The effect of a joint protection education programme for people with rheumatoid arthritis

Abstract

Objective: To evaluate the effects of an education programme in improving adherence with joint protection by people with rheumatoid arthritis (RA). Design: A repeated measures design. Subjects were assessed at six weeks and one week before and six and twelve weeks after education. Setting: Rheumatology unit in a large district general hospital. Subjects: Twenty-one people diagnosed with RA (mean age 48.95 years (SD 12.54) and disease duration of 6.43 years (SD 7.7)). Intervention: An 8-hour arthritis education programme delivered over four sessions, including two hours of joint protection education designed to be typical of current UK practice. Main outcome measures: The Joint Protection Behaviour Assessment (JPBA), an observational assessment of hand joint protection methods used during kitchen activities, to measure adherence with education. Other assessments included a joint protection knowledge questionnaire, hand joint counts, hand pain visual analogue scale, the Health Assessment Questionnaire (HAQ) and HAQ Pain scale to identify any short-term changes in hand pain, pain on activity and functional status. At the beginning and end of the study subjects were interviewed to obtain their self-report of joint protection behaviours and reasons for following or not following the advice given. Results: Median JPBA scores did not improve pre- to posteducation (18.4% to 23.7%; p= 0.65) and neither did hand joint count, hand pain, HAQ and HAQ Pain scores. However, joint protection knowledge improved significantly (p = 0.01) and the majority of people believed joint protection to be a beneficial strategy. Reasons for not changing behaviour included problems recalling information; joint protection being considered inappropriate as ‘hands were not that bad yet’; lack of skill; and difficulties changing habits. Conclusion: The joint protection education programme improved knowledge but not use of taught methods. Educational strategies being used by therapists need to be focused on enhancing adherence.