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INTRODUCTION
Although rheumatoid arthritis can have serious effects on a person's life and
well-being, current treatment strategies—including
• Patient education and support programs--allow most people with the disease
to lead active and productive lives.
SIGNIFICANCE OF THE STUDY
The investigators from their clinical practice felt that the need of assessment
of functional performance by nurses for rheumatoid arthritis patients. Nurses as
health care providers have important role in educating patients about rheumatoid
arthritis and self care management at home. Hence the study was conducted and
the functional capacity, performance of the patients suffering from rheumatoid
arthritis were assessed.
OBJECTIVE:
The research design selected for the present study was Exploratory Design. The
samples were selected and functional capacity, performance were assessed. The
study was conducted in the Government General Hospital, a tertiary referral centre
Chennai-3, Tamilnadu, India. The population of this project comprises of all
patients attending the rheumatology outpatient department. 160 Patients with
rheumatoid arthritis attending the rheumatology outpatient department were
selected as samples using Systematic random sampling . Every 5th patient was
selected for the study. Around 25-30 patients with RA attend the OPD daily.
DATA COLLECTION METHOD
Physical Examination
DESCRIPTION OF TOOL
• Swelling
• Warmth
• Tenderness
• Limitation of movement
All the joints including proximal inter phalangeal joints, meta carpo
phalyngeal joints, wrist, elbow, shouldr, knee joints (28 joints) were
assessed on both left and right side of the body. Finally total number
of joints affected was assessed out of 28 joints
1. Dressing
2. Getting out of bed.
3. Lifting a cup.
4. Walking
5. Bathing
6. Bending, kneeling
7. Turning taps
8. Getting in & out of vehicle.
Score:
CLASS-I -3
CLASS-II -2
CLASS-III -1
CLASS-IV -0
A formal approval was obtained from the authorities of the hospital. Samples
for the study were selected based on the sample selection criteria.Initial rapport
was established and the purpose of the study was explained to the sample subjects.
A total of 160 patients with RA, who attend the rheumatology outpatient
department were selected for the study using systemic random sampling. Every
fifth patient was selected followed by evaluation. The evaluation lasted
approximately 90 minutes and consisted of, a physical examination including
detailed musculoskeletal examination, grouping patients under Steinbrocker
functional capacity classification followed by assessment of physical disability
index based on modified health assessment questionnaire, a review of medical
records, and laboratory and x-ray tests. Brochures related to self care management
of patients with RA were distributed to the patients after data collection.
RESULTS
The data were analysed using descriptive and inferential statistics. Pearson chi
square test was used to find the significance.
Considering the musculo skeletal examination , 80% of patients had swelling in
SB CLASSIFICATION Pearson
CLASS1 CLASS2 CLASS3 chi square
S. Type of test
No joint
N % N % N %
2
1. Knees 4 16.7% 83.3% - -
0 χ2=12.4
affected
P=0.001
6 6 significant
2. Hand joints 4 2.9% 47.1% 50.0%
4 8
affected
their joints,majority (92.5%) of patients had painful tender joints, only 55%of
patients had warm joints and 85% of patients had limitation in movement of the
joints.
The relationship between type of joints involved and class of steinbrocker
functional classification. 50%of Patients whose hand joints are affected have more
functional performance impairment (class-3) than patients whose knee joints are
affected. There is a significant difference in the functional performance and the
type of joints involved.(χ2=12.4, P=0.001)
Majority (50%) of patients whose hand joints are affected are able to do their daily
activities with much difficulty and 32% of patients are unable to do their daily
activities by own due to disability.( χ2=26.1, P=0.001)
From the above tables1 & 2 , it is revealed that Functional capacity and the
functional performance is affected more in patients whose hand joints are affected
than patients whose knee joints are affected. Patient teaching and brochures
regarding, strategies for self care management of patients with rheumatoid arthritis
were provided to the patients and significant others in the OPD
Discussion
The objective was to measure the degree of functional limitation in a sample of
RA patients. 4 established, performance-based test were elected. It helped to
demonstrate RA impairments such as the amount of pain and the number of
tender, swollen, and deformed joints; and measures of physical disability,
including the Modified Health Assessment Questionnaire, Steinbrocker
Functional Capacity classification, as well as knowledge on self care
management of RA.
1. Majority of Patients had painful tender joints (92.5%) and they had
difference in experiencing swelling, warmth, tenderness, limitation in joint
movement independent to each other.
2. The functional performance level was assessed for the patients with
rheumatoid arthritis , patients whose knee joints were affected had minimal
physical disability index .
3. Majority of Patients whose hand joints were involved are classified under
class II, III of Steinbrocker classification and also had high physical
disability index score .
4. Most of them, 75% patients belonged to age group of 20-40 years and 88%
were females.
CONCLUSION
• Stress reduction
• Healthy diet
• Climate
REST AND EXERCISE: People with rheumatoid arthritis need a good balance between
rest and exercise, with more rest when the disease is active and more exercise when it
is not. Rest helps to reduce active joint inflammation and pain and to fight fatigue. The
length of time for rest will vary from person to person, but in general, shorter rest breaks
every now and then are more helpful than long times spent in bed. Alternate periods of
rest and activity through the day. This is called pacing.
• If you must sit for long periods, say at work or while traveling, take a short break
every hour: stand up, walk around, stretch, and flex your joints.
Exercise is important for maintaining healthy and strong muscles, preserving joint
mobility, and maintaining flexibility.
Exercise can also help people sleep well, reduce pain, maintain a positive attitude, and
lose weight. Exercise programs should take into account the person’s physical abilities,
limitations, and changing needs.
PROTECTION OF JOINTS:
• At least once a day, move each joint through its full range of motion. Do not
overdo or move the joint in any way that causes pain. This helps keep freedom of
motion in your joints
• Avoid situations that are likely to strain your joints. Remember that your joints are
more susceptible to damage when they are swollen and painful. Avoid stressing
the joint at such times.
• Learn proper body mechanics. This means learning to use and move your body
in ways that reduce the stress on your joints. This is especially true for your
hands, since you want to protect their flexibility. Ask your health care provider or
physical therapist for suggestions on how to avoid joint strain.
• Use the strongest joint available for the job. Avoid using your fingers, for
example, use your wrist or shoulder for the job.
using a splint for a short time around a painful joint reduces pain and swelling by
supporting the joint and letting it rest. Splints are used mostly on wrists and
hands, but also on ankles and feet.
Other ways to reduce stress on joints include self-help devices like zipper pullers,
long-handled shoe horns help with getting on and off chairs, toilet seats, and beds;
and changes in the ways that a person carries out daily activities.
Apply heat. Heat can help ease your pain and relax tense, painful muscles. One
of the easiest and most effective ways to apply heat is to take a hot shower or bath
for 15 minutes. Other options include using a hot pack or an electric heat pad set
on its lowest setting. If your skin has poor sensation or if you have poor circulation,
don't use heat treatments.
Apply cold. Cold may dull the sensation of pain. Cold also has a numbing effect
and decreases muscle spasms. Don't use cold treatments if you have poor
circulation or numbness. Techniques may include using cold packs, soaking the
affected joints in cold water and ice massage.
Alternating the application of hot and cold helps in reducing joint stiffness
and pain.
HEALTHY DIET: With the exception of several specific types of oils there is no scientific
evidence that any specific food or nutrient helps or harms people with rheumatoid
arthritis. However, an overall nutritious diet with enough – but not an excess of –
calories, protein, and calcium is important. Some people may need to be careful about
drinking alcoholic beverages because of the medications they take for rheumatoid
arthritis.
CLIMATE: Some people notice that their arthritis gets worse when there is a sudden
change in the weather. However, there is no evidence that a specific climate can
prevent or reduce the effects of rheumatoid arthritis. Exposure to extreme cold climate
can be avoided.
MEDICATIONS:
Some medications are used only for pain relief; others are used to reduce inflammation.
Still others, often called disease-modifying antirheumatic drugs (DMARDs), are used to
try to slow the course of the disease.
The objective of the study were to assess the functional capacity and performance
of patients with RA and to provide strategies on self care management of patients
with RA.
The research design selected for the present study was Exploratory Design. The
samples were selected assessed, and interviewed by interview schedule. The
project was conducted in the Government General Hospital, a tertiary referral
centre Chennai-3, TamilNadu, India. 160 Patients with rheumatoid arthritis
attending the rheumatology outpatient department were selected as samples using
Systematic random sampling was used. Every 5th patient was selected for the
study. RA impairments such as the amount of pain and the number of tender,
swollen, and deformed joints; and measures of physical disability, including the
Modified Health Assessment Questionnaire, Steinbrocker Functional Capacity
classification were assessed and strategies on on self care management of patients
with RA were provided.
RESULTS
Majority of Patients had painful tender joints (92.5%) and they had difference in
experiencing swelling, warmth, tenderness, limitation in joint movement
independent to each other.the functional performance level was assessed for the
patients with rheumatoid arthritis , patients whose knee joints were affected had
minimal physical disability index .Majority of Patients whose hand joints were
involved are classified under class II, III of Steinbrocker classification and also
had high physical disability index score .
CONCLUSION