Construction And Effect Evaluation Of Hand Function Rehabilitation Management Program For Patients With Rheumatoid Arthritis

Objectives:Investigating the current situation of hand function rehabilitation management needs of patients with rheumatoid arthritis(RA)and analyzing the influencing factors.Identify hand function intervention priorities based on patient need dimension ranking and influencing factors.A literature search was conducted to summarize the evidence around the program’s content,the integrated theory of health behavior change was used as a guide to construct a program for the rehabilitation management of hand function in RA patients.A non-simultaneous controlled clinical trial was conducted to explore its effects on hand pain,impairment,self-efficacy and hand grip strength in patients with RA.Methods:1.Survey on the health needs of hand function rehabilitation in RA patients: The Chinese version of the Arthritis Education Needs Assessment Tool and the Arthritis Self-Efficacy Scale were used at the individual level,the Family Resilience Scale tool was used at the family level to investigate the hand function health needs,self-efficacy and family resilience levels of RA patients in 2 tertiary hospitals,and to analyze the current status of patients’ health needs and influencing factors in hand function rehabilitation management.2.Construct intervention programs: Based on the previous survey results,the dimension of hand function management needs that patients prioritize and are greatly affected by the disease was selected as the intervention content.A literature search was conducted on the determined content of hand function rehabilitation intervention.Comprehensive search of Up To Date,Pub Med,Cochrane Library,Chinese Biomedical Literature Database,China National Knowledge Infrastructure and other comprehensive databases;guide websites such as the US National Clinical Practice Guidelines Database and the International Guideline Collaboration Network;the websites of American College of Rheumatology,European League Against Rheumatism,Chinese Medical Association Rheumatology Branch and other professional societies were supplemented.The retrieval time was from January 2011 to January 2022.The literature types included clinical decision-making,guidelines,evidence summary and systematic evaluation.The quality of the literature was evaluated by the corresponding literature quality evaluation tools.The evidence was graded using the Australian JBI evidence-based health care center evidence grading and evidence recommendation level system(2014 edition)to summarize the best evidence.Combined with the framework of ’ integrated theory of health behavior change ’,the RA hand function rehabilitation management plan was preliminarily constructed.Through the demonstration method of expert meeting,the plan was discussed,the expert opinions were sorted out,and the final draft of ’ RA hand function rehabilitation management plan ’ was formed.3.Scheme application and effect evaluation:A non-contemporaneous experimental study was conducted to select 66 RA patients who were hospitalized in a tertiary hospital from April to December 2022 as the study subjects through purposive sampling.According to the order of admission,33 patients selected from April 1 to July 1,2022 were included in the control group,and the routine nursing methods of the department were continued.From July 2,2022 to December 1,2022,33 patients selected were included in the intervention group and intervened with the ’ RA Hand Function Rehabilitation Management Program ’.The RA patients ’ pain scale(RAPS),visual analog scale(VAS),hand disorder scale(SOFI),self-efficacy scale(ASES-8)and grip strength were compared between the two groups at admission,discharge,1 month and 3 months after the intervention.Results:1.Referring to other studies and considering a 10% non-response rate,the proposed sample size was calculated to be 115 cases based on the overall mean estimation of sample content.After the survey,110 valid questionnaires were obtained.110 patients with RA had a health education need for hand function score of 81.10±25.02,with a standardized score of 52.05% on average,and the health education need was at an intermediate level.The dimensions were ranked from highest to lowest according to the standardized score formula as self-management(59.28%)> disease process(54.74%)>disease treatment(54.62%)> support system(54.49%)> activity(51.31%)> pain management(47.86%)>emotion(44.55%)> complementary therapy(40.08%).Multiple linear regression analysis showed that age,presence or absence of regular medication,presence or absence of exercise and family resilience were independent influences on the need for health education on hand function in RA patients(all P<0.05);Pearson correlation test showed that there was a significant correlation between the need for health education and family resilience(r=0.206,P<0.05)and self-efficacy(r=0.199,P<0.05)were positively correlated,with statistically significant differences(P<0.05).Based on the results of the survey,after consulting with the specialist medical staff and combining with the clinical reality,the subject group discussed together and selected hand exercise and pain management as the intervention content.2.13 articles were included,including 4 guidelines,3 evidence summaries,4systematic reviews and 2 clinical decisions.13 articles were included in hand pain management,including 3 guidelines,7 systematic reviews and 3 clinical decisions,34 evidences.After FAME evaluation of the evidence by experts,6 pieces of evidence were deleted,1 piece of evidence was modified,and 15 pieces of evidence were classified and formatted into 7 pieces of evidence.18 pieces of evidence were screened and summarized from 4 aspects of evaluation,exercise timing and procedure,exercise time and intensity and health education as the content of scheme construction.Through the expert meeting demonstration method,the degree of authority of the participating experts = 0.935,the expert authority is good,listen to the opinions and suggestions put forward by the experts,modify and improve,and finally form the ’ RA hand function rehabilitation management plan ’ with the ’ health behavior change integration theory ’as the framework,through individualized evaluation,knowledge guidance and skill guidance,goal setting and implementation and creation of the supportive social environment.The four steps,the best evidence for the intervention content of the ’ RA hand function rehabilitation management plan ’ final draft.3.Finally,32 cases of effective case control group and 31 cases of intervention group were included.There was no significant difference in demographic and clinical data between the two groups before intervention(P>0.05).The hand pain(RAPS and VAS)scores,self-efficacy(ASES-8)scores and hand joint dysfunction score(SOFI)scores of the two groups were compared.There was no significant difference in scores between the two groups before the intervention,at discharge and 1 month after intervention(P>0.05).There was a significant difference in scores after 3 months of intervention(P<0.001).After 3 months of intervention,the right-hand grip strength score of the intervention group was higher than that of the control group.There was no significant difference in the score of left hand grip strength between the two groups before intervention,at discharge,1 month and 3 months after intervention(P>0.05).There was no significant difference in the score of right hand grip strength between the two groups before intervention,at discharge and 1 month after intervention(P>0.05).After 3 months of intervention,the score of right hand grip strength in the intervention group was higher than that in the control group(P<0.05).The difference was statistically significant(P<0.05).There were significant differences in hand pain(RAPS and VAS)scores and self-efficacy(ASES-8)scores(P<0.05).There were significant differences in hand pain(RAPS and VAS)scores,self-efficacy(ASES-8)scores and right-hand grip strength scores(P<0.05).Conclusions:Based on the current situation of hand function education needs of RA patients,it is scientific and reasonable to construct a rigorous and reasonable RA hand function rehabilitation management program.The program can effectively reduce the patient ’s hand pain,reduce hand joint dysfunction,and effectively enhance the patient ’s self-efficacy,but the improvement effect on hand grip strength is not significant.It can provide some reference for subsequent related research.