Knowledge, Practice, and Self-Care Management Behaviors for Rheumatoid Arthritis Patients

Knowledge, Practice, and Self-Care Management Behaviors for Rheumatoid Arthritis Patients

Chapter One

Research Objectives

To assess the level of knowledge of rheumatoid arthritis among diagnosed patients.
To evaluate the current self-care management practices employed by RA patients.
To examine the relationship between patients’ knowledge levels and their self-care management behaviors.

CHAPTER TWO

LITERATURE REVIEW

Rheumatoid Arthritis

Epidemiology

Rheumatoid Arthritis (RA) is an autoimmune disease, characterised by chronic systemic inflammation. This high-grade inflammation can lead to articular manifestations such as painful, stiff, tender and swollen joints and poor functional ability (Smolen et al., 2016; Uhlig et al., 2014). Extra- articular manifestations are highly prevalent in people with RA, including fatigue, poor mental health and psychological wellbeing and cardiovascular disease (CVD) (Katz, 2017b; Matcham et al., 2013; Metsios et al., 2015; Smolen et al., 2016). Disease activity is known to fluctuate in people with RA, with periods of acute disease activity, known as flares, interspersed with low disease activity periods, known as remission. If disease activity is poorly controlled in the long term, this can lead to irreversible structural joint damage and functional disability (Lee & Weinblatt, 2001; Smolen et al., 2016). The societal burden of people with RA is substantial, with healthcare and economic costs coming from reduced work capacity and informal care requirements (Smolen et al., 2016). The United Kingdom (UK) has an ageing population and RA is more common in older adults, so this societal burden of RA may continue to rise. A greater wealth of research is needed to investigate novel approaches to manage and treat this disease (Hsieh et al., 2020).

RA is the most common form of inflammatory arthritis, affecting approximately 0.5−1% of adults worldwide (Almutairi et al., 2021; Uhlig & Kvien, 2005; Uhlig et al., 2014), and 0.84% of UK adults aged >16 years (Arthritis Research UK, 2018; Gulati et al., 2018). RA is usually diagnosed in people aged 30−50 years (Smolen et al., 2016; Uhlig et al., 2014). Females are twice as likely to have RA, and there are sex differences in the reported symptoms. For example, hand and foot joints more frequently affected in women, whilst men experience greater large joint involvement (St. Clair et al., 2004). The exact pathophysiology of RA is unclear, but it is thought that disease development is precluded by a combination of genetic, lifestyle, and environmental factors. For example, a family history of RA increases the risk of developing the disease by 3−5% (Smolen et al., 2016). In addition, there are environmental factors predisposing people to developing RA, which include infectious agents, and lifestyle risk factors such as smoking (St. Clair et al., 2004).

Classification and Diagnosis

RA can be classified according to the American College of Rheumatology−European Alliance of Associations for Rheumatology (ACR−EULAR) criteria (Aletaha et al., 2010). This criteria requires the presence of synovitis in at least 1 joint, and a score ≥6 (on a scale of 1-10) from 4 domains: 1) number and site of involved joints (score: 0= 1 large joint; 1= 2−10 large joints; 2= 1−3 small joints (with/without large joint involvement);

CHAPTER THREE

Material and Method

Participant and Procedure

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This cross-sectional study was conducted on 185 patients who were visited in the Rheumatology Clinic of Shari’ati Hospital, Lagos, Iran in 2013. Inclusion criteria were age over 16, diagnosed of RA by a rheumatologist based on the criteria of the American College of Rheumatology (ACR), disease duration at least one year, no history other chronic diseases including cardiovascular diseases, asthma, cancer, psychological disorders (depression), no consumption of mood stabilizers and ability to speak Persian. A total of 500 patients were reviewed,185 patients inter the study and 300 patients were excluded due to exclude criteria or unwilling to participate. Patients willingly participated in the research. patients were selected through convenient sampling method between March 2013 to October 2013. Sample size estimated was performed based on d=0.5, α=0.01 and mean and standard deviation of SMB in a previous study by Nadrian et al (32.33±8.6) (Nadrian et al., 2011). Shariati hospital was general and referral govermental hospital.

CHAPTER FOUR

Results

This study was carried out on 185 RA patients (149 females and 36 males) with a mean age of 46.97±11.47 years. Most of the participants were female 80.5% (149), married 80.5% (149) and 67.6% (125) were houswives. The majority of patients 49.7% (92) had primary school educated and 10.5% (20) had a university degree.

CHAPTER FIVE

Discussion

The purpose of this study was to assess various factors associated with SMB in RA patients. In this study, participants used a minimum of 3-4 SMB to control the disease and different behaviors were applied. About 97.3% of the patients were reported to have regular referrals to their physicians, 99.5% had regular drug management, 93% had supplement consumption, and 91.3% changed the pattern of medication. All of the patients were chosen from the Rheumatology Clinic, so patients were closely observed by a rheumatologist through regular physical exams. Moreover, these behaviors had a positive impact on physical health and disease control, So patients performed these behaviors regularly with more trust in their physician. Our findings confirmed the results of a study by Katz et al in which 86.5% of the patients used medications regularly to alleviate the pain (Katz, 2005). Moreover, 91% of the patients used adequate resting to maintain their quality of life whereas only 70% of the patients used this behavior in the study by Katz (Katz, 2005). The results of the current study indicated that resting had a positive correlation with the DAS28, severity and duration of the disease. This finding is similar to the results of a study by Kett (Kett, Flint, Openshaw, Raza, & Kumar, 2010).

RA patients to decrease stress, anxiety and depression, talked to close friends and relatives. McBain et al reported that social support had a significant relationship with the prevention of depression in RA patients (McBain, Shiley, & Newman, 2013). In a study conducted by Katz et al 54% of the patients used this behaviors to relieve pain (Katz, 2005). In our study, other occupations (students, unemployed, and workers) used this behavior less than housewives, which could be explained by the fact that the members of this group especially students spend most of their time studying and left with little time to talk to their relatives and friends.

Incorrect posture at work time (home or office) may lead to joint destruction. Coordination and adaptation of daily tasks is an accommodation strategy to decrease the problems in RA patients. In this study, over half of the patients used this strategy in their daily activities. In the study by Katz, 50% of patients used to alleviate pain, 82% used to prevent of joint deformity (Katz, 2005). The low rate of this strategy in our study can be related to the lack of knowledge on facilities and available resources. Moreover this study showed that housewives used this strategy less than other groups although the frequency of this behavior was not significant. These issues should be considered in self-management programs to resolve their problems in patients.

In this study, it was found that over half of the patients used joint heating for alleviating pain, which was slightly higher than the results of the study by Katz (2005). The current study revealed that patients with greater disease activity reported more joint heating than patients with less disease activity, which could be related to disease severity. Robinson and Valdes showed that heating reduced pain in OA and RA patients (Robinson et al., 2002; Valdes & Marik, 2010).

In the present study, half of the patients used wrist bands, casts, and bandage for pain relief, reducing joint deformity and movement limitation. In addition, their use lead to improvement in health status and not using this behavior increased disease activity although the increase was not significant, which could be due to the lack of knowledge and facilities. In the study by Katz (33%) was less than in the current study (Katz, 2005). Based on our results, SMB were more commonly used in severe disease activity and was less used when the patients were in remission. Our result are similar to those of Kett et al who showed that the use of self management strategies increased during the flare of RA (Kett et al., 2010). Continuous using of SMB should receive attention in all programs.

In our study some of the patients used massage therapy to reduce RA problems. Several studies have shown the impact of massage therapy on decreasing pain, depression, anxiety, muscle strength, and rate of motion in the shoulder, wrist, and hand (Bell, 2008; Donoyama & Shibasaki, 2010; Field et al., 2013; Field, Diego, Hernandez-Reif, & Shea, 2007). In this study few patients used hot water pools, hot water bags, or hot showers. These behaviors are used as therapeutic methods to improve RA problems such as pain and fatigue. In the current study, men used these behaviors two times more than women and educated patients used these behaviors more than illiterate patients. High educated patients tended to have more information on RA; hence, the effect of education may be through knowledge. A study by Dagfinrud showed that patients who used hot water pools felt much better after treatment compared to those who used similar exercises on land (Dagfinrud & Christie, 2007).

Studies have shown that depression and anxiety have adverse effects on pain, DAS28, quality of life, and functionality in the future (Abu Al-Fadl, Ismail, Thabit, & El-Serogy, 2014; Curtis, Groarke, Coughlan, & Gsel, 2005; Mann, 2010; morris et al., 2011; Rezaei et al., 2014; Treharne et al., 2007). Nevertheless, only third patients used various methods of stress management and meditation or relaxation (the least frequent SMB in our patients) which could be due to their lack of knowledge and skill. Therefore, it is recommended that patients, their families, and health professionals become more familiar with stress management and apply this techniques in daily living.

In our study, meditation was performed by patients with moderate disease activity approximately 3 times more than the patients in remission. Moreover married patients used this behavior 74% less than single patients. With an increase in age, the use of this SMB decreased. This finding is in line with the results of a study conducted by Mostafa was noted a significant relationship between depression, age and disease related factors (Mostafa & Radwan, 2013). The relationship between aging and depression seems to be driven by the socio demographic feature and health status of older patients such as marital status, level of limitation in daily activities, educational level, and cognitive impairment.

Diet is an important behavior for losing weight in order to prevent joint destruction. In the present study, some of the participants used this behavior in their daily living which could be due to family meal plans that is rich in carbohydrates and fat.

In our study, some patients used aquatic exercises such as swimming. Interestingly, patients with higher levels of education and health status using these behaviors more than illiterate patient. With higher levels of education, patients obtained more knowledge about the benefits of SMB such as aquatic exercises like swimming for improving health status. However, the role of health status in this behavior was not considerable, and this behavior could be influenced by other factors such as knowledge, cost, access to facilities, etc. According to the literature review, aquatic exercises have a greater positive psychological effect versus land exercises (Iversen, Chhabriya, & Shadick, 2011). The combination of aquatic exercises and SMB is beneficial to the physical health (Karatepe et al., 2011). Half of the participants in the present study spent more than 10 minutes per day exercising; nonetheless, with the increase in disease activity and pain, physical activity decreased. In addition, exercise increased with improvement in health status that could be related to the functional status. Various studies have shown that exercise has a positive impact on improving the function and quality of life of the RA patients (Chang et al., 2009; Karatepe et al., 2011). Contrary to our study, Iversen et al reported that patients with moderate to severe disease activity and more disability spent more time on physical activity and exercise (Iversen et al., 2011).

Conclusion

In the present study, patient used various types of SMB. Some behaviors such as drug management, frequent referral to the physician, changing the dose or intervals between drug management, adequate rest and sympathy were seen in more than 90% while other behaviors like exercise, swimming, massage, heating, stress management, meditation, hot water pool and bag, and protecting the joints were performed less than the ideal. The education level, gender, occupation, age, health and marital status, DAS28, VAS, and PGA were recognized as factors influencing on SMB in RA patients. According to the literature, continuous use of self-management behaviors plays an important role in controlling RA patients; therefore, should be considered in designing, planning, implementing programs.

References

Abu Al-Fadl, E. M., Ismail, M. A., Thabit, M., & El-Serogy, Y. (2014). Assessment of health-related quality of life, anxiety and depression in patients with early rheumatoid arthritis. The Egyptian Rheumatologist, 36(2), 51-56. http://dx.doi.org/10.1016/j.ejr.2013.12.004
Al-Qubaeissy, K. Y., Fatoye, F. A., Goodwin, P. C., & Yohannes, A. M. (2013). The effectiveness of hydrotherapy in the management of rheumatoid arthritis: a systematic review. Musculoskeletal Care, 11(1), 3-18. http://dx.doi.org/10.1002/msc.1028
Alamanos, Y., Voulgari, P. V., & Drosos, A. A. (2006). Incidence and prevalence of rheumatoid arthritis, based on the 1987 American College of Rheumatology criteria: a systematic review. Semin Arthritis Rheum, 36(3), 182-188. http://dx.doi.org/10.1016/j.semarthrit.2006.08.006
American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines (2002) Guidelines for the management of rheumatoid arthritis. (2002). Arthritis Rheum 46, 328-346.
Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). self management approach with chronic condition: a review. Patient Education and Counselling, 48(2), 177-187.
Bell, J. (2008). Massage therapy helps to increase range of motion, decrease pain and assist in healing a client with low back pain and sciatica symptoms. J Bodyw Mov Ther, 12(3), 281-289. http://dx.doi.org/10.1016/j.jbmt.2008.01.006
Borman, P., Toy, G. G., Babaoğlu, S., Bodur, H., Cılız, D., & Allı, N. (2007). A comparative evaluation of quality of life and life satisfaction in patients with psoriatic and rheumatoid arthritis.

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