Effectiveness of Occupational Therapy in Patients With Rheumatoid Arthritis(RCT)

• joint protection behavior [ Time Frame: before/after intervention, 3,6,12 months follow up ] [ Designated as safety issue: No ]
  

• General quality of life [ Time Frame: before intervention, 3,6,12 months follow up ] [ Designated as safety issue: No ]
  
• Health related quality of life / physical functional ability [ Time Frame: before intervention, 6,12 months follow up ] [ Designated as safety issue: No ]
  
• Self-Illness Separation SIS, derived from the PRISM (intervention group) [ Time Frame: before/during/after intervention, 3,6,12 months follow up ] [ Designated as safety issue: No ]
  
• Goals achievement (intervention group) [ Time Frame: during/after intervention, 3,6,12 months follow up ] [ Designated as safety issue: No ]
  
• Hand impairment status, including pain [ Time Frame: before/during/after intervention, 3,6,12 months follow up ] [ Designated as safety issue: No ]
  
• Arthritis self-efficacy and JP-specific self-efficacy [ Time Frame: before/after intervention, 3,6,12 months follow up ] [ Designated as safety issue: No ]
  
• Self-perceived disease activity [ Time Frame: before intervention, 12 months follow up ] [ Designated as safety issue: No ]
  
• Clinical data [ Time Frame: before intervention, 3, 12 months follow up ] [ Designated as safety issue: No ]
  

Joint Protection (JP)is an important intervention in the management of people with arthritis. Altering working methods (e.g. use of proximal joints, dynamic activities), energy conservation (balance between activity and rest) and using assistive devices should place less strain on joint structures weakened by the disease process. These strategies ought to decrease pain and stress on joints, improve function, and facilitate maintaining social roles.

The effectiveness of JP has been evaluated in a number of studies, all in a group setting. JP has beneficial short-term effects on pain and function in patients with established RA and moderate functional problems. Using assistive devices reduces pain during task performance in comparison to normal methods and altering working methods significantly reduces difficulties in activities of daily living (ADL). However this generally does not result in significant behavioral changes and a long-term impact on reducing pain and maintaining function may only be reached if JP is taught using behavioral education methods. Additionally, adherence of RA patients to different interventions is generally modest, which may well determine the effectiveness of any given intervention, especially in the long-term.

All previous studies were carried out in group settings, however, in Switzerland, standard JP education is provided on a one-to-one basis and an individualized education is assumed to be a promising approach.

This clinical trial aims to test the hypothesis that an individualized, resource-oriented JP education in RA patients leads to a better therapy success in the short and long-term, compared to problem-oriented standard JP education in terms of joint protection behavior. Secondary outcome parameters are self-perception, general and specific self-efficacy and general and health-related quality of life.