The effect of a joint protection education programme for people with rheumatoid arthritis

To evaluate the effects of an education programme in improving adherence with joint protection by people with rheumatoid arthritis (RA).

A repeated measures design. Subjects were assessed at six weeks and one week before and six and twelve weeks after education.

Rheumatology unit in a large district general hospital.

Twenty-one people diagnosed with RA (mean age 48.95 years (SD 12.54) and disease duration of 6.43 years (SD 7.7) ).

An 8-hour arthritis education programme delivered over four sessions, including two hours of joint protection education designed to be typical of current UK practice.

The Joint Protection Behaviour Assessment (JPBA), an observational assessment of hand joint protection methods used during kitchen activities, to measure adherence with education. Other assessments included a joint protection knowledge questionnaire, hand joint counts, hand pain visual analogue scale, the Health Assessment Questionnaire (HAQ) and HAQ Pain scale to identify any short-term changes in hand pain, pain on activity and functional status. At the beginning and end of the study subjects were interviewed to obtain their self-report of joint protection behaviours and reasons for following or not following the advice given.

Median JPBA scores did not improve pre- to posteducation (18.4% to 23.7%; p = 0.65) and neither did hand joint count, hand pain, HAQ and HAQ Pain scores. However, joint protection knowledge improved significantly (p = 0.01) and the majority of people believed joint protection to be a beneficial strategy. Reasons for not changing behaviour included problems recalling information; joint protection being considered inappropriate as 'hands were not that bad yet'; lack of skill; and difficulties changing habits.

The joint protection education programme improved knowledge but not use of taught methods. Educational strategies being used by therapists need to be focused on enhancing adherence.