The effect of arthritis health professional's approach on resting hand splint compliance in rheumatoid arthritis

Judy Rae Feinberg, Purdue University

Abstract

Rheumatoid arthritis is a chronic, inflammatory disease which, if not controlled by medical management, can result in progressive joint destruction and disability. Regardless of the medical protocol used, it is estimated that at least 50% of patients with rheumatoid arthritis are noncompliant with treatment recommendations. This study examined the effects of occupational therapist's approach during the initial splinting session on subsequent compliance with the use of resting hand splints by patients with rheumatoid arthritis. It was hypothesized that an occupational therapist employing a positive interactive approach would increase splint use, enhance patients' attitudes toward splint use, and improve disease outcome. Forty subjects were assigned randomly to either the compliance-enhancement (experimental) or to a standard treatment (control) group. The compliance-enhancement condition stressed the use of learning principles; the sharing of expectations; the promotion of the patients' assuming responsibility; and the use of positive affective tone and behaviors by the occupational therapist. The primary compliance period was 28 days, which was the minimum follow-up period for any subject. The mean number of days splints were used by subjects in the experimental group was 23.3 compared to 18.1 in the control group (t = $-$1.97, p =.056). Initially there were no differences between groups in their attitudes toward splints. There was a significant change in attitude in both groups in a more negative direction (compliance-enhancement, t = $-$2.46, p =.024; standard treatment, t = $-$2.65, p =.016). Attitudes of experimental group subjects tended to be more positive than those in the control group at follow-up (median splint, $\chi\sp2$(1, N = 40) = 3.60, p =.057). There were no significant differences between groups relative to changes in disease parameters, possibly due to the relatively short follow-up period. The potential clinical significance of this study is substantial. Although noncompliance was not eliminated, this intervention provides the health professional with a relatively pragmatic and effective method to enhance compliance. A longer follow-up period and a larger number of subjects are recommended for a replication study.

Degree

Ph.D.

Advisors

Aeschleman, Purdue University.

Subject Area

Rehabilitation|Therapy|Health education

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