Rheumatoid Arthritis Awareness for the Elderly
at NovaCare Rehabilitation Facilities
Danielle Lyner
November 24, 2015
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Table of Contents
Abstract
Introduction
Literature Review
Goals and Objectives
Methods
Program Description
Results
Discussion
Reference List
Appendices
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4
4
6
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9
10
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Table 1
Figure 1
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Abstract
Rheumatoid Arthritis (RA) is a crippling disease that affects almost all aspects of one’s
life. No one knows exactly why, when, or how RA comes about, but it is very important for
those who have the disease to be thoroughly educated on the topic, learn how to live with it, and
also ways to help improve their condition if possible. A person’s knowledge in these areas can
be increased with proper instruction and patience. The goal of this study was to educate and
increase awareness of the symptoms and simple exercises that can be performed to improve the
effects of RA to elderly members of NovaCare Rehabilitation who suffer from the disease.
Pre-tests were distributed to the participants of this study to test their knowledge of
Rheumatoid Arthritis, the symptoms, and exercise programs they should be following routinely.
Each participant was handed out with a brochure that contained all of the impertinent
information know regarding RA and asked to listen to a brief presentation given by myself that
coincided with the information provided in the brochure. At the conclusion of the presentation,
post-tests were distributed to all of the participants to compare what they had learned from the
beginning of the program to the end.
Data was gathered using pre and post-tests that were distributed to the participants before
and after the presentation that was given. Quantitative data was used in this study. At the end of
the study, the data showed that there was an increase in knowledge and awareness amongst the
participants.
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Introduction
A common problem that is seen within the elderly population with rheumatoid arthritis is
that although they keep up with their exercises while they are being monitored and coached by a
professional, once they are home they may not remember certain exercises or have the proper
equipment to do so.
The program that was developed for the clients at NovaCare Rehabilitation was
implemented to increase their awareness of symptoms and teach them easy exercises that can be
performed in the comfort of their own home as well as in a rehabilitation facility. In this way,
overall improvement and comfort of the joints could be achieved in a shorter amount of time and
the client would not forget the exercises that needed to be performed.
Literature Review
People have long feared rheumatoid arthritis (commonly called RA) as one of the most
disabling types of arthritis (American College of Rheumatology, 2013). It is estimated that an
individual suffering from this disease spends about $2,085 a year in treatments on average.
Rheumatoid arthritis is a chronic inflammatory and autoimmune disorder that affects the small
joints of the hands and feet. In this disorder, the immune system begins to attack the lining of
the joints, or the synovium, causing it to become inflamed and thicken. This can lead to bone
deformity, bone erosion, and the destruction of cartilage over time. Tendons and ligaments will
also stretch and weaken, so the joint will lose shape and alignment over time as well (Mayo
Clinic, 2014). RA can begin to affect other organs of the body as well, such as the skin, eyes,
lungs, and blood vessels. According to the Centers for Disease Control, rheumatoid arthritis
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affects more than 1.5 million Americans and 89 out of 100,000 people aged 65-74 are affected
by the disease, making this the most out of any age group.
Signs and symptoms for rheumatoid arthritis include may include: tender, warm, swollen
joints; morning stiffness that may last for hours; firm bumps of tissue under the skin of your
arms and hands; and fatigue, fever and weight loss (Mayo Clinic, 2014). Mayo Clinic also goes
on to say that as the disease progresses, these symptoms will begin to move to the larger joints of
the body, including the wrists, knees, ankles, elbows, hips, and shoulders. Symptoms can come
and go in what are called flares. Sometimes the disease will cause the joints increased pain, and
other times the pain will subside and the sufferer gets temporary relief from the pain.
There are many risk factors that can lead an individual to develop rheumatoid arthritis in
their lifetime, one of which is age. Both men and women are at the highest risk of developing
RA when they are in their sixties. Sex is another factor in determining who is at higher risk. The
disease is two-three times more likely to occur in females than males (CDC, 2015). Family
history and genetics are also said to play a key role as to whether or not an individual suffers
from RA. According to the Arthritis Foundation, there is research that supports that people with
a certain genetic marker called the HLA shared epitope have a fivefold greater chance of
developing the disorder than those who do not have the marker. This is the genetic site that
controls the immune system, which in turn could trigger the immune system to go haywire.
Smoking, like in many other disorders and diseases, is also a common risk factor for RA as well.
Because rheumatoid arthritis can negatively affect the elderly, and frankly anyone, in
such a negative way, it is a good idea that in addition to doing exercises in clinical settings that
they also try to perform the same exercises at home. Doing this can lead to overall improvement
and comfort of the patient’s joints in a shorter amount of time as opposed to just doing exercises
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in therapy with a professional. It is also important that the elderly have take home instructions
on how to perform each exercise in case they forget what was learned in therapy that day. In one
study, after the patients were properly taught how to perform each exercise, they were given
written explanations which illustrated how to perform each exercise so that when they went
home, they would have a reference for themselves. Initially, the study was intended to last over
a four week period, but they decided they would follow up with the participants after a year as
well. Significant improvements on functional status and quality of life in patients with RA were
observed without any increase on disease activity, with 4-week home-based exercise program,
and it was shown that these improvements were maintained at the 1-year follow-up as well
(Karatepe et. al., 2009).
It is important to educate the elderly on rheumatoid arthritis because alongside therapy in
a facility, at-home therapy done on their own can really help to improve a person’s quality of life
and keep them pain-free. That is why it is important that programs similar to the study
performed on these patients are implemented in facilities that deal with rheumatoid arthritis
regularly.
Goals and Objectives
The main goal of this program is to increase awareness and knowledge of rheumatoid
arthritis to the elderly RA patients of NovaCare Rehabilitation, as well as provide them with a
quick and easy guide to refer to for at-home exercises that they can perform in their own homes.
The participants will be given a pre and post test of questions about rheumatoid arthritis with the
expectation score of 80% or better on the post test after the completion of the presentation that
will be given. The participants will better understand their disorder and be able to identify
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proper exercise techniques that they can perform at home to increase the comfort of their joints
and also overall quality of life.
Methods
The design used for this program was the evaluation of the pre and post tests, which
would be a cross-sectional design. This design provides quantitative data collected from the pre
and post test scores to show if knowledge was gained about rheumatoid arthritis after the
conclusion of the presentation, which is why it was chosen for this particular study.
This program correlates with the goals and objectives of the program because the
participants are tested on their knowledge of rheumatoid arthritis to see how much knowledge
they have gained from the program by comparing the scores of the pre and post tests. The
brochures that were handed out to the participants closely follow the presentation that was given
and provide information to educate on symptoms and overall knowledge of RA. The goal is met
by providing participants with easy at-home exercises that can be performed to help improve
overall joint comfort and quality of life, and also by increasing knowledge of RA in the
participants.
The participants in the program are being recruited at Nova Care Rehabilitation through
word of mouth from the therapists at NovaCare. The evaluation will take place at NovaCare
Rehabilitation and the data will be collected at the facility as well. The participants will take the
tests at the facility and must complete the post test by the end of the program for evaluation. The
brochures will be available at NovaCare for anyone to utilize and my contact information will be
given to all participants in case they have any further questions.
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Program Description
This program technically took place over a two week period at NovaCare Rehabilitation.
The first week, which was the week of October 25th, was when participants were recruited for the
program. Therapists at the facility were notified of the program and were asked to speak with
their elderly clients with rheumatoid arthritis if they would be interested in participating in the
program. Once the therapists spoke with all of their RA clients, they contacted me with how
many people would be participating and we picked.
The following week, the presentation on the information in the brochure was given on
November 2nd. Pre and post tests were also distributed on the same day. The pre-test was given
to find a baseline score for the participants’ knowledge on rheumatoid arthritis and included
questions to see just how extensive their knowledge was on general knowledge of the disorder,
symptoms, and the significance of exercise. Questions included on the test were: “What part of
the joints does rheumatoid arthritis affect?” and also asked the participant to list three risk factors
of RA.
After the pre-test, the presentation about the information in the brochure was given. It
was about a 15 minute presentation that highlighted an overall understanding of rheumatoid
arthritis like what it does to the body, what causes it, and risk factors of the disorder; the
common symptoms that are normally seen in an individual with RA; and exercise programs that
could be followed at home to help in improving joint comfort in a shorter amount of time.
At the conclusion of the presentation, a post-test identical to the pre-test was given to the
participants. They were asked to fill it out and return it to me upon completion. Both the pre and
post tests were collected on November 2nd.
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The cost of the program was completely free. I made all of the pre and post tests, along
with the presentation. Participants did not have to pay any extra either because they already
were patients at NovaCare, so they were already paying for the treatment that they were
receiving. Therapists paid nothing either.
Results
Of the seven surveys that were handed out at NovaCare Rehabilitation, all seven of the
participants completed the program. They ranged in age from 63-81. These participants were
picked based on the presence of rheumatoid arthritis. At the end of the program, pre-test scores
were compared to post-test scores (Figure 1), and there was an insignificant difference in the
participant’s scores, P= .649149 (Table 1). P-value was found using a CHITEST to compare
both pre and post test scores.
TABLE 1
p-value
Participant
Pre-Test Score
Post-Test Score
1
7
8
2
6
7
3
6
9
4
8
10
5
7
8
6
4
7
7
5
8
.649149
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FIGURE 1
Rheumatoid Arthritis Awareness Test
100
Score
80
60
40
20
0
1
2
3
4
5
6
7
Participant
Pre-Test Scores
Post-Test Scores
Discussion
Even though my study did not show significant results, I believe that it could show
potential for success based on other studies, like the one mentioned in my Literature Review. I
believe this partially has to do with the power of my study. I had a relatively small amount of
participants and because of that the power was weak, making my p-value insignificant. If more
participants had taken part in the study, it could have been more significant.
Another limitation that I faced was that my study only took place on one day, even
though the recruitment period technically made it about two weeks. If it had taken place over the
course of a few weeks and participants had the time to go home and perform the exercises,
perhaps the results could have proven to be a little more significant.
Although this study does not exactly prove that participants will use and refer to the
brochures for at-home exercises or if the exercise will help quality of life, it does prove that it did
help to increase awareness and knowledge about rheumatoid arthritis. Post-test scores increased
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after the presentation, proving that educating people who suffer from rheumatoid arthritis can
gain new knowledge on the disorder that they did not know before. Of my goals, this one was
achieved amongst the patients at NovaCare.
After planning, implementing, and evaluating this program, I learned that these kinds of
programs are very valuable to the community. They provide an easy-to-read way to inform
anyone who is uneducated on a particular topic with information they may need for themselves.
I also learned that a lot of planning and dedication goes into creating programs such as these. It
is more than just presenting to a group of people on a topic; it is also being educated enough and
enthusiastic about what you are teaching your audience that matters as well. I found that people
are very appreciative when someone takes time out of their busy schedule to come in and educate
a group of people that may really benefit from the information being presented to them.
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References
Karatepe, A.G., Günaydin, R., Türkmen, G., Kaya, T. (2009). Effects of home-based exercise
program on the functional status and the quality of life in patients with rheumatoid
arthritis: 1-year follow-up study. Rheumatology International. 31(2), 171-176. doi:
10.1007/s00296-009-1242-7
Rheumatoid Arthritis. (2013). American College of Rheumatology. Retrieved from
http://www.rheumatology.org/I-Am-A/Patient-Caregiver/DiseasesConditions/Rheumatoid-Arthritis
Rheumatoid Arthritis. Arthritis Foundation. Retrieved from http://www.arthritis.org/aboutarthritis/types/rheumatoid-arthritis/
Rheumatoid Arthritis (RA). (2015). Centers for Disease Control. Retrieved from
http://www.cdc.gov/arthritis/basics/rheumatoid.htm
Rheumatoid arthritis. (2014). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseasesconditions/rheumatoid-arthritis/basics/definition/con-20014868
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Pre and Post Tests for Rheumatoid Arthritis
Name:
1. Rheumatoid Arthritis is a chronic, inflammatory disorder that affects the small joints of
the hands and feet.
True or False?
2. Rheumatoid Arthritis is not considered to be an autoimmune disorder.
True or False?
3. Symptoms of Rheumatoid Arthritis include:
a. Morning stiffness exceeding one hour
b. Firm tissue bumps under the skin
c. Tender, warm, swollen joints
d. All of the above
4. Which gender is more at risk for Rheumatoid Arthritis?
5. About how many adults aged 65-74 years old have Rheumatoid Arthritis?
a. 8.7 per 100,000
b. 89 per 100,000
c. 36.4 per 100,000
d. 54 per 100,000
6. How much money on average does an individual with Rheumatoid Arthritis spend on
treatment per year?
a. $3,520
b. $560
c. $2,085
d. 985
7. List three risk factors of Rheumatoid Arthritis:
1.)
2.)
3.)
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8. Exercises that focus on aerobic training are most beneficial for those with Rheumatoid
Arthritis.
True or False?
9. What part of the joints does Rheumatoid Arthritis affect?
10. How often should an individual with Rheumatoid Arthritis exercise?
a. 1-2 days
b. 3-4 days
c. 4-5 days
d. 5-7 days
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