title: Daily activities in women with rheumatoid arthritis. Aspects of patient education, assistive devices and methods for disability and impairment assessment.
abstract: The major aims of the study were to identify the difficulties in daily activities (ADL) of women with rheumatoid arthritis (RA) and to demonstrate the effect of interventions. Methods were developed for measuring grip force, the Grippit instrument, and assessing ADL without and with assistive devices. Effects of interventions were explored, and the need for new solutions concerning daily activities was identified. Seventy-three women with RA participated in the study, 14 women with fibromyalgia were included in the grip force measurements, and 187 healthy women and 65 healthy men acted as a reference group. In describing the consequences of the disease with regard to daily activities, the patient's perspective was taken into account.
  
  
  RESULTS
  Grip force (peak value and average value over 10 seconds) was reduced in women with RA compared to the reference values. With an elastic wrist orthosis, pain decreased and grip force increased significantly in defined ADL situations. After a patient education programme in joint protection, designed to influence knowledge, inspiration and action, on average 91% of the assistive devices provided were in use, most frequently for kitchen work and personal care. Pain also decreased significantly with the use of specially designed assistive devices like breadsaws, potato peelers, and scissors compared to using standard tools. The cost of these interventions could be judged to be low in relation to its effectiveness. Using an alternative model of the Health Assessment Questionnaire (HAQ) where the use of assistive devices did not influence the ratings, grip force was correlated to more ADL activities than disclosed by the ordinary HAQ ratings. The difference between these two models for rating HAQ items was demonstrated. The Evaluation of Daily Activity Questionnaire (EDAQ) was developed and can be used to evaluate both intrinsic (without assistive devices) and actual (with such assistance) disability. The EDAQ consists of 102 items arranged in 11 dimensions. The number of activities with perceived difficulty without assistive devices/altered working methods in RA women ranged between 13 and 99 and after interventions between 6 and 57. Assistive devices appeared most effective in the dimensions Eating, Cooking and Toileting. Only a few useful devices were identified in the dimensions Dressing, Washing/Clothes care and Cleaning. The ordinal score from EDAQ was transformed by the Rasch analysis to obtain linear measures. This allowed the construction of an acceptable model with items ranging from "hard" to "easy". The hardest items were found to be shopping and cleaning the kitchen floor, the easiest were walking indoors and using telephone.
  
  
  CONCLUSIONS
  Women with RA have reduced grip force and pain, which affect their performance of daily activities. Usage of assistive devices and altered working methods reduced the perceived difficulty in various activities. The ADL items assessed with the EDAQ questionnaire, which also considers the individuals' own solutions to their problems, could be arranged hierarchically from "hard" to "easy".
authors.affiliation: Department of Rehabilitation Medicine, Institute of Community Medicine, Göteborg University, Sahlgrenska University Hospital, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Nordenskiöld
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation*; D016022:Case-Control Studies; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010353:Patient Education as Topic; D012656:Self-Help Devices; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016387:Women's Health