Clinical Applicability of an Educational-Behavioural Joint Protection Programme for People with Rheumatoid Arthritis

• Published in: The British journal of occupational therapy 2002-09, Vol.65 (9), p.405-412
• Main Authors: Hammond, Alison, Jeffreson, Paula, Jones, Nerys, Gallagher, Jane, Jones, Tracy
• Format: Article
• Language: English
• Subjects: Health education; Joint; Limbs; Occupational therapy; Protection; Rheumatoid arthritis
• ISSN: 0308-0226; 1477-6006
• DOI: 10.1177/030802260206500903

Joint protection is a major part of rheumatology occupational therapy. Recent research emphasises that an educational-behavioural approach is more effective than current practice in enabling people with rheumatoid arthritis (RA) to increase their use of joint protection and benefit from reduced pain and inflammation and improved function. The aim of this study was to evaluate whether occupational therapists, following a 2-day training course in delivering an educational-behavioural joint protection programme, could enable people with RA to improve use of joint protection significantly and obtain similar results to previous clinical trials. This tested whether it would be feasible to introduce the programme into clinical practice. Three occupational therapists attended a ‘Looking After Your Joints’ training course for leaders. A single-blind crossover trial was conducted. Three centres participated, with each therapist delivering two or three joint protection programmes. Thirty participants with RA attended: 27 women and 3 men, with a mean age of 52.3 years (SD 12.08) and a mean disease duration of 6.76 years (SD 7.02). The primary outcome measure was an observational assessment of use of joint protection, the Joint Protection Behaviour Assessment (JPBA; Hammond and Lincoln 1999b). The median baseline JPBA score for all 30 participants was 15.39% (IQR 11.45–26.82%), which rose significantly to 35% (IQR 25–42.40%) (Z = −3.97; p = 0.0001) at 6 months following the programme. Both participants and therapists expressed positive views of the efficacy of this training approach. Sixteen participants increased use of joint protection by 20% or more. The findings highlight that the 2-day training course facilitated therapists in delivering the programme effectively and they could gain similar behavioural improvements to previous clinical trials.