Hammond A, Lincoln N, Sutcliffe L
School of Health and Community Studies, University of Derby, UK.
Patient Educ Couns. 1999 May;37(1):19-32. doi: 10.1016/s0738-3991(98)00093-7.
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.
关节保护（JP）是一种广泛传授给类风湿性关节炎（RA）患者的自我管理技巧。JP教育旨在使RA患者通过使用辅助器械以及受影响关节的替代运动模式来进行日常活动，从而减轻疼痛、炎症、关节压力并降低畸形风险。先前评估英国常见的JP教育方法的研究发现，JP的依从性较差。利用健康信念模型和自我效能理论制定了一个团体教育计划。用于最大限度提高JP依从性的策略包括目标设定、契约制定、示范、家庭作业计划、运动学习理论、回忆增强方法和心理练习。进行了一项交叉试验（n = 35）。使用客观观察测试（关节保护行为评估）来衡量对JP的依从性。在教育后的12周和24周，记录到JP使用情况有显著改善（P < 0.01）。教育后，疼痛、功能残疾、握力、自我效能或无助感的测量指标没有显著变化，尽管这可能是由于招募的样本量较小所致。总之，通过使用教育行为策略可以促进对JP的依从性，这表明这种方法应在临床实践中更广泛地采用。
