Construction Of An Evidence-Based Practice Program For Hand Exercises With Rheumatoid Arthritis

Objectives1.To systematically evaluate the qualitative research on the exercise experience of patients with rheumatoid arthritis,understand the exercise needs of patients,identify the factors that affect the exercise of patients,and provide reference for the formulation of intervention strategies.2.To summarize the best evidence of hand exercise program for patients with rheumatoid arthritis,and combine the Meta-synthesis results to form the first draft of an evidence-based practice program for hand exercise for patients with rheumatoid arthritis.3.To demonstrated the first draft of the program by experts,form an evidence-based practice program of hand exercise for patients with rheumatoid arthritis,and provide an evidence-based basis for clinical guidance of hand exercise for patients with rheumatoid arthritis.Methods1.Meta-synthesis:qualitative studies on the exercise experience of rheumatoid arthritis patients were systematically retrieved from CNKI,Wanfang Database,Chinese Science and Technology Journal Database,China Biomedical Literature Database,PubMed,MEDLINE,Embase,Web of Science,CINAHL and PsycINFO.The Joanna Briggs Institute(JBI)Evidence-based Health Center Qualitative Research Quality Assessment Criteria(2017)were used to independently evaluate the literature,and pooled integration method was used to meta-integrate the results.2.Evidence to summarize:the major retrieval guide network,professional associations,database,network,and the grey literature data,and according to the corresponding evaluation tool to evaluate the literature quality,eventually to classification of JBI evidence in the literature and recommended level of evidence,form rheumatoid arthritis hand exercise regimen best evidence,and refer to the result of integrating the Meta,The group discussed the first draft of the preliminary construction plan.3.Specialists seminar:ten experts were organized to hold an expert meeting to evaluate the scientific nature,clinical applicability,operability,economic cost and safety of the structural framework and contents of the draft plan,so as to form a scientific and feasible evidence-based practice plan for rheumatoid arthritis hand movements.Results1.Meta integration into 14 article qualitative study,extracting 41 research results,summarized as 7 new category(disease disorder,lack of negative psychological and social support,self-psychological adjustment,positive coping strategies,improve the body symptoms,reflect the spiritual value of exercise),and finally form the 3 themes(exercise barriers,exercise promotion factors,exercise actively experience).2.A total of 14 articles were included in the best evidence summary,including 4 clinical practice guidelines,3 evidence summaries,1 recommendation,1 expert consensus,3 systematic reviews and 2 randomized controlled trials.A total of 29 pieces of evidence were extracted from 6 aspects,including the principle of hand movement,the significance of exercise,indications/contraindications,pre-exercise preparation,exercise strategy and health education.Combined with the Meta-integration results of qualitative research on the experience of RA patients participating in exercise,form contains scheme of educators,applicable people,preparation before exercise,exercise,exercise tools,movement time,intensity,performance evaluation,movement monitoring,the matters needing attention,the health education for the framework of the rheumatoid arthritis for hand movements of evidence-based practice first draft.3.Through two rounds of expert meetings,an evidence-based practice plan,operation process and implementation manual for rheumatoid arthritis hand exercise was finally constructed,including the overall requirements of hand exercise program,exercise program and health education.ConclusionIn this study,we systematically evaluated the qualitative research on the exercise experience of patients with rheumatoid arthritis,summarized the best evidence of hand exercise program,organized 10 experts to hold a meeting.Finally we formed an evidence-based practice plan of patients with rheumatoid arthritis,including the overall requirements,exercise program and health education,which has the scientificity and operability and can provide evidence basis for clinical staff to implement hand exercise program.