一项针对类风湿性关节炎患者的循证手部锻炼计划的在线版本：一项有效性-实施性研究。

The online version of an evidence-based hand exercise programme for people with rheumatoid arthritis: An effectiveness-implementation study.

作者信息

Srikesavan Cynthia, Williamson Esther, Lamb Sarah E

机构信息

Public Health and Sports Sciences, University of Exeter, Exeter, United Kingdom; The Centre for Rehabilitation Research in Oxford, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom.

出版信息

J Hand Ther. 2025 Jan-Mar;38(1):23-32. doi: 10.1016/j.jht.2024.11.001. Epub 2025 Jan 2.

DOI:10.1016/j.jht.2024.11.001

PMID:39753498

Abstract

BACKGROUND

The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is an evidence-based exercise program for adults with hand function difficulties due to rheumatoid arthritis. A self-guided online version of the program has been developed for direct access by patients.

PURPOSE

To evaluate the delivery of the online program in routine therapy care and its impact on clinical outcomes, before making it widely available.

STUDY DESIGN

An effectiveness-implementation study.

METHODS

Volunteer patients were identified from National Health Service (NHS) hand therapy departments in the United Kingdom. Patients were given access to the 4-week program, delivered via text, videos, polls, and social discussion forums. Self-reported pain and hand function were collected at baseline, discharge, and telephone follow-up at 4 months. Delivery of baseline and discharge sessions, acceptability, and patient engagement and experience were also explored.

RESULTS

A total of 78 patients were enrolled from 18 therapy departments in 15 NHS trusts in England, Scotland, and Wales. Sixty-five patients took part, of whom 46 (71%) registered with the online SARAH program. The majority of baseline and discharge sessions were delivered face-to-face. Pain improved at discharge and was stable at follow-up. Hand function significantly improved with medium effect sizes of Cohen's d of 0.6 and 0.52 respectively. The majority of patients rated themselves as improved and were continuing the SARAH exercises at discharge and 4 months. No related adverse effects were reported. Patient engagement was high during the first week of the program but gradually declined. Most patients were satisfied and found the program useful.

CONCLUSIONS

The online SARAH program delivered in routine therapy care was acceptable and beneficial to patients. Improvements in clinical outcomes were similar to the SARAH clinical trial and our previous implementation work.

摘要

背景

手部类风湿性关节炎强化与伸展（SARAH）计划是一项针对因类风湿性关节炎而存在手部功能障碍的成年人的循证运动计划。该计划已开发出自我引导的在线版本，可供患者直接使用。

目的

在广泛推广在线计划之前，评估其在常规治疗护理中的实施情况及其对临床结果的影响。

研究设计

一项有效性-实施性研究。

方法

从英国国家医疗服务体系（NHS）的手部治疗科室中招募志愿者患者。患者可以使用为期4周的计划，该计划通过文本、视频、投票和社交讨论论坛提供。在基线、出院时以及4个月的电话随访中收集自我报告的疼痛和手部功能情况。还探讨了基线和出院环节的实施情况、可接受性以及患者的参与度和体验。

结果

在英格兰、苏格兰和威尔士的15个NHS信托机构的18个治疗科室中，共招募了78名患者。65名患者参与其中，其中46名（71%）注册了在线SARAH计划。大多数基线和出院环节是面对面进行的。出院时疼痛有所改善，随访时保持稳定。手部功能显著改善，Cohen's d效应量分别为中等的0.6和0.52。大多数患者在出院时和4个月时将自己评为有所改善，并继续进行SARAH锻炼。未报告相关不良反应。计划第一周患者的参与度较高，但逐渐下降。大多数患者感到满意并认为该计划有用。