ETD Collection

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Subject: search.filters.subject.rheumatoid arthritis

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    The nature, extent and functional impact of foot problems in established rheumatoid arthritis
    (2009-11-10T10:48:36Z) Gosai, Hema
    Introduction Foot involvement is common in rheumatoid arthritis (RA). Foot pain, instability and deformity affect ambulation and impacts on health-related quality of life. The aim of this study was to determine the nature, extent and functional impact of rheumatoid foot problems in established RA. Patients and Methods One hundred RA patients were studied. Functional status was evaluated using the modified Health Assessment Questionnaire (mHAQ) and Foot Health Status Questionnaire (FHSQ). Foot deformity and footwear suitability was assessed using the Foot Problems Survey (FP Survey) and Footwear Suitability Scale (FWS Scale). Results In this predominantly female group of 95%, with a mean (± SD) disease duration of 12.2 (7.9) and moderate functional disability [mHAQ: 1.3 (0.6)], the FP Survey showed all patients had one or more foot deformity. Foot function was impaired with a mean (± SD) FHSQ score of 41.3 (12.4) and the FWS Scale showed that 93% wore unsuitable footwear. A strong correlation was observed of the global FHSQ (r=-0.5489, p<0.0001), its pain domain (r=-0.472, p<0.0001) and foot function domain (r=-0.599, p<0.0001), with the global mHAQ score. Despite the high frequency of foot problems observed only 27% had visited a podiatrist. Conclusion In conclusion foot problems and foot function disability is common in Black South African patients with established RA. Furthermore the strong correlation between mHAQ and FHSQ showed that foot functional disability was a major driver of overall functional disability in RA.
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    The effect of a comprehensive occupational therapy intervention programme on the occupational performance of people with rheumatoid arthritis, living in Soweto
    (2008-04-08T12:30:54Z) Dreijer du Plessis, Carin
    ABSTRACT: THE EFFECT OF A COMPREHENSIVE OCCUPATIONAL THERAPY INTERVENTION PROGRAMME ON THE OCCUPATIONAL PERFORMANCE OF PEOPLE WITH RHEUMATOID ARTHRITIS, LIVING IN SOWETO. C Dreijer du Plessis Post-graduate student, University of the Witwatersrand, Johannesburg, South Africa Introduction: Rheumatoid Arthritis (RA) is a chronic disabling joint disease. Empowering patients with RA to self manage the disease can lead to changes in behaviour, pain or physical health and psychosocial health status. Limited evidence exists for the efficacy of comprehensive Occupational Therapy (OT) intervention for patients with RA in improving functional ability. Objective: The primary objective of the study was to evaluate the impact of comprehensive OT intervention on patients with RA in producing a sustained improvement in patients' functional ability. Methods: A prospective randomized control study over 4 months in which patients with moderately disabling RA, following a week of in-patient rehabilitation care, received either home visits and focus group care (group 1) or standard care (group 2). Primary outcome measures included the modified Health Assessment Questionnaire Disability Index (HAQ-DI), Disease activity score (DAS28) and SF- 36 scores. Results: There were 29 and 22 patients in each group, respectively. The HAQ-DI improved significantly in both groups following the 1 week in-patient care (p<0.05) and there was a clinically significant difference between the groups at the 4 months follow-up visit. The SF-36 scores did not change significantly for group 1 while group 2 showed significant improvements in 5 of the 8 domains at four months. However, group 2, had significantly worse SF-36 scores at baseline compared to group 1. There was a significant improvement in disease activity with the experimental group having 25% fewer tender joints. During the focus groups,the two main themes of "behavior and self management" and "problems that interfere with occupational performance" emerged. Conclusion: A comprehensive in-patient occupational therapy programme does lead to sustained significant improvement in functional ability and Health related quality of life (HR-QOL). Focus groups and home based intervention appears to have a clinically significant impact on disease activity. Key words: Rheumatoid Arthritis, Comprehensive Occupational Therapy intervention, Home based intervention, Occupational Performance.