School of Nursing, College of Medicine, Chang Gung University, Wenhua 1st Road, Taoyuan City, Taiwan. No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan; Department of Joint Reconstruction, Chang Gung Memorial Hospital, Linkou. No. 5, Fu-Hsin St., Guishan Dist., Taoyuan City 333, Taiwan.
Department of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taiwan. No.5, Fu-Hsin St., Guishan Dist., Taoyuan City 333, Taiwan; Chang Gung University, Taiwan. No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City 333, Taiwan.
Int J Nurs Stud. 2021 Apr;116:103752. doi: 10.1016/j.ijnurstu.2020.103752. Epub 2020 Aug 19.
Rheumatoid arthritis is a chronic, systemic disease, which results in progressive destruction of the joints and a reduction in quality of life. Joint protection can minimize injuries that worsen arthritis and pain and certain activities can help patients control or reduce the symptoms of this chronic disease.
To determine the effectiveness of a self-management program for joint protection and physical activity for patients with rheumatoid arthritis based on self-efficacy theory.
A two-arm (experimental vs control) randomized trial.
Adult patients with rheumatoid arthritis were recruited from rheumatology departments of a medical center in Northern Taiwan. A total of 224 patients met the inclusion criteria and agreed to participate in the study.
Eligible participants with rheumatoid arthritis were randomly assigned to either an 8-week program in self-management of joint protection and physical activity with nursing support (intervention group, n = 112) or standard care for rheumatology (control group, n = 112). Outcome variables were assessed at baseline and 2-, 3-, and 6-months after commencement of the intervention, which included measures of disease activity, and self-assessments for self-efficacy, quality of life, and self-management behaviors. Differences in outcome variables over time between the groups were analyzed with generalized estimating equations; the level of significance was set at p < 05.
The mean age of participants was 58.8 years, duration of the rheumatoid arthritis was 10 years, and most participants (86%) were female. Characteristics and assessment variables did not differ between the two groups at baseline. When compared with the control group at 6 months following initiation of the self-management program, participants in the intervention group demonstrated significantly greater improvement in physical functioning (B = 4.08, p < 05), self-efficacy of pain (B = 4.89, p < .05), and self-management behaviors (B = 4.65, p < 05).
A self-management program based on self-efficacy theory that focused on joint protection and physical activities resulted in significant improvements in physical functioning, self-efficacy, and self-management behaviors 6 months following commencement of the intervention. Nurses provided individualized evaluations and support, which may have made it easier for participants to learn and perform the activities. After commencement of participation in the intervention, no improvements were seen until 6 months of participation. This delay may suggest patients with chronic disease may need a longer duration of self-management training and increased follow-up time to incorporate lifestyle changes. Future studies measuring long-term outcomes are suggested.
类风湿关节炎是一种慢性全身性疾病，会导致关节进行性破坏和生活质量下降。关节保护可以最大限度地减少加重关节炎和疼痛的损伤，某些活动有助于患者控制或减轻这种慢性疾病的症状。
基于自我效能理论，确定类风湿关节炎患者关节保护和身体活动自我管理计划的有效性。
双臂（实验组与对照组）随机试验。
来自台湾北部一家医学中心风湿病科的成年类风湿关节炎患者。共有 224 名符合纳入标准并同意参加研究的患者。
将符合条件的类风湿关节炎患者随机分配至 8 周的关节保护和身体活动自我管理计划与护理支持（干预组，n=112）或风湿病标准护理（对照组，n=112）。在干预开始后 2、3 和 6 个月评估结局变量，包括疾病活动度以及自我效能、生活质量和自我管理行为的自我评估。使用广义估计方程分析组间随时间变化的结局变量差异；显著性水平设为 p<0.05。
参与者的平均年龄为 58.8 岁，类风湿关节炎持续时间为 10 年，大多数（86%）参与者为女性。基线时两组的特征和评估变量无差异。与自我管理计划开始后 6 个月的对照组相比，干预组参与者在身体机能（B=4.08，p<0.05）、疼痛自我效能（B=4.89，p<0.05）和自我管理行为（B=4.65，p<0.05）方面的改善更为显著。
基于自我效能理论的自我管理计划侧重于关节保护和身体活动，在干预开始后 6 个月可显著改善身体机能、自我效能和自我管理行为。护士提供个性化评估和支持，这可能使参与者更容易学习和执行活动。参与干预后，6 个月才开始看到改善。这种延迟可能表明慢性病患者可能需要更长时间的自我管理培训和增加随访时间来改变生活方式。建议进行测量长期结局的未来研究。
