Background Previous clinical trials proved an educational-behavioural joint protection (EB-JP) programme is more effective than “standard” teaching in increasing people with rheumatoid arthritis’ (RA) use of joint protection (JP).
Objective This study aimed to investigate if rheumatology occupational therapists (OT), following a 2 day training course, can in clinical practice similarly enable people with RA to increase use of JP.
Methods The study was conducted with 3 trained OTs at 3 hospitals using a randomised, crossover design. Demographic, Patient Knowledge Questionnaire (PKQ), hand and functional status measures were recorded at baseline, 3 and 6 months. The main outcome was the Joint Protection Behaviour Assessment (JPBA): a valid, reliable observational assessment of JP hand actions in kitchen activities.
Results 30 people with RA participated: 27 women and 3 men, average age 52.3 years (SD 12.1) with average disease duration of 6.76 years (SD 7.02). There was no significant difference in JPBA scores at baseline between the two groups: E1 (education first) = 17% (SD 15%) and E2 (education delayed) = 20% (SD 7.4%) (p = 0.16). At 3 months E1 JPBA scores significantly increased to 41% (SD 15.9%) and E2 did not change: 25% (SD 20%) (p = 0.003). Both groups increased use of JP overall at 6 months (p < 0.01). There was a significant increase in PKQ scores (p < 0.00). No change in hand and functional status occurred, apart from increased grip strength (p < 0.01), but the follow-up period was probably too short to identify improvements. Most participants considered the programme relevant to their needs and found the emphasis on practical training very helpful.
Conclusion A 2 day training course, plus detailed programme manual, enables rheumatology OTs to deliver this programme successfully in practice, suggesting this programme should now be disseminated.
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