Joint Protection: A Critical Review

Abstract

This literature review considers the evidence to support or disclaim the efficacy of joint protection principles in the treatment of rheumatoid arthritis. The principles used in the occupational therapy department of the Guest Hospital, Dudley, are examined and appraised individually. The application of these principles is then discussed in the context of overall patient care.

Joint Protection Education: What are We Doing?

“…The 14 principles listed were identified from literature review (Furst et ai, 1987a, b;Melvin, 1989;Lorig and Fries, 1990;Unsworth, 1990;Palmer and Simons, 1991) (see Table 3). • What teaching methods are used (verbal instructions; written instructions; visual aids; demonstrations; and an openended 'other' section).…”

“…Respondents recorded spending a median of 9 hours of their working week in providing JP education. Sources of lP principles: Furst et ai, 1987a, b;Melvin, 1989;Lorig and Fries, 1990;Unsworth, 1990;Palmer and Simons, 1991. …”

“…These included respect for pain, distributing loads over as many joints as possible and avoiding positions of deformity (see Table 3) (Furst et al, 1987a, b;Melvin, 1989;Lorig and Fries, 1990;Unsworth, 1990;Palmer and Simons, 1991). Other principles were less commonly included in this construct, such as losing weight.…”

Effect of assistive technology in hand osteoarthritis: a randomised controlled trial

“…The activity limitations identified in the COPM interview gave directions for the choice of AT, and provision of AT was based on the human activity assistive technology model, taking both the person, the activity, the AT and the context into consideration 18. Depending on the problems described by the patient, the intervention could also include teaching of energy conservation and alternative working methods, in which use of AT was part of the working method 19. Both groups received medical treatment as usual, including use of medication due to their HOA.…”

What is Evidence-Based Practice?

“…Palmer and Simons' (1991) article gives a broad summary of the evidence underpinning the principles of joint protection. Whilst this search does not provide absolute proof for the clinical effectiveness of joint protection education programmes, it does provide food for thought for evidence-based practitioners to aid their clinical reasoning process.…”