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Joint protection is a self-management strategy aimed at preserving function and energy conser- vation through modi!cation in working habits, enhanced awareness of posture and joint position, use of proper joint and body mechanics by applying ergonomic principles, activity pacing, environmental adaptation, and the use of orthotic and assistive devices.Furthermore, clinical heterogeneity is contributed by the characteristics of the RA patient and the disease trajectory.The provision of TPE programs can be delivered by various health professionals such as nurses, occupational therapists, physiotherapists, psychologists, social workers, podiatrists as well as rheu- matologists, and physical and rehabilitation medicine physicians [33].A recent RCT has revealed that needs-based patient education, using the Educational Needs Assessment Tool for guidance, helps to improve patients' self-ef!cacy and some aspect of health status [40].The !rst one reported moderate evidence to improve joint pro- tection behaviors, whereas low evidence to improve pain and physical function [34].
Joint protection is a self-management strategy aimed at preserving function and energy conser- vation through modi!cation in working habits, enhanced awareness of posture and joint position, use of proper joint and body mechanics by applying ergonomic principles, activity pacing, environmental adaptation, and the use of orthotic and assistive devices. Effectiveness of joint protection in RA was evaluated in 3 recent SRs [34,37,38]. The !rst one reported moderate evidence to improve joint pro- tection behaviors, whereas low evidence to improve pain and physical function [34]. The second SR reported strong evidence to improve function and decrease pain [37]. The most recent one, which included a meta-analysis also, revealed that mid-term and long-term effects of joint protection pro- grams on pain and hand function in RA were superior over usual care. However, the quality of evidence was low and the effect was too small to be clinically important [38].
The content and methods of delivery of TPE programs are highly heterogeneous. Furthermore, clinical heterogeneity is contributed by the characteristics of the RA patient and the disease trajectory. Thus, the patients are likely to have different educational needs depending on the impact of RA on their functioning. Therefore, TPE interventions in established RA should be individually tailored and needs- based [39]. The assessment of a patient's educational needs might be helpful in this respect. A recent RCT has revealed that needs-based patient education, using the Educational Needs Assessment Tool for guidance, helps to improve patients' self-ef!cacy and some aspect of health status [40].
The provision of TPE programs can be delivered by various health professionals such as nurses, occupational therapists, physiotherapists, psychologists, social workers, podiatrists as well as rheu- matologists, and physical and rehabilitation medicine physicians [33]. Whenever possible, delivery should be carried out by the multidisciplinary team [18]. Which and how many professionals should be involved will depend on the aim and the content of the program as well as the setting and the context
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