESULTS Twenty-four studies met the inclusion criteria, with a total of 2882 participants with rheumatoid arthritis. Included studies investigated physical activity interventions (n = 6 studies; 388 participants), psychosocial interventions (n = 13 studies; 1579 participants), herbal medicine (n = 1 study; 58 participants), omega-3 fatty acid supplementation (n = 1 study; 81 participants), Mediterranean diet (n = 1 study; 51 participants), reflexology (n = 1 study; 11 participants) and the provision of Health Tracker information (n = 1 study; 714 participants). Physical activity was statistically significantly more effective than the control at the end of the intervention period (standardized mean difference (SMD) -0.36, 95% confidence interval (CI) -0.62 to -0.10; back translated to mean difference of 14.4 points lower, 95% CI -4.0 to -24.8 on a 100 point scale where a lower score means less fatigue; number needed to treat for an additional beneficial outcome (NNTB) 7, 95% CI 4 to 26) demonstrating a small beneficial effect upon fatigue. Psychosocial intervention was statistically significantly more effective than the control at the end of the intervention period (SMD -0.24, 95% CI -0.40 to -0.07; back translated to mean difference of 9.6 points lower, 95% CI -2.8 to -16.0 on a 100 point scale, lower score means less fatigue; NNTB 10, 95% CI 6 to 33) demonstrating a small beneficial effect upon fatigue. For the remaining interventions meta-analysis was not possible and there was either no statistically significant difference between trial arms or findings were not reported. Only three studies reported any adverse events and none of these were serious, however, it is possible that the low incidence was in part due to poor reporting. The quality of the evidence ranged from moderate quality for physical activity interventions and Mediterranean diet to low quality for psychosocial interventions and all other interventions. AUTHORS' CONCLUSIONS This review provides some evidence that physical activity and psychosocial interventions provide benefit in relation to self-reported fatigue in adults with rheumatoid arthritis. There is currently insufficient evidence of the effectiveness of other non-pharmacological interventions.
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Affiliation(s)
- Fiona Cramp
- Faculty of Health & Life Sciences, University of the West of England, Glenside campus, Blackberry Hill, Bristol, UK, BS16 1DD
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Beasley J. Osteoarthritis and rheumatoid arthritis: conservative therapeutic management. J Hand Ther 2012; 25:163-71; quiz 172. [PMID: 22326361 DOI: 10.1016/j.jht.2011.11.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/05/2011] [Accepted: 11/07/2011] [Indexed: 02/03/2023]
Abstract
Hand therapists need to understand the basic science behind the therapy they carry out and the current evidence to make the best treatment decisions. The purpose of this article was to review current conservative therapeutic management of patients with rheumatoid arthritis (RA) or osteoarthritis (OA) of the hand. Treatment interventions such as orthotics, exercise, joint protection, modalities, and adaptive equipment are discussed from a basic science and evidence-based practice perspective.
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Affiliation(s)
- Jeanine Beasley
- Occupational Therapy Department, Grand Valley State University, Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan 49503, USA.
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Jehanne Dubouloz C, King J, Ashe B, Paterson B, Chevrier J, Moldoveanu M. The process of transformation in rehabilitation: what does it look like? INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.11.79541] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | - Barbara Paterson
- Tier 1 Canada Research Chair, Dean, School of Nursing, Thompson Rivers University, Kamloops
| | - Jacques Chevrier
- Département des Sciences de l'éducation, Université du Québec en Outaouais, Gatineau, and
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18
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Friedberg F, Sohl SJ. Longitudinal change in chronic fatigue syndrome: what home-based assessments reveal. J Behav Med 2008; 32:209-18. [PMID: 19101789 DOI: 10.1007/s10865-008-9189-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2008] [Accepted: 11/14/2008] [Indexed: 11/30/2022]
Abstract
The purpose of this 2-year prospective study was to compare standard self-report and ecologically-based outcome measures in patients with chronic fatigue syndrome (CFS). Standard measures assessed physical function, fatigue impact, psychological variables, and global impression of change ratings. Ecological measures included actigraphy, a structured activity record, and an electronic fatigue/energy diary. Results for this high functioning sample (N = 75) revealed that self-report global improvement was significantly associated with lower momentary fatigue and fatigue impact, and a higher frequency of standing up (at home), but not with actigraphy or psychological variables. However, actigraphy change was significantly correlated with change in self-report physical function. At follow-up, only a small minority (<20%) scored in the healthy adult range for fatigue impact and physical function. The findings suggest that home-based measures of symptom severity and physical functioning may provide evidence of change (or lack of change) that is important for interpreting standard self-report outcomes in CFS.
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Affiliation(s)
- Fred Friedberg
- Department of Psychiatry and Behavioral Science Putnam Hall, Stony Brook University, NY 11794-8790, USA.
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Dubouloz CJ, Vallerand J, Laporte D, Ashe B, Hall M. Occupational performance modification and personal change among clients receiving rehabilitation services for rheumatoid arthritis. Aust Occup Ther J 2007; 55:30-8. [DOI: 10.1111/j.1440-1630.2006.00639.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
This article considers the evidence for effectiveness and timing of rehabilitation for people with rheumatoid arthritis (RA). The Cochrane Library, DARE, Medline, Embase, CINAHL and AMED were searched to identify systematic reviews and randomized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis. Many trials identified had methodological limitations (e.g. short follow-up periods, small sample sizes). Evidence to date is that symptomatic relief results from thermotherapy, laser therapy, acupuncture and assistive devices. In the short-term, comprehensive occupational therapy (in established rheumatoid arthritis), orthoses, and mind-body approaches can help maintain function. Over at least a one-year period, the following are effective in reducing pain and maintaining function: patient education and joint protection training using behavioural approaches; dynamic exercise therapy, hand exercises and hydrotherapy; and cognitive-behavioural therapy (in people with poorer psychological status). Many trials have recruited people with moderate to severe, established RA and relatively little is known about the long-term effectiveness of early rehabilitation, although this is becoming much more common in practice. Despite the increased availability of guidelines and systematic reviews, most conclude there is insufficient evidence for many areas of rheumatology rehabilitation. Further well-designed clinical trials are needed recruiting people with early disease using patient-centred outcomes.
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Affiliation(s)
- Alison Hammond
- Rheumatology Department, Derbyshire Royal Infirmary, Derby.
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Hewlett S, Hehir M, Kirwan JR. Measuring fatigue in rheumatoid arthritis: a systematic review of scales in use. ACTA ACUST UNITED AC 2007; 57:429-39. [PMID: 17394228 DOI: 10.1002/art.22611] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Fatigue is an important outcome for patients with rheumatoid arthritis (RA). The purpose of this study was to identify the scales being used to measure RA fatigue, and to systematically examine the evidence for their validation. METHODS Articles measuring fatigue in RA were sought using the terms RA and fatigue, and RA and tiredness, plus scale, questionnaire, inventory, and checklist. Index articles reporting identifiable RA fatigue data were examined for the fatigue scale used. Index and validation articles for each scale were reviewed for evidence supporting scale validation to measure RA fatigue using a standardized checklist of content, face, criterion, and construct validity, reliability, and sensitivity to change. RESULTS A total of 61 index articles used 23 different fatigue scales to measure RA fatigue on 71 occasions. Seventeen scales had either no data on validation in RA or limited evidence. Reasonable evidence of validation was identified for 6 scales, each also having some evidence of sensitivity to change: ordinal scales, the Short Form 36 vitality subscale, the Functional Assessment of Chronic Illness Therapy Fatigue Scale, visual analog scales (VAS), the Profile of Mood States, and the RA-specific Multidimensional Assessment of Fatigue scale (MAF). However, the 4 generic scales would benefit from further validation in patients with RA, the VAS requires standardization, and the MAF would benefit from further sensitivity data. CONCLUSION It was possible to identify evidence of reasonable validation for 6 of 23 scales being used to measure RA fatigue. Researchers and clinicians should select scales to measure RA fatigue carefully.
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Affiliation(s)
- S Hewlett
- University of the West of England, Bristol, UK.
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Neill J, Belan I, Ried K. Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review. J Adv Nurs 2006; 56:617-35. [PMID: 17118041 DOI: 10.1111/j.1365-2648.2006.04054.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions. BACKGROUND A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap. METHODS The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987-2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue. RESULTS Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons. CONCLUSION Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.
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Affiliation(s)
- Jane Neill
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia.
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Abstract
PURPOSE OF REVIEW Rehabilitation, including physical therapy and occupational therapy, complements drug therapy in the management of symptoms in patients with rheumatoid arthritis. Approximately 26% of patients with rheumatoid arthritis receive a referral for rehabilitation by rheumatologists. This review summarizes findings on the effectiveness and economic outcomes of physical therapy and occupational therapy in managing rheumatoid arthritis. RECENT FINDINGS Studies evaluating the outcomes of various service delivery models for physical therapy and occupational therapy demonstrate improvements, especially in physical function, among people with rheumatoid arthritis. A recent pilot study examining the primary therapist model also suggests that the primary therapist model may be a viable option for delivering rheumatoid arthritis rehabilitation services. However, the evidence on other alternative models such as the physical therapy/occupational therapy practitioner model is limited. Only a few economic evaluations have been performed, and among those, none examine the cost-effectiveness of different service models. SUMMARY Systematically interpreting the findings of service delivery models in rehabilitation is challenging because of the wide range of interventions and outcome measures used. A thorough understanding of the value of different rehabilitation models will require the guidance of a sound evaluation framework. Future clinical trials should consider including a component for evaluating cost-effectiveness. Such knowledge can contribute to evidence-informed resource allocation.
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Affiliation(s)
- Linda C Li
- Ottawa Health Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada.
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Steultjens EEMJ, Dekker JJ, Bouter LM, Schaardenburg DD, Kuyk MMAH, Van den Ende ECHM. Occupational therapy for rheumatoid arthritis. Cochrane Database Syst Rev 2004; 2004:CD003114. [PMID: 14974005 PMCID: PMC7017227 DOI: 10.1002/14651858.cd003114.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND For persons with rheumatoid arthritis (RA) the physical, personal, familial, social and vocational consequences are extensive. Occupational therapy (OT), with the aim to facilitate task performance and to decrease the consequences of rheumatoid arthritis for daily life activities, is considered to be a cornerstone in the management of rheumatoid arthritis. Till now the efficacy of occupational therapy for patients with rheumatoid arthritis on functional performance and social participation has not been systematically reviewed. OBJECTIVES To determine whether OT interventions (classified as comprehensive therapy, training of motor function, training of skills, instruction on joint protection and energy conservation, counseling, instruction about assistive devices and provision of splints) for rheumatoid arthritis patients improve outcome on functional ability, social participation and/or health related quality of life. SEARCH STRATEGY Relevant full length articles were identified by electronic searches in Medline, Cinahl, Embase, Amed, Scisearch and the Cochrane Musculoskeletal group Specialised Register. The reference list of identified studies and reviews were examined for additional references. Date of last search: December 2002. SELECTION CRITERIA Controlled (randomized and non-randomized) and other than controlled studies (OD) addressing OT for RA patients were eligible for inclusion. DATA COLLECTION AND ANALYSIS The methodological quality of the included trials was independently assessed by two reviewers. Disagreements were resolved by discussion. A list proposed by Van Tulder et al. (Van Tulder 1997) was used to assess the methodological quality. For outcome measures, standardized mean differences were calculated. The results were analysed using a best evidence synthesis based on type of design, methodological quality and the significant findings of outcome and/or process measures. MAIN RESULTS Thirty-eight out of 58 identified occupational therapy studies fulfilled all inclusion criteria. Six controlled studies had a high methodological quality. Given the methodological constraints of uncontrolled studies, nine of these studies were judged to be of sufficient methodological quality. The results of the best evidence synthesis shows that there is strong evidence for the efficacy of "instruction on joint protection" (an absolute benefit of 17.5 to 22.5, relative benefit of 100%) and that limited evidence exists for comprehensive occupational therapy in improving functional ability (an absolute benefit of 8.7, relative benefit of 20%). Indicative findings for evidence that "provision of splints" decreases pain are found (absolute benefit of 1.0, relative benefit of 19%). REVIEWER'S CONCLUSIONS There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis.
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Affiliation(s)
| | - Joost J Dekker
- VU University Medical Center, AmsterdamDepartment of Rehabilitation Medicine, Institute for Research in Extramural Medicine (EMGO)PO Box 7057AmsterdamNetherlands1007 MB
| | - Lex M Bouter
- Vrije UniversiteitExecutive Board of V U UniversityDe Boelelaan 1105, Room 2d‐18AmsterdamNetherlands1081 BT
| | | | - Marie‐Antoinette MAH Kuyk
- University of Professional education Arnhem NijmegenSchool of Occupational therapyP.O. Box 6960NijmegenNetherlands6503 GL
| | - Els CHM Van den Ende
- Sint MaartenskliniekDepartment of RheumatologyHengstdal 3NijmegenNetherlands6522 JV
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25
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Warsi A, LaValley MP, Wang PS, Avorn J, Solomon DH. Arthritis self-management education programs: a meta-analysis of the effect on pain and disability. ARTHRITIS AND RHEUMATISM 2003; 48:2207-13. [PMID: 12905474 DOI: 10.1002/art.11210] [Citation(s) in RCA: 201] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Some reports suggest that education programs help arthritis patients better manage their symptoms and improve function. This review of the published literature was undertaken to assess the effect of such programs on pain and disability. METHODS Medline and HealthSTAR were searched for the period 1964-1998. The references of each article were then hand-searched for further publications. Studies were included in the meta-analysis if the intervention contained a self-management education component, a concurrent control group was included, and pain and/or disability were assessed as end points. Two authors reviewed each study. The methodologic attributes and efficacy of the interventions were assessed using a standardized abstraction tool, and the magnitude of the results was converted to a common measure, the effect size. Summary effect sizes were calculated separately for pain and disability. RESULTS The search strategy yielded 35 studies, of which 17 met inclusion criteria. The mean age of study participants was 61 years, and 69% were female. On average, 19% of patients did not complete followup (range 0-53%). The summary effect size was 0.12 for pain (95% confidence interval [95% CI] 0.00, 0.24) and 0.07 for disability (95% CI 0.00, 0.15). Funnel plots indicated no significant evidence of bias toward the publication of studies with findings that showed reductions in pain or disability. CONCLUSION The summary effect sizes suggest that arthritis self-management education programs result in small reductions in pain and disability.
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Affiliation(s)
- Asra Warsi
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Suite 341, Boston, MA 02115, USA
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26
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Steultjens EMJ, Dekker J, Bouter LM, van Schaardenburg D, van Kuyk MAH, van den Ende CHM. Occupational therapy for rheumatoid arthritis: a systematic review. ARTHRITIS AND RHEUMATISM 2002; 47:672-85. [PMID: 12522844 DOI: 10.1002/art.10801] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Barsevick AM, Whitmer K, Sweeney C, Nail LM. A pilot study examining energy conservation for cancer treatment-related fatigue. Cancer Nurs 2002; 25:333-41. [PMID: 12394560 DOI: 10.1097/00002820-200210000-00001] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this pilot study was to examine the feasibility of conducting an energy conservation and activity management (ECAM) intervention for cancer treatment-related fatigue and describe patterns of cancer treatment-related fatigue for two groups undergoing active treatment, one receiving the ECAM intervention and a nonequivalent control group receiving standard care for cancer treatment-related fatigue. The ECAM group received 3 telephone sessions focusing on the provision of information about fatigue, development of an energy conservation plan, and evaluation of the plan's effectiveness. Data for the ECAM group were collected before treatment, at an expected fatigue high point during treatment, and an expected low point of fatigue after treatment. The nonequivalent control group lacked the pretreatment measure but had equivalent follow-up measurement points. The feasibility of conducting the ECAM intervention was supported by patient adherence in receiving all 3 sessions of the intervention and by their self-reports of its usefulness and plans to continue using ECAM skills. Patterns of fatigue differed for the ECAM study group and the nonequivalent control group, suggesting that the intervention moderates the expected rise in fatigue due to cancer therapy. A full-scale clinical trial is needed to evaluate the efficacy of the ECAM intervention.
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Abstract
BACKGROUND Because of the unpredictability people with arthritis face on a daily basis, patient education programmes have become an effective complement to traditional medical treatment giving people with arthritis the strategies and the tools necessary to make daily decisions to cope with the disease. OBJECTIVES To assess the effectiveness of patient education interventions on health status in patients with rheumatoid arthritis. SEARCH STRATEGY We searched MEDLINE, EMBASE and PsycINFO and the Cochrane Controlled Trials Register. A selection of review articles (see references) were examined to identify further relevant publications. There was no language restriction. SELECTION CRITERIA Randomised controlled trials (RCT's) evaluating patient education interventions that included an instructional component and a non-intervention control group; pre- and post-test results available separately for RA, either in the publication or from the studies' authors; and study results presented in full, end-of-study report. MAIN RESULTS Twenty-four studies with relevant data were included. We found significant effects of patient education at first follow-up for scores on disability, joint counts, patient global assessment and psychological status. Physician global assessment was not assessed in any of the included studies. The two separate dimensions of psychological status: anxiety and depression showed no significant effects, nor did the dimensions of pain and disease activity. At final follow up no significant effects of patient education were found. REVIEWER'S CONCLUSIONS Patient education as provided in the studies reviewed here had moderate short-term effects on patient global assessment, and small short-term effects on disability, joint counts and psychological status. There were no long-term benefits.
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Affiliation(s)
- R P Riemsma
- NHS Centre for Reviews and DIssemination, University of York, Heslington, York, UK, YO10 5DD.
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29
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Mathiowetz V, Matuska KM, Murphy ME. Efficacy of an energy conservation course for persons with multiple sclerosis. Arch Phys Med Rehabil 2001; 82:449-56. [PMID: 11295003 DOI: 10.1053/apmr.2001.22192] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the efficacy of an energy conservation course on fatigue impact, self-efficacy, and quality of life (QOL) for persons with multiple sclerosis (MS). DESIGN Repeated measures with control and experimental interventions conducted during a 19-week study. SETTING Community-based treatment center. PARTICIPANTS A convenience sample of 54 individuals from 79 community-dwelling volunteers with fatigue secondary to MS. INTERVENTION A 6-session, 2-hr/wk energy conservation course taught by occupational therapists for groups of 8 to 10 participants. MAIN OUTCOME MEASURES Fatigue Impact Scale (self-report measure of fatigue impact on cognitive, physical, social functions), Self-Efficacy Gauge (self-report measure of confidence in ability to perform specific behaviors), and Medical Outcomes Study Short-Form Health Survey (QOL measure). RESULTS Participants reported, as predicted, significantly less fatigue impact, increased self-efficacy, and improved QOL (ie, 3 of 4 subscales expected to improve). There were no significant differences, as predicted, in any of the dependent variables after the control (ie, support group) and no intervention periods. CONCLUSION Results provide strong evidence for the efficacy of this energy conservation course for persons with MS.
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Affiliation(s)
- V Mathiowetz
- Department of Physical Medicine & Rehabilitation, University of Minnesota, Minneapolis, MN 55455, USA.
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30
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Keysor JJ, Currey SS, Callahan LF. Behavioral Aspects of Arthritis and Rheumatic Disease Self-Management. ACTA ACUST UNITED AC 2001. [DOI: 10.2165/00115677-200109020-00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Hammond A, Lincoln N, Sutcliffe L. A crossover trial evaluating an educational-behavioural joint protection programme for people with rheumatoid arthritis. PATIENT EDUCATION AND COUNSELING 1999; 37:19-32. [PMID: 10640116 DOI: 10.1016/s0738-3991(98)00093-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Joint protection (JP) is a self-management technique widely taught to people with rheumatoid arthritis (RA). JP education aims to enable people with RA to reduce pain, inflammation, joint stress and reduce risks of deformity through using assistive devices and alternative movement patterns of affected joints to perform everyday activities. Previous studies evaluating JP education methods common in the UK have identified JP adherence is poor. A group education programme was developed using the Health Belief Model and Self-efficacy Theory. Strategies used to maximise JP adherence included goal-setting, contracting, modelling, homework programmes, motor learning theory, recall enhancing methods and mental practice. A crossover trial (n = 35) was conducted. Adherence with JP was measured using an objective observational test (the Joint Protection Behaviour Assessment). Significant improvements in use of JP were recorded at 12 and 24 weeks post-education (P < 0.01). No significant changes in measures of pain, functional disability, grip strength, self-efficacy or helplessness occurred post-education, although this may have been due to the small sample size recruited. In conclusion, JP adherence can be facilitated through the use of educational-behavioural strategies, suggesting this approach should be more widely adopted in clinical practice.
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Affiliation(s)
- A Hammond
- School of Health and Community Studies, University of Derby, UK
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32
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Brus HL, van de Laar MA, Taal E, Rasker JJ, Wiegman O. Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis. Ann Rheum Dis 1998; 57:146-51. [PMID: 9640129 PMCID: PMC1752549 DOI: 10.1136/ard.57.3.146] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the effects of patient education on compliance and on health in patients with active, recent onset rheumatoid arthritis (RA). METHODS A randomised, controlled, assessor blinded, one year trial. The experimental group followed an education programme. All patients started on sulphasalazine therapy. Compliance with sulphasalazine was measured by pill counting. Compliance rates with regimens of physical exercise, endurance activities, and energy conservation were measured by questionnaires. Compliance with prescriptions of joint protection was scored using a test for joint protection performance. Health was measured by a Disease Activity Score (function of erythrocyte sedimentation rate, Ritchie score, and number of swollen joints), C reactive protein, Dutch-AIMS scores, and M-HAQ scores, range of motion of shoulder, elbow, and knee joints. Parameters were scored at baseline and after three, six, and 12 months. RESULTS Sixty of 65 patients gave informed consent, five of them withdrew from follow up. Compliance with sulphasalazine exceeded 80% with no differences between groups. Compliance with physical exercise (at three months), energy conservation (at three and at 12 months), and joint protection (at three months) improved significantly more in the experimental group. The improvements of health were not different in the groups. CONCLUSION Compliance with sulphasalazine among patients with active, recent onset RA is high, whether formal patient education is followed or not. Compliance with physical exercise, energy conservation, and joint protection was increased by patient education. Formal patient education did not improve health status.
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Affiliation(s)
- H L Brus
- Department of Rheumatology, Medisch Spectrum Twente, The Netherlands
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33
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Abstract
This article reviews the effectiveness of group education programs in improving the knowledge, behavior, and health status of patients with rheumatoid arthritis (RA) and evaluates to what extent various programs fulfill certain criteria for educational self-management programs. Thirty-one studies are reviewed: in 12, patients with various rheumatic diseases including RA were included, and in 19, only RA patients were studied. Group education increased the knowledge of the participants, which was maintained over long intervals. Beneficial behavioral effects were found in mixed populations but less often found in RA patients. Group education often improved physical health status both in mixed and in RA populations, but seldom led to improved psychosocial health status. In general, the beneficial effects of group education were found more often in mixed populations than in strictly RA patients. Further investigations must examine which mechanisms make educational interventions effective and determine the types of interventions or combinations of interventions that are effective. Effects of group education on health status are almost never maintained over long intervals. More research is needed to develop strategies for maintaining and enhancing early gains from group education.
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Affiliation(s)
- E Taal
- Department of Psychology, University of Twente, Enschede, The Netherlands
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34
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Brus H, van de Laar M, Taal E, Rasker J, Wiegman O. Compliance in rheumatoid arthritis and the role of formal patient education. Semin Arthritis Rheum 1997; 26:702-10. [PMID: 9062951 DOI: 10.1016/s0049-0172(97)80006-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was performed to determine the compliance with the basic treatments for rheumatoid arthritis (RA; medication, physical therapy, and ergonomic measures), to study psychological factors that influence compliance in light of the social learning theory, to learn whether patient education positively influences compliance and health, and to find an approach to patient education that improves compliance. METHODS A MEDLINE search of the English language literature was performed. RESULTS Few studies have dealt with compliance in RA patients; levels of adherence are generally low. According to the social learning theory, human function involves a continuous interaction between behavior, personal factors, and external environment. Self-efficacy is a personal factor that refers to the belief in one's capabilities and opportunities for being compliant with treatment advice. Patient education may improve ergonomic performance and compliance with physical exercise programs. CONCLUSIONS Compliance with medication was infrequently studied. Whether improved compliance leads to better health status could not be determined. Compliance with RA treatments are generally low. Systematic study of the effect of patient education on treatment and health is warranted. Self-efficacy enhancing techniques in patient education may improve compliance.
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Affiliation(s)
- H Brus
- Rheumatology Twente, Department of Rheumatology, Enschede, The Netherlands
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35
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Hill J. A practical guide to patient education and information giving. BAILLIERE'S CLINICAL RHEUMATOLOGY 1997; 11:109-27. [PMID: 9088528 DOI: 10.1016/s0950-3579(97)80036-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Patient education is accepted as an essential component in the management of rheumatoid arthritis (RA) and this chapter provides an overview of patient education for practising clinicians. It includes an explanation of the need for patient education including the results of studies into what patients already know. The effectiveness of patient education and its benefits to patients are discussed in the light of recent research, reviews and meta-analyses. Alternative methods of delivering patient education are compared including, one-to-one teaching, opportunity education, group teaching and self-management programmes. Topics for inclusion in education programmes are suggested and the merits of written literature, audio-visual and computer assisted learning are explained. Practical guidance is given on methods of ensuring that written information is readily understandable by patients, including the use of readability formulae.
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Affiliation(s)
- J Hill
- Clinical Pharmacology Unit (Rheumatism Research), University of Leeds, Chapel Allerton Hospital, UK
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36
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Henriksson C, Burckhardt C. Impact of fibromyalgia on everyday life: a study of women in the USA and Sweden. Disabil Rehabil 1996; 18:241-8. [PMID: 8743302 DOI: 10.3109/09638289609166308] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The study investigated how 39 women with fibromyalgia (FM), living in two countries (USA or Sweden), report the consequences of fibromyalgia on everyday life activities. Data were collected using questionnaires, diaries and interviews. The result showed that the impact on everyday life was considerable. The majority of the women experienced pain and fatigue for more than 90% of their time awake. There were no significant differences between the national groups in time use, problems with everyday activities, or quality of life. Overall, the differences between individuals were greater than between the national groups. The majority of the employed patients in the Swedish group had reduced their working time, while the employed patients in the USA group worked mainly full-time. Patients who were able to reduce their working hours to fit their perceived capacity were less exhausted during their leisure, and reported higher satisfaction with daily activities.
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Affiliation(s)
- C Henriksson
- Department of Caring Sciences, Faculty of Health Sciences, University Hospital, Linköping, Sweden
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37
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Henriksson KG, Bäckman E, Henriksson C, de Laval JH. Chronic regional muscular pain in women with precise manipulation work. A study of pain characteristics, muscle function, and impact on daily activities. Scand J Rheumatol 1996; 25:213-23. [PMID: 8792798 DOI: 10.3109/03009749609069990] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Pain characteristics, muscle function and impact on daily activities were studied in 39 women with chronic regional muscular pain (RMP). They were all blue-collar workers in work involving precise manipulations. The main location of the pain was in the neck-shoulder region. Nineteen age-matched women with fibromyalgia (FM) were studied in the same way as the RMP patients. Thirty-seven women with no pain and with the same age and weight as the RMP patients served as reference group with respect to muscle strength and endurance. A follow-up study was done with respect to pain distribution and other pain characteristics 20 months after the initial examination. The findings were of the same nature in the RMP and the FM groups. The intensity of pain, the lowering of pain threshold for pressure, and the degree of sleep disturbance were greater in the FM than in the RMP group. Isometric muscle strength and static muscular endurance were reduced in both FM and RMP compared to reference values. The reduction in strength and endurance was greater in FM than in RMP. Even if the impact on everyday activities were greater in FM than in RMP, the impact was substantial in RMP patients also, for example with regard to work capacity. There were no transitions from RMP to FM during the 20 months to follow-up. Three FM patients, however, did not meet the ACR criteria for FM at follow-up.
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Affiliation(s)
- K G Henriksson
- Neuromuscular Unit and Pain Clinic, University Hospital, Linköping, Sweden
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38
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Hawley DJ. Psycho-educational interventions in the treatment of arthritis. BAILLIERE'S CLINICAL RHEUMATOLOGY 1995; 9:803-23. [PMID: 8591655 DOI: 10.1016/s0950-3579(05)80315-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patient education has a long history as an integral part of clinical practice; however, controlled clinical trials of psycho-educational interventions for the rheumatic disorders emerged in significant numbers over the last 15 to 20 years. In this chapter, the efficacy of these interventions was reviewed in 34 reports (54 separate treatment arms) published in the last 10 years. Psycho-educational interventions included both traditional educational or teaching activities and psychological interventions. The most common types of intervention were self-management programmes ((21 treatment arms) and cognitive-behavioral therapy (10 treatment arms). Both approaches emphasize learning new skills helpful in managing one's disease. Self-management programmes are broadly focused on using information, problem-solving and coping skills for symptom management. Cognitive-behavioural therapy usually emphasizes control of pain by understanding the interaction of emotions and cognition with the physical and behavioral aspects of pain. Other interventions, tested either individually or as comparisons for self-management or cognitive-behavioural therapy interventions, included traditional classroom-type programmes (four treatment arms), 'materials' including pamphlets, books and computerized instruction (seven treatment arms), individualized instruction (five treatment arms), psychotherapy (one), and support groups (three treatment arms). Sixty per cent of studies used clinic samples, 52% rheumatoid arthritis and 8% with osteoarthritis. The remaining studies recruited from community samples where the exact diagnosis was not always clear, though most had either RA or OA. The majority of self-management interventions used community samples. The average effect size for treatment compared to non-intervention controls (weighted for sample size) for RA patient pain, functional ability and depression at post intervention was 0.13, -0.16 and 0.01 compared with 0.44, 0.28 and 0.56 for OA patients and 0.21, 0.08 and 0.12 for community samples. At 3 months follow-up, self-management programmes demonstrated improvement compared to controls for self-efficacy (effect sizes 0.22 to 0.29) with community patients while cognitive-behavioural therapy interventions demonstrated similar improvements in active coping skills (effect sizes 0.09 to 0.18) with RA patients. Effect sizes ranged from 0.6 to 1.1 for exercise compliance following self-management interventions. In the few studies with follow-up evaluations extending beyond 3 months post-intervention, effects generally weaken. As expected, psycho-educational interventions do not alter physical functioning with functional abilities continuing to decline over time. Lorig and colleagues have demonstrated in 4-year outcome studies important reductions in the use of health care services for participants in self-management programmes despite the progression of functional disability. Psycho-educational interventions are difficult to evaluate because of the differences in interventions, methods of assessment and varying follow-up times. Studies of these interventions differ in quality, patient population, etc., precluding a useful meta analysis. Overall, there is improvement in pain, depressive symptoms, self-efficacy, coping abilities, and self-management behaviours such as exercise compliance following psycho-educational interventions, with a trend to greater improvement for OA than RA patients. Utilization of health care services may be reduced following educational interventions. Although the overall improvement is small, it is probably of the order of that seen with therapy with NSAIDs and is independent of medical treatment. Psycho-educational interventions are a useful additional modality in the management of rheumatic diseases and may improve treatment effects and patient quality of life.
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Affiliation(s)
- D J Hawley
- Graduate Program, School of Nursing, Wichita State University, Fairmont, KS 67260-0041, USA
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Beeson P. Podiatric perspective: a case study of rheumatoid arthritis and a multidisciplinary approach. ACTA ACUST UNITED AC 1995. [DOI: 10.12968/bjtr.1995.2.10.566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P Beeson
- Senior Lecturer in Podiatry at the Northampton School of Podiatry, Northampton General Hospital, Cliftonville, Northampton NN1 5BD
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Chwalow AJ. Cross-cultural validation of existing quality of life scales. PATIENT EDUCATION AND COUNSELING 1995; 26:313-318. [PMID: 7494743 DOI: 10.1016/0738-3991(95)00767-t] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Health care has recently tended to take a more global perspective when considering the individual patient. In addition to a measure of functional status, the integration of the disease into the daily life of the individual, or his quality of life, is now being evaluated. This concept, while relatively recent, is the result, in part, of changes in attitudes towards diagnosis and treatment of patients, particularly those with chronic and severe diseases. Over time, what is sought is a measurement of change in the level of well-being during the evolution of an illness. In clinical trials, the different levels that exist between 2 groups may be measured. The validation of a quality of life scale requires both a qualitative and a quantitative approach with attention being paid to the methodological issues in scale development. Specific statistical techniques are used to modify evolving versions. The cross-cultural adaptation of an existing scale into another language requires a rigorous qualitative phase before the quantitative phase is begun. The end product of this approach should be an equivalent scale, rather than a literal translation.
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Kraaimaat FW, Brons MR, Geenen R, Bijlsma JW. The effect of cognitive behavior therapy in patients with rheumatoid arthritis. Behav Res Ther 1995; 33:487-95. [PMID: 7598669 DOI: 10.1016/0005-7967(94)00094-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In order to examine the effectiveness of cognitive behavioral therapy for patients with rheumatoid arthritis (RA) three patients groups were studied: a cognitive behavioral therapy group (CBT), an occupational therapy group (OT), and a waiting-list control group. The CBT received a comprehensive, 10-session treatment package that taught progressive relaxation, rational thinking and the differential use of pain coping strategies. CBT resulted in minor changes in pain coping behavior at posttreatment, while CBT and OT showed an increase of knowledge of RA. No therapeutic effects with regard to health status were demonstrated at posttreatment and at 6 months follow-up. Clinical and laboratory measures of disease activity revealed progressive deterioration of the patients during the course of the study. It is suggested that the ineffectiveness of CBT might be due to the progressive course of RA in the patients studied, as well as to the rather small changes in coping behavior.
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Affiliation(s)
- F W Kraaimaat
- Department of Clinical Psychology, University of Amsterdam, The Netherlands
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Belza B. The impact of fatigue on exercise performance. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1994; 7:176-80. [PMID: 7734475 DOI: 10.1002/art.1790070404] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this paper is to discuss the impact of fatigue on exercise performance. First, fatigue will be defined and distinguished from similar constructs. Second, examples of instruments to measure fatigue in the rheumatic diseases are highlighted. Next, the social implications of fatigue are briefly mentioned. Fourth, methods in which fatigue impacts exercise performance are discussed. Fifth, the prevalence of fatigue in arthritis and its relationship to exercise will be presented. And last, areas of future research and roles of clinicians in managing fatigue relative to exercise performance are proposed.
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Hammond A. Joint protection behavior in patients with rheumatoid arthritis following an education program: a pilot study. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1994; 7:5-9. [PMID: 7918727 DOI: 10.1002/art.1790070103] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Joint protection (JP) education is a common feature in rheumatoid arthritis (RA) treatment programs. However, no objective studies have been published demonstrating patients' behavior changes following such education. This study evaluated whether RA patients' hand movement patterns altered following a JP education program. METHODS An assessment procedure was constructed to assess application of four JP principles related to altering patterns of hand use during common everyday activities (making a hot drink and snack meal). RESULTS Eleven RA patients were assessed. There was no significant behavioral change at 6 weeks post-JP education (t = 10; P > 0.1). In contrast, follow-up interviews of self-perceived JP behavior showed all subjects considered JP relevant for them and seven believed they had changed to using these techniques. CONCLUSIONS This suggests education led to attitudinal change but that behavioral change requires longer and more targeted input than is currently normally provided.
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Gerber LH, Furst GP. Scoring methods and application of the activity record (ACTRE) for patients with musculoskeletal disorders. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1992; 5:151-6. [PMID: 1457490 DOI: 10.1002/art.1790050307] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The National Institutes of Health (NIH) Activity Record (ACTRE) has been used to document daily activities in patients with musculoskeletal disorders. Quantification of the amount of time spent resting and physically active, the intensity of pain and fatigue associated with patterns of activities, and motivational considerations are possible with the ACTRE. Scoring has been streamlined to permit identification of the amount of pain, fatigue, and motivational factors as they relate to activity patterns (e.g., rest and physical activity). The ACTRE provides a performance-based, quantifiable measure of daily activity.
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Gerber LH, Furst GP. Validation of the NIH activity record: a quantitative measure of life activities. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1992; 5:81-6. [PMID: 1390968 DOI: 10.1002/art.1790050206] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article reports the results of the validation of a life activity record. We devised a self-administered daily log (the NIH Activity Record, ACTRE), for persons with rheumatoid arthritis (RA), which recorded specific daily activities over a 24-hour period and identified the level of physical effort for each task. In addition, each activity was assigned a level of pain, fatigue, difficulty, competence, meaningfulness and enjoyment. Twenty-one persons with RA completed the log. They underwent an articular examination (AI) (Ritchie Articular Index) as well as completed the following self-reports: Psychosocial Adjustment to Illness Scale (PAIS); The Feeling Tone Checklist (FTC), a measure of fatigue; The Modified Health Assessment Questionnaire (ALI); and the Pain and Disability Index (PDI). Significant correlations were found between fatigue measured by ACTRE and FTC (p = 0.028); pain measured by ACTRE, PDI (p = 0.002), and (p = 0.01) and the visual analog scale in the ALI (p = 0.0002). Pain experienced while performing self-care measured by ACTRE correlated with AI (p = 0.001) and ALI (p = 0.0013). Difficulty with self-care activities on the ACTRE correlated with difficulty (p = 0.007) and pain (p = 0.012) on the ALI. The ACTRE is a valid measure of symptoms and perceptions that can be quantified, and is unique in that it identifies specific daily activities likely to produce them.
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Abstract
Individuals experiencing post-polio sequelae (PPS) are usually advised to make significant lifestyle changes to lessen symptoms and prevent further decline in function. These individuals have spent most of their lives equating success with over-achievement and find it difficult to implement such recommendations. As specialists in energy conservation and work simplification, occupational therapyists increasingly are being called on to evaluate and treat these patients. Over the past 2 years, an occupational therapy educational program has been developed to educate patients about their condition and about ways to implement lifestyle changes while preserving the ability to do valued activities. This article describes the components of a thorough occupational therapy evaluation and the design and functional outcomes of a successful occupational therapy educational program to treat PPS.
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Affiliation(s)
- G R Young
- Department of Occupational Therapy, Kaiser-Permanente Medical Center, Downey, Calif. 90242
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Abstract
Fatigue was studied in 12 subjects with post-polio sequelae (PPS). Results of the Fatigue Severity Scale (FSS) demonstrated a mean score of 4.8 +/- 1.6 (non-disabled scores = 2.3 +/- 0.7). The Human Activity Profile (HAP) was not sensitive enough to measure fatigue. Fifty percent of subjects scored below the first percentile based on age and sex matched norms. The Activity Record (ACTRE) results revealed that subjects spent 5% of their time resting and 1% in planning or preparation activities. Fatigue peaked in the late morning or early afternoon and was relieved by rest periods. Use of energy conservation and work simplification skills along with frequent rest periods was suggested as a possible method for managing PPS fatigue.
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Affiliation(s)
- T L Packer
- Division of Occupational Therapy, School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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Tack BB. Fatigue in rheumatoid arthritis: Conditions, strategies, and consequences. Arthritis Care Res (Hoboken) 1990. [DOI: 10.1002/art.1790030203] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bell MJ, Bombardier C, Tugwell P. Measurement of functional status, quality of life, and utility in rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 1990; 33:591-601. [PMID: 2183806 DOI: 10.1002/art.1780330420] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
In 40 years of development in the area of quality of life, the goal of applicability to the individual patient has not been accomplished. During the 1980s, we strived to improve the applicability of these instruments by refining disease-specific measures and developing patient-specific measures so that the sensitivity of these tools to clinically important change could be increased and comparative indices across conditions could be established. Finding the balance between brevity, reliability, and comprehensiveness will improve practicality. The reliability of serial measurements using the various instruments in individual patients and in small groups of patients needs to be established. In the absence of a gold standard, validity will continue to be derived from testing new measures against accepted clinical measures. The ideal tool for use in clinical practice has not yet been developed. At this time, the clinician may choose among the many reliable and valid questionnaires assessing functional status, health status, and utility, according to his or her purpose. The information gathered from these instruments may help identify patients' problems, set treatment priorities, direct interventions, monitor the longitudinal course of disease, and assist in program evaluation and policy planning.
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Affiliation(s)
- M J Bell
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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