Hammond A, Young A, Kidao R
Rheumatology, Derbyshire Royal Infirmary, London Road, Derby DE1 2QY, UK.
Ann Rheum Dis. 2004 Jan;63(1):23-30. doi: 10.1136/ard.2002.001511.
Occupational therapy (OT) aims at improving performance of daily living tasks, facilitating successful adjustments in lifestyle, and preventing losses of function.
To evaluate the effects of a pragmatic, comprehensive OT programme on self management and health status of people with early rheumatoid arthritis (RA) (<2.5 years).
A randomised, controlled "assessor blinded" trial was conducted with assessments made at entry, 6, 12, and 24 months. Main outcomes were AIMS2: physical function (PF), pain visual analogue scale (VAS), and Arthritis Self-Efficacy Scale (ASES).
Groups had similar disease duration (9 months OT (n = 162) v 10 months control (n = 164)). The OT group received 7.57 (SD 3.04) hours of therapy. Self management significantly increased in the OT group. Otherwise, there were no significant differences in any outcome measures, or between groups, by ACR functional class: AIMS2: PF (F = 0.04; p = 0.96); pain VAS (F = 0.29; p = 0.74); total ASES score (F = 0.93; p = 0.39).
OT improved self management but not health status in early RA. Functional ability remains reasonably good for many in the first five years, so preventive benefits of self management may not yet be apparent and longer follow up is needed. Although many considered the education and therapy useful, insufficient numbers in the OT group used self management sufficiently to make a difference. Behavioural approaches can improve adherence and, potentially, the long term benefits. Future research should evaluate OT as a complex intervention and develop programmes from a theoretical and evidence base.
职业治疗（OT）旨在提高日常生活任务的执行能力，促进生活方式的成功调整，并预防功能丧失。
评估一项实用、全面的职业治疗方案对早期类风湿关节炎（RA）（病程<2.5年）患者自我管理和健康状况的影响。
进行一项随机对照的“评估者盲法”试验，在入组时、6个月、12个月和24个月进行评估。主要结局指标为AIMS2：身体功能（PF）、疼痛视觉模拟量表（VAS）和关节炎自我效能量表（ASES）。
两组疾病持续时间相似（职业治疗组9个月（n = 162），对照组10个月（n = 164））。职业治疗组接受了7.57（标准差3.04）小时的治疗。职业治疗组的自我管理能力显著提高。此外，根据美国风湿病学会（ACR）功能分级，在任何结局指标或两组之间均无显著差异：AIMS2：PF（F = 0.04；p = 0.96）；疼痛VAS（F = 0.29；p = 0.74）；ASES总分（F = 0.93；p = 0.39）。
职业治疗改善了早期类风湿关节炎患者的自我管理能力，但未改善健康状况。在最初五年中，许多患者的功能能力仍相当良好，因此自我管理的预防益处可能尚未显现，需要更长时间的随访。尽管许多人认为教育和治疗有用，但职业治疗组中充分使用自我管理方法以产生差异的人数不足。行为方法可以提高依从性，并可能带来长期益处。未来的研究应将职业治疗评估为一种复杂干预措施，并从理论和证据基础上制定方案。
