Joint Protection Principles: Difference between revisions

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== Introduction  ==
== Introduction  ==
*Functional ability is reduced in 60% of people&nbsp;with rheumatoid arthritis (RA) within the first five&nbsp;years from diagnosis, with 16% developing more&nbsp;severe functional disability and 44% following a&nbsp;remittingurelapsing course.<ref name="young">Young A, Dixey J, Cox Net al. How does functional ability in early rheumatoid arthritis (RA)affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early Rheumatoid Arthritis Study (ERAS)Rheumatology 2000;39: 603�/11.</ref>&nbsp;<br>  
 
*<span>&nbsp;</span>Within two years 50%&nbsp;experience difficulties in household tasks.<ref name="eb">Eberhardt KB, Rydgren LC, Petersson H, WollheimfckLRFA. Early rheumatoid arthritis�/ onset, course andfckLRoutcomes after two years.Rheumatol Int 1990;10:fckLR135�/42.</ref>&nbsp;  
*Functional ability is reduced in 60% of people&nbsp;with rheumatoid arthritis (RA) within the first five&nbsp;years from diagnosis, with 16% developing more&nbsp;severe functional disability and 44% following a&nbsp;remittingurelapsing course.<ref name="young">Young A, Dixey J, Cox Net al. How does functional ability in early rheumatoid arthritis (RA)affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early Rheumatoid Arthritis Study (ERAS)Rheumatology 2000;39: 603-11.</ref>&nbsp;<br>  
*Women&nbsp;with RA can have on average only 40% of normal&nbsp;power and pinch grip within six months of&nbsp;diagnosis, even with early commencement of&nbsp;disease-modifying drugs (DMARDs).<ref name="hammond">Hammond A, Kidao R, Young A. Hand impairment and function in early rheumatoid arthritis.Arthritis Rheum2000;43(9 suppl):S285.</ref>&nbsp;This suggests therapy to help maintain hand function and&nbsp;independence should be provided early for those&nbsp;developing functional limitations.  
*<span>&nbsp;</span>Within two years 50%&nbsp;experience difficulties in household tasks.<ref name="eb">Eberhardt KB, Rydgren LC, Petersson H, WollheimfckLRFA. Early rheumatoid arthritis- onset, course andfckLRoutcomes after two years.Rheumatol Int 1990;10:135-42.</ref>&nbsp;  
*Joint protection is a self-management approach&nbsp;that aims to maintain functional ability through&nbsp;altering working methods and movement patterns&nbsp;of affected joints, using assistive devices and&nbsp;pacing activities. This helps reduce pain, inflammation and stresses applied to joints during daily&nbsp;activity and may help preserve the integrity of joint&nbsp;structures longer term.<ref name="cj">Cordery J, Rocchi M. Joint protection and fatigue  management. In: Melvin J, Jensen G eds. Rheumatologic rehabilitation, Volume 1:Assessment and management. Bethesda, MD: American Occupational Therapy Association, 1998: 279�/322.</ref>&nbsp;<ref name="mj">Melvin J.Rheumatic disease: occupational therapyfckLRand rehabilitation, second edition. Philadelphia: FA Davis, 1989: 351�/71</ref>  
*Women&nbsp;with RA can have on average only 40% of normal&nbsp;power and pinch grip within six months of&nbsp;diagnosis, even with early commencement of&nbsp;disease-modifying drugs (DMARDs).<ref name="hammond">Hammond A, Kidao R, Young A. Hand impairment and function in early rheumatoid arthritis.Arthritis Rheum 2000;43(9 suppl):S285.</ref>&nbsp;This suggests therapy to help maintain hand function and&nbsp;independence should be provided early for those&nbsp;developing functional limitations.  
*Joint protection is a self-management approach&nbsp;that aims to maintain functional ability through&nbsp;altering working methods and movement patterns&nbsp;of affected joints, using assistive devices and&nbsp;pacing activities. This helps reduce pain, inflammation and stresses applied to joints during daily&nbsp;activity and may help preserve the integrity of joint&nbsp;structures longer term.<ref name="cj">Cordery J, Rocchi M. Joint protection and fatigue  management. In: Melvin J, Jensen G eds. Rheumatologic rehabilitation, Volume 1:Assessment and management. Bethesda, MD: American Occupational Therapy Association, 1998: 279-322.</ref>&nbsp;<ref name="mj">Melvin J.Rheumatic disease: occupational therapy and rehabilitation, second edition. Philadelphia: FA Davis, 1989: 351-71</ref>  
*Rheumatology health&nbsp;professionals commonly teach joint protection. Focus is on&nbsp;changing hand habits, and increasingly people are&nbsp;referred earlier in the disease process for this&nbsp;education.  
*Rheumatology health&nbsp;professionals commonly teach joint protection. Focus is on&nbsp;changing hand habits, and increasingly people are&nbsp;referred earlier in the disease process for this&nbsp;education.  
*Providing self-management information (such as&nbsp;joint protection advice) does not, on its own, lead&nbsp;to significant improvements in adherence or health&nbsp;status.<ref name="rrp">Riemsma RP, Kirwan JR, Taal E, Rasker JJ. PatientfckLReducation for adults with rheumatoid arthritis(Cochrane review). In:The Cochrane Library, Issue 2. Oxford: Update Software, 2003.</ref> Behavioural approaches (i.e., skills practice, goal-setting and home programmes) are&nbsp;significantly more effective in increasing use of&nbsp;joint protection than ‘standard’ education (i.e.,&nbsp;information, demonstration and short supervised&nbsp;practice) anduor information booklets.  
*Providing self-management information (such as&nbsp;joint protection advice) does not, on its own, lead&nbsp;to significant improvements in adherence or health&nbsp;status.<ref name="rrp">Riemsma RP, Kirwan JR, Taal E, Rasker JJ. PatientfckLReducation for adults with rheumatoid arthritis(Cochrane review). In:The Cochrane Library, Issue 2. Oxford: Update Software, 2003.</ref> Behavioural approaches (i.e., skills practice, goal-setting and home programmes) are&nbsp;significantly more effective in increasing use of&nbsp;joint protection than ‘standard’ education (i.e.,&nbsp;information, demonstration and short supervised&nbsp;practice) anduor information booklets.  
*&nbsp;This&nbsp;approach is effective for people with both early&nbsp;(&lt;5 years) <ref name="ha">Hammond A, Freeman K. One year outcomes of afckLRrandomised controlled trial of an educational�/fckLRbehavioural joint protection programme for peoplefckLRwith rheumatoid arthritis.Rheumatology2001;40:fckLR1044�/51.</ref>&nbsp;<ref name="bh">Brus HLM, van der Laar MAFJ, Taal E, Rasker JH. Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis.Ann Rheum Dis  1998; 57: 146�/51.</ref>and established RA (&gt;/5 years).<ref name="haln">Hammond A, Lincoln N, Sutcliffe L. A crossoverfckLRtrial evaluating an educational�/behavioural jointfckLRprotection education programme for people with rheumatoid arthritis.Patient Educ CounsellingfckLR1999;37:19�/32.</ref>&nbsp;<ref>Hammond A, Jeffreson P, Jones N, Gallagher J, Jones T. Clinical applicability of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Br J Occup Ther 2002;65: 405�/12</ref>
*&nbsp;This&nbsp;approach is effective for people with both early&nbsp;(&lt;5 years) <ref name="ha">Hammond A, Freeman K. One year outcomes of afckLRrandomised controlled trial of an educational- behavioural joint protection programme for peoplefckLRwith rheumatoid arthritis.Rheumatology2001;40:1044-51.</ref>&nbsp;<ref name="bh">Brus HLM, van der Laar MAFJ, Taal E, Rasker JH. Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis.Ann Rheum Dis  1998; 57: 146-51.</ref>and established RA (&gt;/5 years).<ref name="haln">Hammond A, Lincoln N, Sutcliffe L. A crossoverfckLRtrial evaluating an educational behavioural joint protection education programme for people with rheumatoid arthritis.Patient Educ CounsellingfckLR1999;37:19-32.</ref>&nbsp;<ref>Hammond A, Jeffreson P, Jones N, Gallagher J, Jones T. Clinical applicability of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Br J Occup Ther 2002;65: 405-12</ref>


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== References  ==
== References  ==
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Revision as of 19:29, 2 December 2013

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Introduction[edit | edit source]

  • Functional ability is reduced in 60% of people with rheumatoid arthritis (RA) within the first five years from diagnosis, with 16% developing more severe functional disability and 44% following a remittingurelapsing course.[1] 
  •  Within two years 50% experience difficulties in household tasks.[2] 
  • Women with RA can have on average only 40% of normal power and pinch grip within six months of diagnosis, even with early commencement of disease-modifying drugs (DMARDs).[3] This suggests therapy to help maintain hand function and independence should be provided early for those developing functional limitations.
  • Joint protection is a self-management approach that aims to maintain functional ability through altering working methods and movement patterns of affected joints, using assistive devices and pacing activities. This helps reduce pain, inflammation and stresses applied to joints during daily activity and may help preserve the integrity of joint structures longer term.[4] [5]
  • Rheumatology health professionals commonly teach joint protection. Focus is on changing hand habits, and increasingly people are referred earlier in the disease process for this education.
  • Providing self-management information (such as joint protection advice) does not, on its own, lead to significant improvements in adherence or health status.[6] Behavioural approaches (i.e., skills practice, goal-setting and home programmes) are significantly more effective in increasing use of joint protection than ‘standard’ education (i.e., information, demonstration and short supervised practice) anduor information booklets.
  •  This approach is effective for people with both early (<5 years) [7] [8]and established RA (>/5 years).[9] [10]



References[edit | edit source]

  1. ↑ Young A, Dixey J, Cox Net al. How does functional ability in early rheumatoid arthritis (RA)affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early Rheumatoid Arthritis Study (ERAS)Rheumatology 2000;39: 603-11.
  2. ↑ Eberhardt KB, Rydgren LC, Petersson H, WollheimfckLRFA. Early rheumatoid arthritis- onset, course andfckLRoutcomes after two years.Rheumatol Int 1990;10:135-42.
  3. ↑ Hammond A, Kidao R, Young A. Hand impairment and function in early rheumatoid arthritis.Arthritis Rheum 2000;43(9 suppl):S285.
  4. ↑ Cordery J, Rocchi M. Joint protection and fatigue management. In: Melvin J, Jensen G eds. Rheumatologic rehabilitation, Volume 1:Assessment and management. Bethesda, MD: American Occupational Therapy Association, 1998: 279-322.
  5. ↑ Melvin J.Rheumatic disease: occupational therapy and rehabilitation, second edition. Philadelphia: FA Davis, 1989: 351-71
  6. ↑ Riemsma RP, Kirwan JR, Taal E, Rasker JJ. PatientfckLReducation for adults with rheumatoid arthritis(Cochrane review). In:The Cochrane Library, Issue 2. Oxford: Update Software, 2003.
  7. ↑ Hammond A, Freeman K. One year outcomes of afckLRrandomised controlled trial of an educational- behavioural joint protection programme for peoplefckLRwith rheumatoid arthritis.Rheumatology2001;40:1044-51.
  8. ↑ Brus HLM, van der Laar MAFJ, Taal E, Rasker JH. Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis.Ann Rheum Dis 1998; 57: 146-51.
  9. ↑ Hammond A, Lincoln N, Sutcliffe L. A crossoverfckLRtrial evaluating an educational behavioural joint protection education programme for people with rheumatoid arthritis.Patient Educ CounsellingfckLR1999;37:19-32.
  10. ↑ Hammond A, Jeffreson P, Jones N, Gallagher J, Jones T. Clinical applicability of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Br J Occup Ther 2002;65: 405-12

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