Effect of Energy Conservation and Joint Protection Education en Rheumatoid Arthritis

Abstract

As there is relatively little information about the effectiveness of occupational therapy (OT) in RA a questionnaire was devised to assess whether patient knowledge and performance of joint protection manoeuvres improved following OT intervention and, if improved, whether this was sustained over 6 months. A photographic multiple choice questionnaire was devised covering major categories of activities of daily living. The study population consisted of 55 patients with RA attending a rheumatology clinic who had not previously had OT treatment. Patients had a single instruction/treatment session with an occupational therapist of 1-h duration. Prior to treatment the questionnaire was administered by an independent assessor who re-administered the questionnaire 1 month and 6 months after the OT session. Following treatment there was a significant increase in scores at 1 month compared with pre-treatment (P < 0.001). There was no significant change in score at 6 months compared with 1 month. Qualitative analysis of age and sex showed no significant effects. OT leads to sustained improvement in patient knowledge and probably performance of joint protection manoeuvres in RA.

Is health equity considered in systematic reviews of the cochrane musculoskeletal group?

“…Five of the 11 primary studies analyzed the results by gender (41, 48–51); only 1 study reported a difference (48). In this study, Hall et al reported the results of balneotherapy on knee range of motion separately for men and women (48).…”

Occupational therapy for rheumatoid arthritis: A systematic review

“…Four RCTs/CCTs (19,24,40) and four ODs (45)(46)(47)(48) (Table 3) were identified for the intervention "instruction on joint protection and energy conservation." One of the RCTs (40) had high methodological quality.…”

“…Seven studies (19,24,40,45,47,48) assessed functional ability. Hammond et al (40) reported significant improvement in functional ability.…”

“…Of the 7 studies (19,24,40,45,46,48) that assessed knowledge, 2 RCTs/CCTs (24,40) demonstrated a significant increase in knowledge after patients received instruction on joint protection. All ODs with sufficient methodologic quality (45,46,48) supported these findings. Thus, on the basis of the results of one high quality RCT (40), there is limited evidence that instruction on joint protection leads to an improvement of functional ability (Table 5).…”

What is Evidence-Based Practice?

“…No RCT of joint protection was found; however, of the eight articles identified, Neubergeret al (1993), Hammond (1994), Undroth et al (1995), Barry et al (1994) and Nordenskiold (1994) provide some research evidence of the value of joint protection education programmes on attitudes, knowledge and coping strategies. Palmer and Simons' (1991) article gives a broad summary of the evidence underpinning the principles of joint protection.…”