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Daily activites in women with RA. Aspects of patient education, assistive devices & methods for disability & impairment assessment

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By Nordenskiold U • www.ProHealth.com • March 16, 1997


The major aims of the study were to identify the difficulties
in daily activities (ADL) of women with rheumatoid arthritis
(RA) and to demonstrate the effect of interventions. Methods
were developed for measuring grip force, the Grippit
instrument, and assessing ADL without and with assistive
devices. Effects of interventions were explored, and the need
for new solutions concerning daily activities was identified.
Seventy-three women with RA participated in the study, 14
women with fibromyalgia were included in the grip force
measurements, and 187 healthy women and 65 healthy men acted
as a reference group. In describing the consequences of the
disease with regard to daily activities, the patient's
perspective was taken into account.

RESULTS: Grip force (peak value and average value
over 10 seconds) was reduced in women
with RA compared to the reference values. With an elastic
wrist orthosis, pain decreased and grip force increased
significantly in defined ADL situations. After a patient
education programme in joint protection, designed to influence
knowledge, inspiration and action, on average 91% of the
assistive devices provided were in use, most frequently for
kitchen work and personal care. Pain also decreased
significantly with the use of specially designed assistive
devices like breadsaws, potato peelers, and scissors compared
to using standard tools. The cost of these interventions could
be judged to be low in relation to its effectiveness.

Using an alternative model of the Health Assessment Questionnaire
(HAQ) where the use of assistive devices did not influence the
ratings, grip force was correlated to more ADL activities than
disclosed by the ordinary HAQ ratings. The difference between
these two models for rating HAQ items was demonstrated. The
Evaluation of Daily Activity Questionnaire (EDAQ) was
developed and can be used to evaluate both intrinsic (without
assistive devices) and actual (with such assistance)
disability. The EDAQ consists of 102 items arranged in 11
dimensions.

The number of activities with perceived difficulty without
assistive devices/altered working methods in RA women
ranged between 13 and 99 and after interventions between 6 and
57. Assistive devices appeared most effective in the
dimensions Eating, Cooking and Toileting. Only a few useful
devices were identified in the dimensions Dressing,
Washing/Clothes care and Cleaning. The ordinal score from EDAQ
was transformed by the Rasch analysis to obtain linear
measures. This allowed the construction of an acceptable model
with items ranging from "hard" to "easy". The hardest items
were found to be shopping and cleaning the kitchen floor, the
easiest were walking indoors and using telephone.

CONCLUSIONS: Women with RA have reduced grip force and pain,
which affect their performance of daily activities. Usage of assistive
devices and altered working methods reduced the perceived
difficulty in various activities. The ADL items assessed with
the EDAQ questionnaire, which also considers the individuals'
own solutions to their problems, could be arranged
hierarchically from "hard" to "easy".




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