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The effectiveness of Joint Protection Programmes for individuals with Rheumatoid Arthritis; A comprehensive literature review

The effectiveness of Joint Protection Programmes for individuals with Rheumatoid Arthritis; A comprehensive literature review

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An essay for the 2011 Undergraduate Awards Competition by Meghan O Brien. Originally submitted for Evidence Based Practice at National University of Ireland Galway, with lecturer Dorothy Armstrong in the category of Medical Sciences
An essay for the 2011 Undergraduate Awards Competition by Meghan O Brien. Originally submitted for Evidence Based Practice at National University of Ireland Galway, with lecturer Dorothy Armstrong in the category of Medical Sciences

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Published by: Undergraduate Awards on Aug 29, 2012
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10/27/2013

 
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The effectiveness of Joint Protection Programmes for individuals with Rheumatoid ArthritisA comprehensive literature reviewIntroduction
This literature review considers the evidence for the effectiveness of using joint protection programmes onindividuals with Rheumatoid Arthritis (RA)
.
RA is a chronic systemic,
 
inflammatory disease affecting oneto two percent of the worldwide population, and is characterized by pain, disability and reduced quality of life (Helliwell, 2007). Joint protection is a fundamental component of rheumatology occupational therapyprogrammes, which endeavours to minimise the risk of deformities developing by decelerating handfunction deterioration, reducing pain and inflammation as well as the stresses assigned to joints duringdaily activities (Cordery and Rocchi, 1998, as cited in Hammond et al., 2002). Typically, joint protectioneducation includes information regarding RA and its subsequent effects on joint structures and deformitypatterns, how strain during routine activities can contribute to deformities, swelling and pain, as well asdemonstration of the joint protection principles (Hammond et al., 2002).This review will endeavour to examine and contribute to the existing literature on the effectiveness of  joint protection. Areas to be addressed include the impact of joint protection on functional ability, theefficacy of educational behavioural versus standard joint protection approaches, as well as determining theimpact of joint protection on pain, disease activity and swollen joints. Limitations within existingliterature will also be examined, as well as recommendations for future practice.
Search strategyTable 1:
 
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Table one illustrates the database searches conducted, as well as the associative MeSH terms and BooleanLogic applied. Note that the MeSh terms and Boolean logic were invariably applied in each databasesearch.
Database MeSH terms Boolean Logic
See table two below for acomprehensive list of databases searched.Rheumatoid Arthritis,rheumatism, Arthritis, Human,occupational therapy,occupational therap*,occupational therap?,occupational therapy: hand,rehabilitation, joint protection, joint protection programmeJoint Protection AND(Rheumatoid Arthritis NOTOsteo Arthritis) AND(Occupational Therapy ORRehabilitation) OR Jointprotection programme.
Table 2:
Table two portrays the precise number of studies found in each individual database search, as well as thequantity of studies rejected.
Name of database No. of studies found No. of studies rejected
ScopusMedline(Ebsco)CINAHLTheses (ETHOS)Proquest digital dissertationCochraneCochrane Database of Systematic Reviews.Galway Theses OTMedline (Ovid)OT Seeker39334321010930601534330291010620579
 
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Additionally, the reference lists of all retrieved articles were scrutinized. Alison Hammond, the author of four of the included journals, was also emailed on Alison.hammond@derbyhospitals.nhs.uk., to provideadditional unpublished studies relevant to this literature review. Unfortunately, no reply was received.
Table 3:
Table three lists the inclusion criteria applied to the search strategy, as well as exclusion criteria and therationale for same.
Inclusion criteria Exclusion criteria
 
Diagnosis of RA, as other arthritic diseasesare not being analysed.
 
English language only to facilitatecomprehension.
 
Adults over 18 years of age, in order tofocus specifically on the adult populationand not Juvenile RA.
 
Joint protection education had to be anexplicit intervention method used, eithersingly or as the predominant segment of abroader intervention.
 
Peer-reviewed journals only.
 
Ethically approved articles only.
 
Studies with one or more or the followingoutcome measures; pain, functional abilityand quality of life as well as secondaryoutcomes including knowledge of thedisease and adherence.
 
 
Trial designs less than level 4 were excludedas they have a lower hierarchical evidenceclassification.
 
If outcome measures did not evaluatephysical or functional ability, as thepredominant objective of joint protection isthe promotion or maintenance of functionalability.
 
Abstracts of articles requiring payment forfull-text editions were excluded, as theywould lead to excessive costs.
Table 4:
Table 4 illustrates a list of the literature featured in this review, as well as the methodologicalclassification for the various publication types, as defined by Guyatt & Rennie (2004).

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