基于ICF理论的类风湿关节炎患者手功能康复管理方案

doi:10.3969/j.issn.1006-9771.2021.04.004

Abstract

Abstract: Objective

To development a management program of hand function rehabilitation for patients with rheumatoid arthritis.

Methods

Based on the International Classification of Functioning, Disability and Health, the primary version of management program of hand function rehabilitation for patients with rheumatoid arthritis was developed after evidence-based research and group discussion. The primary version was consulted to 15 experts twice with Delphi method, and revised as the final program.

Results

The enthusiasm of experts was 100% in both rounds, the authority coefficient of experts was 0.90, and the Kendall's W coefficient was 0.204 in the first round and 0.202 in the second round. The final program included an item of evaluation and 19 items of intervention in four dimensions: body function, body structure, activity and participation, and environmental factors.

Conclusion

A management program of hand function rehabilitation for patients with rheumatoid arthritis has been prepared for further clinical evaluation.

Key words: rheumatoid arthritis, hand function, rehabilitation, International Classification of Functioning, Disability and Health, Delphi method

CLC Number:

R593.22

Bing ZHOU,Xi-hong ZHOU,Yi-yue CHEN,Ting-na TAN,Meng-yun CHENG. Development of Hand Function Rehabilitation Management Program for Patients with Rheumatoid Arthritis Based on ICF Theory[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(4): 405-411.

Figures/Tables 2

维度	方法	内容	证据等级	推荐等级
身体功能	认知行为治疗	通过转移注意力、目标设定和自我强化提高应对技能，每次60~75 min，共12次。每次结束时布置作业，并在下节课开始时复习^[10]	Ⅰ	A
	心理访谈	通过访谈了解患者的心理，分析不良情绪的产生原因，选择合适的方式与患者交流^[11]	Ⅱ	A
	放松训练	①腹式呼吸放松：双眼闭合，鼻子缓缓吸气，吸气时腹部鼓起，然后缓缓呼气；②渐进式肌肉放松：按头、面、颈、肩、上臂、前臂、手掌、背、胸、腹、大腿、小腿、足的顺序逐步放松各个肌群，每个部位20~30 s，视情况循环。每次50~60 min，共8次^[12]	Ⅱ	A
	关节炎教育	疾病的常见症状及自我护理^[12]	Ⅱ	A
	疼痛非药物疗法	有氧运动：慢跑、散步等，运动心率维持在60%~80%最大心率^[13]	Ⅱ	B
	疼痛药物疗法	使用镇痛药物，如非甾体类抗炎药、阿片类药物^[14]	Ⅳ	A
	水疗	矿泉水浴，温度35~38 ℃^[15]	Ⅳ	B
	物理治疗	由康复治疗师评估后选择干预方法^[16]	Ⅲ	A
	运动疗法	血沉< 50 mm/h，体温在正常范围，手关节局部无明显肿胀、疼痛，无严重急性心血管疾病，经风湿科医师和康复治疗师评估后实施^[16]	Ⅲ	A
		关节活动度训练：双手握拳伸展；双手手指内收和外展；五指对指训练；腕关节屈伸及环转运动^[17]	Ⅰ	A
		抗阻训练：借助手部抗阻力工具，如抗阻训练胶网^[18]	Ⅰ	A
		肌力训练：关节准备活动10 min，运用弹力带、握力球、训练胶泥锻炼20 min，放松运动5?min^[19]	Ⅰ	A
身体结构	功能位摆放	拇指与其余四指相对，余四指稍屈曲，腕关节约45°背伸^[20]	Ⅰ	A
	使用矫形器	由康复治疗师根据患者情况制作，在休息时使用，注意观察使用部位的皮肤^[21]	Ⅴ	B
活动和参与	日常生活能力训练	自行起床、倒水、进食、梳头发、洗脸、穿衣服、拾物、躺下，不能使用筷子则提供加长柄和粗把的勺，选择方便抓握的杯子和牙刷^[22]	Ⅲ	A
	关节保护技术	注意手关节的休息，避免提举重物和长时间处于疲劳姿势，如抓握鼠标、工厂流水线生产等^[23]	Ⅳ	A
	能量节约技术	注意能量节约，用推车代替提举，大关节代替小关节活动^[23]	Ⅳ	A
环境因素	选择合适的辅具	根据患者情况选择合适的辅具，使患者适应患病环境^[24]	Ⅱ	B
	增强社会支持	鼓励亲友交往，增强沟通和家庭支持，尤其是配偶和子女的支持^[25]	Ⅲ	A
	同伴支持	培训自我管理良好的患者对其他患者进行指导^[26]	Ⅱ	A
	职业治疗	职业技能训练、咨询和教育^[27]	Ⅰ	B
康复评估	评估内容	疼痛；握力；晨僵；疾病活动度评分(DAS28)；手功能评估(关节炎影响测量量表-2、密歇根大学手功能问卷、手臂肩残疾问卷)；健康评估问卷；不良事件(手关节肿胀或疼痛加重/数量增加)^[28]	Ⅰ	A

维度	方法	具体措施
身体功能	心理访谈	通过访谈了解患者的心理，分析不良情绪的产生原因，选择合适的方式与患者交流，运用共情、倾听等沟通技巧 ①腹式呼吸放松：双眼闭合，鼻子缓缓吸气，吸气时腹部鼓起，然后缓缓呼气；②渐进式肌肉放松：按头、面、颈、肩、上臂、前臂、手掌、背、胸、腹、大腿、小腿、足的顺序逐步放松各个肌群，每个部位20~30 s，视情况循环训练。每次50~60 min，共8次
	放松训练
	关节炎教育	疾病常见症状及自我护理
	疼痛非药物疗法	有氧运动：慢跑、散步等，运动心率维持在60%~80%最大心率，教患者转移注意力的方法
	疼痛药物疗法	遵医嘱正确使用镇痛药物，进行药物知识宣教
	物理治疗	由康复治疗师评估患者后选择干预方法
	运动疗法	血沉< 50 mm/h，疾病活动度评分≤ 5.1分，体温在正常范围，手关节无明显肿胀、疼痛，无严重急性心血管疾病，经风湿科医师及康复治疗师评估后实施关节活动度训练：双手握拳伸展、双手指内收和外展、五指对指腕关节屈伸及环转运动抗阻训练：借助手部抗阻力工具，如手抗阻力训练胶网肌力训练：关节准备活动10 min，运用弹力带、握力球、训练胶泥锻炼20?min，放松运动5 min
身体结构	功能位摆放	拇指与其余四指相对，余四指稍屈曲，腕关节约45°背伸
身体结构	使用矫形器	由康复治疗师根据患者情况制作，在休息时使用，注意观察使用部位的皮肤
活动和参与	日常生活能力训练	自行起床、倒水、进食、梳头发、洗脸、穿衣服、拾物、躺下，不能使用筷子提供加长柄和加粗的勺，选择方便抓握的杯子、牙刷
	关节保护技术	注意手关节的休息，避免提举重物及长时间处于疲劳姿势，如抓握鼠标、工厂流水线生产等
	能量节约技术	注意能量节约，用推车代替提举，大关节代替小关节活动
环境因素	选择合适的辅具	根据患者的情况选择合适的辅具，使患者适应患病的环境
	增强社会支持	鼓励亲友交往，增强沟通及家庭支持，尤其是配偶和子女的支持
	同伴支持	培训自我管理良好的患者对其他患者进行指导
	康复训练指导	坚持合理锻炼的重要性；正确的锻炼方式；关节肿痛情况的评估
康复评估	评估内容	疼痛；握力；晨僵；疾病活动度评分(DAS28)；手功能评估(关节炎影响测量量表-2、密歇根大学手功能问卷、手臂肩残疾问卷)；健康评估问卷；不良事件(手关节肿胀或疼痛加重/数量增加)；医院焦虑抑郁量表；焦虑自评量表；抑郁自评量表
康复评估	评估时间	根据实际情况选择康复评估内容，评估时间不宜太长

References 34

1	葛均波,徐永健,王辰. 内科学[M]. 9版. 北京:人民卫生出版社, 2018.
	Ge J B, Xu Y J. Internal Medicine [M]. 8th ed. Beijing: People's Medical Publishing House, 2013: 129-130.
2	Wilburn J, McKenna S P, Twiss J, et al. Further international adaptation and validation of the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire [J]. Rheumatol Int, 2015, 35(4): 669-675.
3	Zhang L, Wang J, Zhang Q, et al. Factors associated with hand joint destruction in Chinese patients with rheumatoid arthritis [J]. BMC Musculoskelet Disord, 2017, 18(1): 211.
4	Xavier R M, Zerbini C A F, Pollak D F, et al. Burden of rheumatoid arthritis on patients' work productivity and quality of life [J]. Adv Rheumatol, 2019, 59(1): 47.
5	Zhou Y, Wang X, An X, et al. Disability and health-related quality of life in Chinese patients with rheumatoid arthritis: a cross-sectional study [J]. Int J Rheum Dis, 2018, 21(9): 1709-1715.
6	李沁燚,邱卓英,陈迪,等.基于ICF构建国家功能、残疾和健康的信息架构和数据体系[J]. 中国康复理论与实践, 2017, 23(4): 385-389.
	Li Q Y, Qiu Z Y, Chen D, et al. Construction of national framework and data systems of functioning, disability, and health of information using ICF [J]. Chin J Rehabil Theory Pract, 2017, 23(4): 385-389.
7	姜静远,邱卓英,王国祥,等. 世界卫生组织国际健康分类家族在康复中系统应用的方案与路线图[J]. 中国康复理论与实践, 2020, 26(11): 1241-1255.
	Jiang J Y, Qiu Z Y, Wang G X. et al. Systematic Implementation of World Health Organization Family International Classifications in rehabilitation: protocol and roadmap [J]. Chin J Rehabil Theory Pract, 2020, 26(11): 1241-1255.
8	邱卓英. 国际社会有关残疾发展的重要文件——世界卫生组织、世界银行共同发布首份«世界残疾报告»[J]. 中国康复理论与实践, 2011, 17(6): 508-511.
	Qiu Z Y. Chin J Rehabil Theory Pract, 2011, 17(6): 508-511.
9	Prodinger B, Stucki G, Coenen M, et al. The measurement of functioning using the International Classification of Functioning, Disability and Health: comparing qualifier ratings with existing health status instruments [J]. Disabil Rehabil, 2019, 41(5): 541-548.
10	Ferwerda M, van Beugen S, van Middendorp H, et al. Tailored, therapist-guided internet-based cognitive behavioral therapy compared to care as usual for patients with rheumatoid arthritis: economic evaluation of a randomized controlled trial [J]. J Med Internet Res, 2018, 20(10): e260.
11	李艳丽,孙娟,马玲,等. 舒适护理对类风湿性关节炎患者心理和生活质量的影响[J]. 中华全科医学, 2017, 15(12): 2163-2165.
	Li Y L, Sun J, Ma L, et al. The effect of comfortable nursing on psychological status and quality of life in patients with rheumatoid arthritis [J]. Chin J Gener Prac, 2017, 15(12): 2163-2165.
12	Barsky A J, Ahern D K, Orav E J, et al. A randomized trial of three psychosocial treatments for the symptoms of rheumatoid arthritis [J]. Semin Arthritis Rheum, 2010, 40(3): 222-232.
13	Löfgren M, Opava C H, Demmelmaier I, et al. Long-term, health-enhancing physical activity is associated with reduction of pain but not pain sensitivity or improved exercise-induced hypoalgesia in persons with rheumatoid arthritis [J]. Arthritis Res Ther, 2018, 20(1): 262.
14	Geenen R, Overman C L, Christensen R, et al. EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis [J]. Ann Rheum Dis, 2018, 77(6): 797-807.
15	Verhagen A P, Bierma-Zeinstra S M, Boers M, et al. Balneotherapy (or spa therapy) for rheumatoid arthritis [J]. Cochrane Database Syst Rev, 2015, 4(4): CD000518.
16	王慧,孔莉,陈晓翔. 康复治疗技术在类风湿关节炎中的应用进展[J]. 中国康复理论与实践, 2018, 24(4): 405-409.
	Wang H, Kong L, Chen X X. Application progress of rehabilitation therapy in rheumatoid arthritis (review) [J]. Chin J Rehabil Theory Pract, 2018, 24(4): 405-409.
17	Williamson E, Mcconkey C C, Heine P J, et al. Hand exercises for patients with rheumatoid arthritis: an extended follow-up of the SARAH randomised controlled trial [J]. BMJ Open, 2017, 7(4): 1-11.
18	肖文,绳宇,朱宏伟,等. 抗阻训练对类风湿关节炎患者手关节功能康复的效果评价[J]. 中国实用护理杂志, 2018, 34(3): 176-181.
	Xiao W, Shen Y, Zhu H W, et al. The effect of resistance training on the rehabilitation of hand in rheumatoid arthritis patients [J]. Chin J Prac Nurs, 2018, 34(3): 176-181.
19	Ellegaard K, von Bülow C, Røpke A, et al. Hand exercise for women with rheumatoid arthritis and decreased hand function: an exploratory randomized controlled trial [J]. Arthritis Res Ther, 2019, 21(1): 158.
20	许冠华. 运动疗法对类风湿关节炎患者关节功能的影响[D]. 杭州:浙江大学, 2015.
	XU G H. The effect of exercise therapy on the function of rheumatoid arthritis patients [D]. Hangzhou: Zhejiang University, 2015.
21	Küçükdeveci A A. Nonpharmacological treatment in established rheumatoid arthritis [J]. Best Pract Res Clin Rheumatol, 2019, 33(5): 101482.
22	Ksiezopolskaorlowska K, Sadurasieklucka T, Kasprzak K, et al. The beneficial effects of rehabilitation on hand function in patients with rheumatoid arthritis [J]. Reumatologia, 2016, 54(6): 285-290.
23	Siegel P, Tencza M, Apodaca B, et al. Effectiveness of occupational therapy interventions for adults with rheumatoid arthritis: a systematic review [J]. Am J Occup Ther, 2017, 71(1): 7101180050p1-7101180050p11.
24	Tonga E, Düger T, Karataş M. Effectiveness of client-centered occupational therapy in patients with rheumatoid arthritis: exploratory randomized controlled trial [J]. Arch Rheumatol, 2015, 31(1): 6-13.
25	Poh L W, He H G, Chan W C S, et al. Experiences of patients with rheumatoid arthritis: a qualitative study [J]. Clin Nurs Res, 2017, 26(3): 373-393.
26	Shadick N A, Zibit M J, Iannaccone C K, et al. A development and feasibility study of a peer support telephone program in rheumatoid arthritis [J]. J Clin Rheumatol, 2018, 24(6): 346-349.
27	Hoving J L, Lacaille D, Urquhart D M, et al. Non-pharmacological interventions for preventing job loss in workers with inflammatory arthritis [J]. Cochrane Database Syst Rev, 2014, 6(11): CD010208.
28	Williams M A, Srikesavan C, Heine P J, et al. Exercise for rheumatoid arthritis of the hand [J]. Cochrane Database Syst Rev, 2018, 7(7): CD003832.
29	邱卓英,李安巧,黄珂,等. 基于ICF和联合国«残疾人权利公约»对国际组织有关残疾定义及其测量的内容研究[J]. 中国康复理论与实践, 2018, 24(10): 1117-1121.
	Qiu Z Y, Li A Q, Huang K, et al. Content analysis of definition and measurement of disability: based on ICF and UN Convention on the Rights of Persons with Disabilities [J]. Chin J Rehabil Theory Pract, 2018, 24(10): 1117-1121.
30	邱卓英,郭键勋,杨剑,等. 康复2030:促进实现«联合国2030年可持续发展议程»相关目标[J]. 中国康复理论与实践, 2017, 23(4): 373-378.
	Qiu Z Y, Kwok J K F, Yang J, et al. Rehabilitation 2030: realization of United Nation Sustainable Development Goals 2030 [J]. Chin J Rehabil Theory Pract, 2017, 23(4): 373-378.
31	康复2030:国际康复发展状况与行动呼吁[J]. 李安巧,邱卓英,吴弦光,等,译. 中国康复理论与实践, 2017, 23(4): 379.
	Rehabilitation2030: a call for action [J]. Li A Q, Qiu Z Y, Wu X G,et al., trans. Chin J Rehabil Theory Pract, 2017, 23(04): 379.
32	邱卓英,李伦,陈迪,等. 基于世界卫生组织国际健康分类家族康复指南研究:理论架构和方法体系[J]. 中国康复理论与实践, 2020, 26(2): 125-135.
	Qiu Z Y, Li L, Chen D, et al. Research on rehabilitation guidelines using World Health Organization Family International Classifications: framework and approaches [J]. Chin J Rehabil Theory Pract, 2020, 26(2): 125-135.
33	邱卓英,郭键勋,李伦,等. 世界卫生组织康复指南«健康服务体系中的康复»:背景、理论架构与方法、主要内容和实施[J]. 中国康复理论与实践, 2020, 26(1): 16-20.
	Qiu Z Y, Kwok J K F, Li L, et al. Rehabilitation in Health Service System: background, theoretical framework and methods, main contents and implementation [J]. Chin J Rehabil Theory Pract, 2020, 26(1): 16-20.
34	井淇,孙宏伟,邱卓英. 国际康复人力资源构成和配置及其对发展现代康复高等教育的启示[J]. 中国康复理论与实践, 2018, 24(9): 1011-1017.
	Jing Q, Sun H W, Qiu Z Y. Composition and allocation of rehabilitation workforces: implications to development of higher education of modern rehabilitation [J]. Chin J Rehabil Theory Pract, 2018, 24(9): 1011-1017.

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Development of Hand Function Rehabilitation Management Program for Patients with Rheumatoid Arthritis Based on ICF Theory

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