Effect of Self-care Education on the Functional Status of Patients with Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune disease with a chronic and progressive nature. It starts with periods of inflammation in the synovium, and causes it to be thicken resulting in edema in the synovial tissue. It affects 1% of people worldwide, but its prevalence varies among different regions, different races, and different groups of people. Like other chronic diseases, this disease not only has no definitive cure, but also leads to a severe decline in the performance of the affected people and a decrease in independence in performing their daily activities. Studies show that structured educational approaches about self-care can improve the performance and health of patients with chronic diseases such as rheumatoid arthritis. Accordingly, individuals must learn the knowledge and skills needed to make decisions, solve their problems, and communicate with others. Self-care education in these patients helps them to reach a level of health where they not only feel satisfaction with their personal life, but also can contribute effectively and significantly to the community as a citizen. Therefore, encouraging patients to adopt appropriate self-care behaviors is an important factor in the management of rheumatoid arthritis. People with high levels of self-care have more access to health care, experience shorter periods of hospitalization, and subsequently less complications caused by hospitalization in these centers. Without education and patientschr('39') participation in the self-care process, health care programs will be more expensive and the patient’s quality of life will be reduced. Thus, self-care education along with other treatment and rehabilitation processes seems necessary in patients with rheumatoid arthritis. Despite the importance of self-care, studies suggest that patients with rheumatoid arthritis have little knowledge and information about their disease and self-care methods, and lack of knowledge leads to frequent recurrence of the disease and an increase in the frequency of their hospitalizations. Likewise, there is a gap in the studies about education of affected people and few studies have investigated this issue. Therefore, the researcher decided to conduct a study to evaluate the effectiveness of self-care education on the functional status of people with rheumatoid arthritis.

This is an evaluation and single group study conducted on 40 patients with rheumatoid arthritis, and evaluated the effect of self-care education on functional status of patients with rheumatoid arthritis. The sampling process continued from October 2019 to February 2020 among patients hospitalized in the rheumatology wards of Imam Reza and Ghaem educational-research center and treatment centers in Mashhad. Before the intervention, the samples were asked to complete demographic and functional status questionnaire. They also completed the form of informed consent and the researcher ensured that their information would remain confidential. Five 25-minute self- care educational sessions were held for samples individually and at their bedside every other day. The researcher was responsible for holding educational sessions and presenting educational contents. Two weeks after the last educational session, functional status questionnaire was performed again to record the patientschr('39') function scores in different areas after the intervention. After the data collection process, data were analyzed using statistical tests in SPSS 16. Frequency and percentage were used for qualitative variables and numerical indices including minimum, maximum, mean, and standard deviation were used for quantitative variables. Paired t-test was used for inferential statistics for comparison before and after the intervention.

This study included 40 patients with rheumatoid arthritis hospitalized in rheumatology wards of Imam Reza and Ghaem hospitals. The Findings showed that the mean age of the samples was 45.72 ± 9.77 years, most samples (%70) were female, married (%87.5), housewives (%57.5), had a diploma and lower degrees (90%), and 55% reported an underlying disease. Most of them (%62.5) had rheumatoid arthritis for five years and less. Table 1 shows these findings. The results of t-test revealed that the score of activities of daily living (P<0.001), basic activities of daily living (P<0.0001), psychological function (P=0.001), job function (P<0.001), and social activities (P=0.002) increased significantly after the intervention.  However, the increase in the dimension of the quality of social interaction was not significant (P=0.77). In terms of tool cut point, the findings showed that the mean score of activities of daily living was at warning zone before the intervention for all samples, but after the intervention, (15.0%) showed good performance. In activities of daily living, before intervention all samples were at the warning zone but after the intervention, (12.5%) ​had a good performance. In terms of psychological function, before the intervention, 80% of the samples were at warning zone, but after the intervention, (25%) showed good performance and (75%) were at the warning zone. In job function dimension, all patients were at warning zone before the intervention, but after the intervention, (10%) had good performance. In social function dimension, 95% of the subjects were at the warning zone. After the intervention, (75%) were at warning zone and (25%) showed good function. In quality of social interactions dimension, before the intervention, (85.0%) were at the warning zone and after the intervention, (72.5%) of the subjects were at the warning zone and (27.5%) showed good performance.

The results of the present study indicated that a self-care education approach plays an effective positive role in the treatment and rehabilitation of people with rheumatoid arthritis and these programs can be used as a part of the healing process of these patients along with other treatment and rehabilitation processes. In addition, the research hypothesis concerning the positive effect of self-care education on the functional status of people with Rheumatoid Arthritis was confirmed using the research data. There was no statistically significant increase in the quality of social interactions, which may require more time, and it is suggested that future studies devote more time to examining changes. Also, using more specialized educational contents for quality of social interaction can improve and enhance the results of educational process in this area of functional status of rheumatoid arthritis patients.