Occupational therapy for rheumatoid arthritis (Review)
Occupational therapy for rheumatoid arthritis (Review)
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类风湿性关节炎的职业治疗（综述）
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
C. V. D. Ende
中科院分区：
文献类型：
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作者：
E. Steultjens;J. Dekker;L. Bouter;D. Schaardenburg;M. V. Kuyk‐Minis;C. V. D. Ende
58个确定的职业治疗研究中有38个符合所有纳入标准。6项对照研究具有较高的方法学质量。考虑到非对照研究的方法学限制，这些研究中有9项被认为具有足够的方法学质量。最佳证据综合的结果显示，“关节保护指导”的有效性有强有力的证据（绝对效益为17.5 - 22.5，相对效益为100%），而综合职业治疗在改善功能能力方面的证据有限（绝对效益为8.7，相对效益为20%）。发现了“提供夹板”减轻疼痛的指示性发现（绝对获益为1.0，相对获益为19%）。作者的结论：有证据表明，职业治疗对类风湿关节炎患者的功能能力有积极的影响。类风湿关节炎的职业疗法是否对类风湿关节炎有帮助？为了回答这个问题，科学家们分析了38项研究。这些研究测试了1700多名类风湿关节炎患者。人们要么接受咨询，接受技能培训，要么接受训练，以减轻运动或做日常家务的痛苦，教他们保护关节，给他们夹板，教他们使用辅助设备，要么不接受治疗。并非所有的研究都是高质量的，但这篇Cochrane综述提供了我们今天所拥有的关于职业治疗的最佳证据。什么是职业疗法？它如何帮助类风湿关节炎？类风湿性关节炎是一种身体免疫系统攻击自身健康组织的疾病。这种疾病主要发生在脚和手的关节，导致关节周围发红、疼痛、肿胀和发热。类风湿性关节炎患者很难做日常琐事，如穿衣、做饭、清洁和工作。职业治疗师可以就如何减少疼痛进行日常活动或如何使用夹板和辅助设备提供建议。它的效果如何？一项高质量的研究表明，经过培训、建议和咨询的职业治疗后，人们可以更好地完成日常家务。两项高质量的研究表明，在如何保护关节方面得到建议的人比没有得到建议或其他类型的职业治疗的人能更好地完成日常家务。但这两种疗法都无助于改善整体健康状况或缓解疼痛。另一项高质量的研究表明，接受运动或日常活动训练的人与没有接受职业治疗的人一样可以运动得很好，而且疼痛程度相同。在佩戴夹板后，他们的握力也立即得到改善。但戴上夹板后，手部活动变少了。没有足够的信息来说明使用辅助设备的建议是否有帮助。底线是什么？有“黄金”级证据表明，职业疗法可以帮助类风湿关节炎患者做日常琐事，如穿衣、做饭和清洁，并减轻疼痛。职业疗法的好处包括培训、建议和咨询，以及关节保护方面的建议。夹板可以减轻疼痛，提高握力，但可能会减少手部活动。2类风湿性关节炎的职业治疗（综述）版权所有©2008 Cochrane协作。约翰·威利父子有限公司出版。与健康人相比，类风湿关节炎（RA）患者表现出身体能力的下降。疼痛、疲劳、僵硬和肌肉力量下降等症状导致日常活动出现困难，如梳妆打扮、做饭、打扫卫生、购物、工作和休闲活动。类风湿性关节炎对身体、个人、家庭、社会和职业的影响是广泛的。职业治疗（OT）关注的是促进人们进行日常生活活动，并通过维持或提高能力来克服障碍，或弥补职业表现中能力的下降（Lindquist 1999）。职业治疗中最重要的干预措施是技能培训、咨询、关节保护技能教育、辅助装置处方和提供夹板（Melvin 1998）。职业治疗师对类风湿性关节炎患者最常选择的三种干预措施是使用辅助设备的建议/指导、自我护理活动的培训和生产力活动（Driessen 1997）。到目前为止，关于类风湿关节炎患者的职业治疗对功能表现和社会参与的影响的证据还没有系统的综述。到目前为止，一篇叙述性综述（Clarke 1999）仅基于少数关于职业治疗的研究结果，讨论了夹板、关节保护和提供辅助/设备对几种风湿性疾病的有效性。一篇Cochrane综述（Egan 2003）探讨了夹板和矫形器对RA患者的疗效，仅评估了一小部分OT干预措施。因此，我们对已发表的评估类风湿性关节炎职业治疗的研究进行了系统回顾，以确定职业干预是否能改善RA患者的功能能力、社会参与和/或健康相关生活质量。
Main results Thirty-eight out of 58 identified occupational therapy studies fulfilled all inclusion criteria. Six controlled studies had a high methodological quality. Given the methodological constraints of uncontrolled studies, nine of these studies were judged to be of sufficient methodological quality. The results of the best evidence synthesis shows that there is strong evidence for the efficacy of “instruction on joint protection” (an absolute benefit of 17.5 to 22.5, relative benefit of 100%) and that limited evidence exists for comprehensive occupational therapy in improving functional ability (an absolute benefit of 8.7, relative benefit of 20%). Indicative findings for evidence that “provision of splints” decreases pain are found (absolute benefit of 1.0, relative benefit of 19%). Authors’ conclusions There is evidence that occupational therapy has a positive effect on functional ability in patients with rheumatoid arthritis. P L A I N L A N G U A G E S U M M A R Y Occupational therapy for rheumatoid arthritis Does occupational therapy help people with rheumatoid arthritis? To answer this question, scientists analysed 38 studies. The studies tested over 1700 people who had rheumatoid arthritis. People were either counseled, trained in skills or trained to move or do daily chores with less pain, taught to protect their joints, given splints, taught to use assistive devices, or had no therapy. Not all studies were high quality but this Cochrane Review provides the best evidence about occupational therapy that we have today. What is occupational therapy and how could it help rheumatoid arthritis? Rheumatoid arthritis is a disease in which the body’s immune system attacks its own healthy tissues. The attack happens mostly in the joints of the feet and hands and causes redness, pain, swelling and heat around the joint. People with rheumatoid arthritis can find it difficult to do daily chores such as dressing, cooking, cleaning and working. Occupational therapists can give advice on how to do every day activities with less pain or advice on how to use splints and assistive devices. How well does it work? A high quality study showed that people could do daily chores better after having occupational therapy with training, advice and counseling. Two high quality studies showed that people given advice about how to protect their joints could do daily chores better than people with no advice or another type of occupational therapy. But both therapies did not help overall well-being or pain. Another high quality study showed that people trained to move or do daily activities could move just as well as and with the same amount of pain as people who did not have occupational therapy. The strength of their grip was also improved immediately after wearing a splint. But hand movement was less after wearing a splint There was not enough information to say whether advice about using assistive devices is helpful. What is the bottom line? There is “gold” level evidence that occupational therapy can help people with rheumatoid arthritis to do daily chores such as dressing, cooking and cleaning and with less pain. Benefits are seen with occupational therapy that includes training, advice and counseling and also with advice on joint protection. Splints can decrease pain and improve the strength of one’s grip, but it may decrease hand movement. 2 Occupational therapy for rheumatoid arthritis (Review) Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. B A C K G R O U N D Rheumatoid arthritis (RA) patients show a reduction in physical capacities compared to healthy persons. Symptoms such as pain, fatigue, stiffness and decreased muscle strength cause difficulties with daily activities like grooming and dressing, cooking a meal, cleaning, shopping, workand leisure activities. The physical, personal, familial, social and vocational consequences of rheumatoid arthritis are extensive. Occupational therapy (OT) is concerned with facilitating people in performing their daily living activities, and in overcoming barriers by maintaining or improving abilities or to compensate for decreased ability in the performance of occupations (Lindquist 1999). The most important interventions in occupational therapy are training of skills, counseling, education of joint protection skills, prescription of assistive devices and the provision of splints (Melvin 1998). Advice/instruction in the use of assistive devices, training of self care activities and productivity activities are the three most often chosen interventions by occupational therapists for rheumatoid arthritis patients (Driessen 1997). Till now, the evidence on the effects of occupational therapy for patients with rheumatoid arthritis on functional performance and social participation has not been reviewed systematically. So far, one narrative review (Clarke 1999) discussed the effectiveness of splinting, joint protection, and provision of aids/equipment for several rheumatic diseases on basis of the results of only a few studies on occupational therapy. One Cochrane review (Egan 2003) addresses the efficacy of splints and orthosis for RA patients, evaluating only a small part of OT interventions. Therefore, we conducted a systematic review of published studies evaluating occupational therapy for rheumatoid arthritis O B J E C T I V E S To determine whether OT interventions for RA patients improve outcome on functional ability, social participation and/or health related quality of life.