Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial
Effects of a modular behavioural arthritis education programme: a pragmatic parallel-group randomized controlled trial
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DOI：
10.1093/rheumatology/ken380
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发表时间：
2008-11-01
期刊：
影响因子：
5.5
通讯作者：
Hardy, A.
中科院分区：
文献类型：
--
作者：
Hammond, A.;Bryan, J.;Hardy, A.
目标.风湿病学指南建议RA患者接受行为自我管理教育。本研究开发了一个模块化的行为组程序，并评估其对疼痛，身体和心理状态的长期影响。RA或PsA患者被随机分配到一个模块化的行为或标准的以信息为重点的教育计划中，这两个计划都由一家大型地区综合医院的经验丰富的风湿病学卫生专业人员提供。结果指标包括疼痛、自我效能、疲劳、功能能力、心理状态和健康行为的使用（运动、关节保护、疲劳和认知症状管理）。采用意向治疗分析，比较6个月和12个月时的结果，并进行协方差分析。在498名转诊患者中，218名同意参加，符合入选标准并被随机分配; 51名在教育前退出。其余患者中，86人参加了行为方案，81人参加了标准方案。参与者年龄为55.4岁（S.D. 12.42），病程7.39（S.D. 6.88）岁（53%<5岁）。在6个月时，行为组的疼痛（P = 0.01）、疲劳（P = 0.01）、功能能力（P = 0.05）和自我效能（P = 0.01）评分更好，并且更多地使用健康行为。在12个月时，他们继续有更好的疼痛（P = 0.03），自我效能（P = 0.001）和心理状态（P = 0.0001）评分和更多的使用一些健康行为。参加模块化行为教育计划至少有效1年，使RA和PsA患者能够减轻疼痛，改善心理状态和自我管理病情。
Objectives. Rheumatology guidelines recommend people with RA receive behavioural self-management education. This study developed a modular behavioural group programme and evaluated its longer term effects on pain, physical and psychological status.Methods. People with RA or PsA were randomized to a modular behavioural or standard information-focused education programme, both delivered by experienced rheumatology health professionals at one large district general hospital. Outcome measures were pain, self-efficacy, fatigue, functional ability, psychological status and use of health behaviours (exercise, joint protection, fatigue and cognitive symptom management). Using an intent-to-treat analysis outcomes were compared at 6 and 12 months with analysis of covariance.Results. Out of 498 referred patients, 218 agreed to participate, met entry criteria and were randomized; 51 withdrew before education. Of the remaining patients, 86 attended the behavioural and 81 the standard programmes. Participants were aged 55.4 yrs (S.D. 12.42) with disease duration of 7.39 (S.D. 6.88) yrs (53% < 5 yrs). At 6 months, the behavioural group had better pain (P = 0.01), fatigue (P = 0.01), functional ability (P = 0.05) and self-efficacy (P = 0.01) scores and greater use of health behaviours. At 12 months, they continued to have better pain (P = 0.03), self-efficacy (P = 0.001) and psychological status (P = 0.0001) scores and greater use of some health behaviours.Conclusion. Attending a modular behavioural education programme is effective for at least 1 yr in enabling people with RA and PsA to reduce pain, improve psychological status and self-manage their condition.