To facilitate the adoption of energy conservation (EC) and joint protection (JP) behaviors in adults with rheumatoid arthritis (RA), a workbook based education program using behavioral modification techniques with emphasis on developing behavioral awareness and problem-solving skills was designed. To evaluate the effectiveness of this intervention, a randomized study was designed to compare traditional occupational therapy (OT) training in EC and JP with the new program at three participating multipurpose arthritis centers and the NIH. (Ann Arbor, Michigan; Brigham and Womens, Boston; and Good Samaritan, Baltimore.) Patients were evaluated using an Activity Record adapted to measure behavioral objectives, as well as ADL, joint, psychosocial adjustment to illness and patient and family knowledge evaluations. Experimental and control patients were tested immediately prior to treatment, three months and one year following treatment. Behavioral objectives included modified patterns of rest and physical activity including increasing frequency of rest during physical activity periods, increasing time spent physically active and in preparation and planning. A total of 28 patients from all centers were entered from March, 1983 until March, 1984. Three months data on 23 patients is currently available. Findings from the Activity Record showed that 46% of the experimental and 12% of the control patients improved in the amount of time spent physically active (p=.1); 53% of the experimental and 16% of the control patients increased the frequency of rest during periods of physical activity (p=.07), and 50% of the experimental and 20% of the control patients increased the time spent in preparation and planning. Three months after treatment, 25% of the control patients increased their index of Physical Activity (IPA) (i.e. index of the balance between rest and physical activity) while 47% of the experimental patients increased their IPA. Although the number of patients in this preliminary research study is small, the results indicate that the new program may be more effective in changing energy conservation behaviors in adults with RA than current 01 approaches.
