Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial

Niedermann, Karin; de Bie, Rob A.; Kubli, Regula; Ciurea, Adrian; Steurer-Stey, Claudia; Villiger, Peter M.; Büchi, Stefan

doi:10.1016/j.pec.2010.02.014

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Volume 82, Issue 1 , Pages 42-48, January 2011

Effectiveness of individual resource-oriented joint protection education in people with rheumatoid arthritis. A randomized controlled trial

Karin Niedermann
- Department of Rheumatology and Institute of Physical Medicine, University Hospital, Zurich, Switzerland
- CAPHRI Research Institute, Maastricht University, Netherlands
- Institute of Physiotherapy, Zurich University of Applied Sciences, Winterthur, Switzerland
- Corresponding author at: University Hospital, Department of Rheumatology and Institute of Physical Medicine, Gloriastrasse 25, CH-8091 Zurich, Switzerland. Tel.: +41 44 255 21 49; fax: +41 44 255 43 88.
Rob A. de Bie
- Department of Epidemiology, Faculty of Health Sciences, Maastricht University, Netherlands
- CAPHRI Research Institute, Maastricht University, Netherlands
Regula Kubli
- Institute of Occupational Therapy, Zurich University of Applied Sciences, Winterthur, Switzerland
Adrian Ciurea
- Department of Rheumatology and Institute of Physical Medicine, University Hospital, Zurich, Switzerland
Claudia Steurer-Stey
- Department of General Practice and Health Services Research, Section Chronic Care and Patient Education, University of Zurich, Switzerland
Peter M. Villiger
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital, Inselspital, University of Bern, Switzerland
Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics “Hohenegg”, Meilen, Switzerland

Received 24 September 2009; received in revised form 6 February 2010; accepted 14 February 2010. published online 07 May 2010.

Abstract

Objective

The modern joint protection (JP) concept for people with rheumatoid arthritis (RA) is an active coping strategy to improve daily tasks and role performance by changing working methods and using assistive devices. Effective group JP education includes psycho-educational interventions. The Pictorial Representation of Illness and Self Measure (PRISM) is an interactive hands-on-tool, assessing (a) the individual's perceived burden of illness and (b) relevant individual resources. Both issues are important for intrinsic motivation to take action and change behaviour. This study compared individual conventional JP education (C-JP) with PRISM-based JP education (PRISM-JP).

Methods

An assessor-blinded multicentre randomized controlled trial, including four JP education sessions over 3 weeks, with assessments at baseline and 3 months.

Results

In total 53 RA patients participated. At 3 months, the PRISM-JP (n=26) participants did significantly better compared to the C-JP participants (n=27) in JP behaviour (p=0.02 and p=0.008 when corrected for baseline values), Arthritis Self-efficacy (ASES, p=0.015) and JP self-efficacy (JP-SES, p=0.047). Within-group analysis also showed less hand pain (p<0.001) in PRISM-JP group.

Conclusion

PRISM-JP more effectively supported learning of JP methods, with meaningful occupations, resource activation and self-efficacy acting as important mediators.