"類風溼性關節炎患者對治療達標(Treat to Target, T2T)衛教計畫之認知、態度與實行意願之初探"

Abstract

研究目的： 類風濕性關節炎（Rheumatoid Arthritis, RA） 是一種慢性全身性的發炎疾病，嚴重時會導致殘障、心血管疾病，甚至影響患者的壽命。過去十幾年，類風濕性關節炎的治療已有長足之進步，但仍未有明確之流程及明確之治療目標，因此在2010年的專家結論中定義出治療類風濕性關節炎的治療目標(Treat to Target ,T2T)及治療建議。為推廣此概念，本研究希望藉由問卷瞭解類風濕性關節炎患者對T2T之認知、態度與實行意願，並透過RA T2T衛教的實施，比較介入前後治療達標之認知、態度、行為以及28個關節疾病活動度評估（DAS28）是否有明顯差異。 方法： 本研究採單組前後測類實驗設計，以確診類風濕性關節炎3年內患者為研究對象，利用知識、態度、行為量表進行問卷調查，並施予類風濕性關節炎治療達標衛教以及28個關節疾病活動度評估。以描述性統計分析人口學變項比例，再以Wilcoxon Signed Rank檢定及相關統計進行統計分析。 結果： 全程參與的研究對象共28位，男性5人、女性23人；男女比為1:4.6，平均年齡51歲，疾病嚴重度以中度疾病活動度(DAS28：3.2~5.1)患者居多，平均發病到確診時間為4.1年，有43%的病人有罹患其他慢性病。研究結果顯示類風濕性關節炎治療達標的衛教介入後，對患者之達標認知、態度與行為有顯著成效，衛教後得分皆高於衛教前，達統計顯著性差異，但於28個關節疾病活動度評估（DAS28）則未達顯著差異。9成患者認同「類風濕性關節炎治療達標」之概念很重要，也願意實行「類風濕性關節炎治療達標」衛教計劃。 結論： 於類風濕性關節炎早期，及早施予治療達標的衛教計劃將可提昇患者「類風 濕性關節炎達標」之認知、態度、行為及施行意願。本研究整理製作之治療達標手冊可運用於RA T2T患者衛教參考。

Objective Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease, which can result in loss of mobility, cardiovascular diseases, or even reduce life expectancy. In the past decades, there has been advancement in the treatments for RA; however, there was still no clear treatment process and treatment goal. Consequently, treating RA to target (RA T2T) and treatment recommendations were defined in a 2010 expert’s meeting. For RA T2T promotion, this study aimed to understand the changes of knowledge, attitude and intent to practice of patients with rheumatoid arthritis toward Treat to Target (T2T) educational program and DAS28 scores between pretest - posttest T2T intervention was also performed. Method One group pretest - posttest quasi-experimental design was adopted in this study, targeting RA patients who have diagnosis in the past 3 years in a tertiary hospital. Before and after the intervention of RA T2T education program, the DAS28 was used to assess disease activity of joints and a questionnaire was used to survey their knowledge, attitude and behavior toward treat-to-target. Descriptive analysis was used to analyze proportion of demographic variables. Wilcoxon Signed Rank test and correlation statistical analysis were used to test the hypotheses. Results There were 28 participants in this study: 5 males, 23 females; proportion of male to female is 1:4.6; average age was 51 years old; in terms of DAS28, most patient were moderate conditions (DAS28: 3.2~5.1); average time from onset till diagnosis was 4.1 years; 43% of patients have chronic disease. The research showed that following the intervention of RA T2T education program, patient’s knowledge, attitude and behavior intention has significant improved. After educational program, there was no significant difference in terms of DAS28 scores. Ninety percent of participants agreed that RA T2T was important, and showed high intention to practice RA T2T educational program. Conclusion For early stage RA patients, a timely patient education program can increase their knowledge, attitude, behavior intention. The RA T2T education booklet can be used in clinics in the future.