Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center, Leiden, the Netherlands.
Amsterdam Rehabilitation Research Center, Amsterdam, the Netherlands.
Phys Ther. 2021 Aug 1;101(8). doi: 10.1093/ptj/pzab127.
This guideline revises the 2008 Royal Dutch Society for Physical Therapy guideline for physical therapy for patients with rheumatoid arthritis (RA).
This revised guideline was developed according to the Appraisal of Guidelines for Research and Evaluation tool and the Guidelines International Network standards. A multidisciplinary guideline panel formulated clinical questions based on perceived barriers in current care. For every clinical question, a narrative or systematic literature review was undertaken, where appropriate. The guideline panel formulated recommendations based on the results of the literature reviews, the values and preferences of patients and clinicians, and the acceptability, feasibility, and costs, as described in the Grading of Recommendations Assessment, Development and Evaluation evidence-to-decision framework.
The eventual guideline describes a comprehensive assessment based on the International Classification of Functioning, Disability and Health Core Set for RA. It also includes a description of yellow and red flags to support direct access. Based on the assessment, 3 treatment profiles are distinguished: (1) education and exercise instructions with limited supervision, (2) education and short-term supervised exercise therapy, and (3) education and intensified supervised exercise therapy. Education includes RA-related information, advice, and self-management support. Exercises are based on recommendations concerning the desired frequency, intensity, type, and time-related characteristics of the exercises (FITT factors). Their interpretation is compliant with the individual patient's situation and with public health recommendations for health-enhancing physical activity. Recommended measurement instruments for monitoring and evaluation include the Patient-Specific Complaint instrument, Numeric Rating Scales for pain and fatigue, the Health Assessment Questionnaire Disability Index, and the 6-minute walk test.
An evidence-based physical therapy guideline was delivered, providing ready-to-use recommendations on the assessment and treatment of patients with RA. An active implementation strategy to enhance its use in daily practice is advised.
This evidence-based practice guideline guides the physical therapist in the treatment of patients with RA. The cornerstones of physical therapist treatment for patients with RA are active exercise therapy in combination with education. Passive interventions such as massage, electrotherapy, thermotherapy, low-level laser therapy, ultrasound, and medical taping play a subordinate role.
本指南修订了 2008 年荷兰皇家物理治疗学会针对类风湿关节炎（RA）患者的物理治疗指南。
本修订指南是根据评估研究和评估工具以及指南国际网络标准制定的。一个多学科的指南小组根据当前护理中的障碍制定了临床问题。对于每个临床问题，都进行了叙述性或系统的文献综述，如果合适的话。指南小组根据文献综述的结果、患者和临床医生的价值观和偏好以及可接受性、可行性和成本制定建议，如在推荐评估、制定和评估证据决策框架中所述。
最终的指南描述了基于 RA 的国际功能、残疾和健康分类核心集的全面评估。它还包括描述了支持直接访问的黄色和红色标志。基于评估，区分了 3 种治疗方案：（1）教育和有限监督下的运动指导，（2）教育和短期监督下的运动治疗，以及（3）教育和强化监督下的运动治疗。教育包括与 RA 相关的信息、建议和自我管理支持。运动基于有关所需频率、强度、类型和与时间相关的运动特征（FITT 因素）的建议。它们的解释符合患者的个体情况和促进健康的身体活动的公共卫生建议。用于监测和评估的推荐测量仪器包括患者特定投诉量表、疼痛和疲劳的数字评分量表、健康评估问卷残疾指数和 6 分钟步行测试。
提供了一份基于证据的物理治疗指南，为 RA 患者的评估和治疗提供了现成的建议。建议采取积极的实施策略来增强其在日常实践中的应用。
本循证实践指南指导物理治疗师治疗 RA 患者。物理治疗师治疗 RA 患者的基石是主动运动治疗与教育相结合。被动干预，如按摩、电疗、热疗、低水平激光治疗、超声和医用胶带，发挥次要作用。
