The Application Of Exercise Intervention Based On The Self-efficacy Theory In Patients With Rheumatoid Arthritis

Objectives1 To investigate the status of quality of life in patients with rheumatoid arthritis?RA?and to analyze the influencing factors of the quality of life with RA patients.2 To explore the effects of exercise intervention based on the self-efficacy theory on quality of life,physical function,fatigue severity,pain,the tender joint counts,swollen joint counts,morning stiffness and Disease Activity Score 28?DAS28?of patients with rheumatoid arthritis.Methods1 A cross-sectional study was carried out in the Department of Rheumatology and Immunology,Tianjin Medical University General Hospital from May 2017 to December 2017.Statistical analysis was performed using t-test,U-test,Pearson correlation analysis,Spearman rank correlation analysis and multiple stepwise regression analysis to explore the factors affecting the quality of life in patients with rheumatoid arthritis.2 72 patients with rheumatoid arthritis were admitted who had visited to the department of rheumatology of Tianjin Medical University General Hospital from December 2017 to August 2018.32 RA patients were divided into the intervention group and the other 36 RA patients were divided into the control group according to the visiting time.Patients in the control group received the conventional nursing care,and patients in the intervention group received the conventional nursing care and exercise intervention based on the self-efficacy theory.The Self-efficacy for Exercise Scale?SEE?,36-Item Short Form Health Survey?SF-36?,Health Assessment Questionnaire?HAQ?,Fatigue Severity Scale?FSS?,Visual Analog Scale?VAS?were assessed three months after the intervention.Results1 Results of cross-sectional study1.1 We distributed 205 questionnaires and retrieved 201 effective questionnaires.The effective ratio was 98.05%.1.2 The average age of 201 RA patients enrolled in this study was 61.00?54.50,67.00?years old,of which 75.62%were female.The patient's duration of disease was5.00?1.00,11.00?years,BMI was 23.83±3.50 kg·m^-2,and DAS28 was 4.91±1.51.The morning stiffness time of RA patients was 30.00?0.00,90.00?minutes,and the tender and swollen joint counts were 4.00?1.00,10.50?and 2.00?0.00,8.50?,respectively.1.3 The total quality of life of 201 patients with RA included in this study was51.19±23.46,the score of Physical Functioning was 48.03±29.02,the score of Role-Physical was 0.00?0.00,75.00?,and the score of Bodily Pain was 7.66±23.75,the score of General Health was 35.35±23.39,the score of Vitality dimension was53.96±25.61,the score of Social Functioning dimension was 62.75±31.22,and the score of Role-Emotional dimension score was 66.67?0.00,100.00?,the score of Mental Health dimension score is 68.08±23.32.The scores of the dimensions of Physical Functioning,Bodily Pain,General Health,Vitality,Social Functioning,Mental Health were lower than those in healthy adults,and the difference was statistically significant?P<0.05?.1.4 The 201 patients with RA who were included in the study had the health assessment questionnaire score of 0.75?0.23,1.20?,the fatigue severity score of 4.56?2.56,6.00?,and the pain visual score of 5.00?3.00,7.00?.1.5 t test and U test showed that different joint function status and address have difference on SF-36 scores which has statistically significant?P<0.05?.Correlation analysis showed that the total score of SF-36 and RA patients with DAS28?r=-0.433,P<0.05?,age?r=-0.141,P<0.05?,morning stiffness time?r=-0.287,P<0.05?,tender joint count?r=-0.331,P<0.05?,swollen joint count?r=-0.260,P<0.05?,VAS score?r=-0.540,P<0.05?,HAQ score?r=-0.764,P<0.05?,FSS score?r=-0.531,P<0.05?showed a correlation.The results showed that HAQ score,FSS score,VAS score,joint function status grade and age entered the equation,and the standardized partial regression coefficients were-0.481,-0.279,-0.210,-0.183,0.126,respectively,explaining the71.0%total variation of quality of life.2 Results of quasi-experimental study2.1 Before the intervention,there were no significant differences in the general conditions,the self-efficacy for exercise,quality of life,physical function,fatigue,pain,tender joint counts,swollen joint counts,morning stiffness and DAS28 between the two groups?P>0.05?.2.2 Three months after the intervention,the scores of the the self-efficacy and the 36-Item Short Form Health Survey of the intervention group were higher than those of the control group.The scores of the health assessment questionnaire,the scores of the fatigue severity scale,the visual pain scores,tender joint counts,swollen joint counts and morning stiffness were lower than the control group,and the differences were statistically significant?P<0.05?.The DAS28 had no statistically significant between two groups.Conclusions1 The age,pain,joint function,physical function and fatigue severity are the factors influencing quality of life of RA patients.2 The exercise intervention based on the self-efficacy theory can effectively improve the quality of life of patients with RA,improve their physical function,reduce their fatigue severity and morning stiffness,and show positive significance for improving the physical pain of patients with RA.