ارزشیابی اثر آموزش خود مراقبتی به روش بازخورد محور بر شدت درد و کیفیت خواب افراد مبتلا به آرتریت روماتوئید

زمینه و هدف: آرتریت روماتوئید بیماری‌ مزمن، التهابی و خود ایمنی پیش‌رونده با علائم بالینی متغیراست، که می‌تواند علت اصلی ناتوانی، کوتاهی عمر و مرگ باشد. شایع‌ترین علامت آرتریت روماتوئید درد است. درد از عوامل تاثیر گذار بر الگوی خواب و استراحت است، و حدود 80 درصد افراد مبتلا به آرتریت روماتوئید از اختلالات خواب شاکی هستند.روش بررسی: مطالعه حاضر از نوع ارزشیابی اثر، تک گروهی با انجام پیش آزمون و پس آزمون است، که طی آن اثر آموزش خود مراقبتی به روش بازخورد محور بر شدت درد و کیفیت خواب در افراد مبتلا به آرتریت روماتوئید در درمانگاه روماتولوژی بیمارستان امام‌رضا (ع) شهرستان آمل بررسی شد. در این پژوهش نمونه‌ها به روش مستمر انتخاب شدند. آموزش به روش بازخورد محور داده شد. در مرحله قبل و یک ماه پس از آموزش، پرسشنامه‌های مقیاس دیداری درد و شاخص کیفیت خواب پیتزبرگ تکمیل شدند. سپس داده‌ها با استفاده از آمارهای توصیفی، آزمون تی زوجی و ویلکاکسون با بکارگیری نرم افزار spss نسخه 16 تحلیل شدند.یافته‌ها: این مطالعه شامل 56 نمونه‌ با میانگین سنی 04/45 و جنسیت 3/89 درصد زن بودند. نتایج پژوهش حاضر نشان داد. بطور خلاصه؛ میانگین نمره شدت درد و کیفیت خواب بعد از مداخله در نمونه‌ها بطور معنی‌داری کمتر از قبل از مداخله بود (001/0p<).نتیجه‌گیری کلی: این مطالعه نشان داد که آموزش به روش بازخورد محور می‌تواند باعث کاهش شدت درد و بهبود کیفیت خواب در افراد مبتلا به آرتریت روماتوئید گردد. لذا پیشنهاد می‌شود، از رویکرد آموزشی بازخورد محور در کنار سایر روش‌های آموزشی جهت کاهش شدت درد، بهبود کیفیت خواب و افزایش رضایتمندی افراد مبتلا به آرتریت روماتوئید استفاده کرد.

Effects of the Teach-back Method of Self-care Education on the Pain Intensity and Sleep Quality of Rheumatoid Arthritis Patients

Background Aims: Rheumatoid arthritis is a chronic, inflammatory, and progressive autoimmune disease with variable clinical symptoms, which could also be the main cause of disability, short life, and even death. Pain is the most common symptom of rheumatoid arthritis, which plays a key role in the pattern of sleep and rest, and approximately 80% of patients with rheumatoid arthritis complain of sleep disorders. Among the other influential factors in the sleep pattern are inactivity and medication use. Sleep disturbance could increase pain, fatigue with depression, inflammation, and even disease and symptom deterioration. The patients mostly refer on an outpatient basis and receive routine training. However, the management of chronic diseases requires the empowerment of the patients in terms of disease management, care, and participation in the treatment. Therefore, these patients must receive comprehensive education about the disease, symptoms, and complications (especially the correct methods of selfcare) in order to achieve the desired outcomes. Selfcare education is an important task of nurses, which promotes healthy behavior. As a result, adult patients learn and take actions to maintain their survival, quality of life, and wellbeing. The feedbackbased method is a clientoriented educational approach, which is often preferred over other educational methods. Assessing the proper understanding of the individuals toward the training materials provides feedback to ensure that they have received the training information accurately and completely, which has a significant impact on the quality of selfcare and patient satisfaction with the treatment and care. The main complaints of patients with rheumatoid arthritis are pain and sleep disorders, along with daily symptoms, fatigue, drowsiness, depression, mood and cognitive disorders, decreased concentration, and anxiety. Therefore, it is paramount to evaluate the impact of selfcare education on the pain management and sleep disorders of these patients. The present study aimed to investigate the effects of feedbackoriented selfcare training on the pain intensity and sleep quality of patients with rheumatoid arthritis. We also compared sleep quality and pain intensity before and after the intervention with the assumption that sleep quality would improve and pain intensity would decrease after the intervention.Materials Methods: This study was conducted based on the onegroup evaluation of effect with a pretestposttest design, in which we evaluated the effects of selfcare training by the feedback method on the pain intensity and sleep quality of the patients with rheumatoid arthritis referring to the rheumatology clinic of Imam Reza (AS) Hospital in Amol city, Iran. The study was performed during one year (August 2019July 2020), and 60 patients were selected via continuous sampling within six months (October 2019April 2020) considering attrition. Four patients were also excluded. The inclusion criteria were rheumatoid arthritis diagnosed by a physician, age of 1860 years, at least one year of disease history, complaints of pain and poor sleep quality (scores >5), basic literacy, awareness of time and location, ability to understand the Persian language, and no psychological disorders based on medical records. The exclusion criteria were employment in the health system, other chronic diseases (e.g., cardiovascular diseases, asthma, cancer, and mental illnesses), using psychotropic drugs, absence in one training session, and unwillingness or the impossibility of continuing participation. The training was implemented in three sessions using the feedback method. At the pretraining stage and one month posttraining, data were collected using the Pittsburgh visual pain scale and sleep quality index, which were completed and compared. Data of 56 patients were analyzed in SPSS version 16 using descriptive statistics, paired ttest, and Wilcoxon test at the significance level of P<0.001.Results: The mean age of the subjects was 45.04 ± 8.83 years. The majority of the patients (89.3%) were female, married (87.5%), had an undergraduate degree (71.5%), and poor economic status (71.4%). In addition, 32.1% were unemployed, 55.3% were housewives, 58.9% had no history of other diseases, and 64.3% had a history of surgery. Also, 64.3% of the patients had a family history of rheumatoid arthritis, and 35.7% the duration of the disease to be 610 years. The highest involvement was with the joints of the upper torso (55.4%), while 76.8% of the patients did not use sleeping pills, 92.9% did not smoke, and 96.4% did not consume alcohol. Before the intervention, the sleep quality of the majority of the patients (96.4%) was poor. After the intervention, the sleep quality of the majority (92.9%) was observed to be favorable, and the sleep quality scores in all the domains were significantly lower after the intervention compared to before the intervention (P<0.001). According to Table 4, pain intensity was high in 58.9% of the subjects before the intervention, and none of the patients had low pain intensity. After the intervention, the majority (67.9%) experienced moderate pain intensity, and high pain intensity was observed in none of the subjects. Furthermore, the mean pain intensity score was significantly lower after the intervention compared to before the intervention (P<0.001).Conclusion: According to the results, feedbackbased training could reduce pain intensity and improve sleep quality in the patients with rheumatoid arthritis. Considering the key role of education in the empowerment of patients with chronic diseases, it is suggested that feedbackbased educational approaches be used along with other training methods in order to decrease pain intensity, improve sleep quality, and increase the satisfaction of rheumatoid arthritis patients.