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Assistive technology for rheumatoid arthritis

  • Review
  • Intervention

Authors


Abstract

Background

Provision of assistive technology is a widely used intervention for people with rheumatoid arthritis. Assistive technology is any item used to increase or maintain functional ability in individuals with disabilities. It includes a wide range of products, from low-technology devices to technologically complex equipment. Yet, there are few systematic reviews on the effectiveness of assistive technology in this population.

Objectives

To assess the benefits of assistive technology for adults with rheumatoid arthritis in terms of improving functional ability and reducing pain, and to assess potential adverse effects in terms of psychological discomfort, personal injury or material damage related to device use.

Search methods

We searched the following databases: CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, ISI Web of Science, PEDro, and OTseeker (to October 2008). In addition, we scanned reference lists, sought grey literature, and had personally communicated with authors. We updated the literature searches in January 2009.

Selection criteria

Included study designs were randomised controlled trials, clinical controlled trials, controlled before and after studies, and interrupted time series where the effectiveness of assistive technology was evaluated. In addition, comparative observational studies were included if addressing adverse effects.

Data collection and analysis

Two authors independently selected trials, extracted data, and assessed study quality. Investigators were contacted to obtain missing information.

Main results

Only one randomised controlled trial with 29 participants was included. The study compared the use of an eye drop device to a standard bottle in people with rheumatoid arthritis suffering from persistent dry eyes. The study was considered to have low quality of evidence. The proportions with observed difficulties when using the device to squeeze out drops and getting the drops in the eyes were 10% and 14%, respectively. This compared to 52% and 52% when using the standard bottle (P = 0.001; P = 0.003, respectively). The proportions of participants reporting difficulties with squeezing the bottle, controlling the number of drops, and aiming the drops when using the device were 40%, 44%, and 46% respectively, while using the standard bottle the proportions with difficulties were 72%, 84%, and 76% (P = 0.001; P = 0.003; P = 0.031, respectively).

Authors' conclusions

Only one trial met the inclusion criteria for this review. Thus, there is very limited evidence for the effect of assistive technology for adults with rheumatoid arthritis and, therefore, an urgent need for high-quality research addressing the effectiveness of commonly used interventions.

摘要

背景

類風濕性關節炎的輔助科技

提供輔助科技被廣泛採用於類風濕性關節炎病人的處置。任何形式的輔助科技都是用於增進和維持殘障病人的功能。這包括了許多產品,從低科技產品到高科技的複雜設備。然而,關於輔助科技在這些病人身上的效果只有少數有系統的回顧。

目標

評估輔助科技在類風濕性關節炎的成人病患身上的助益,包括功能改善和減輕疼痛。也評估潛在的副作用,包括心理上的不適和器具使用相關的傷害。

搜尋策略

搜尋的資料庫包括以下幾個:CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, ISI Web of Science, PEDro, 和 OTseeker (to October 2008)。此外,我們也搜尋參考文獻並私下與作者聯絡。我們在2009年1月更新文獻搜尋。

選擇標準

納入的條件為評估輔助科技有效性的隨機化及對照組之實證研究,臨床對照試驗,控制之前和之後的研究,以及干涉時間序列設計研究。此外關於副作用的比較性觀察研究也納入。

資料收集與分析

兩位作者獨立選擇試驗,提取數據,以及評估研究的品質。並與調查人員取得聯繫以得到漏刊的訊息。

主要結論

只有一個包含29個人的隨機化控制組實證研究被納入。這個研究比較為持續乾眼所苦的類風濕性關節炎患者使用特殊眼淚設備和標準瓶子。這個研究被認為只有低品質的證據力。觀察在使用該設備擠出眼淚及將眼淚滴入眼睛困難的比率分別為10%和14%。而使用標準瓶子的比率則為52%和52%(P = 0.001; P = 0.003)。參與者報告擠瓶子、控制滴下的數目、以及將眼淚對準眼睛的困難的比率分別為40%,44%,及46%。而當使用標準瓶時困難的比率則為72%,84%,和76%。(P = 0.001; P = 0.003; P = 0.031).

作者結論

在這篇回顧中只有一個研究符合納入條件。因此,對於類風濕性關節炎患者的輔助科技的效果只有非常有限的證據。因此,對於這些普遍使用的方式的效果需要高品質的研究。

翻譯人

本摘要由臺灣大學附設醫院黃全敬翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

類風濕性關節炎的輔助科技:這篇Cochrane回顧表達了我們對於類風濕性關節炎患者輔助科技的所知。很不幸的,在這篇回顧中只有一個研究符合納入條件。這個研究針是對人工淚液施予的輔助科技。 這不是一個普遍使用的器具。輔助器具的目的是使類風濕性關節炎患者的生活更方便。而這個定義為任何可以維持或改善殘障病人的功能的設備。除了藥物和手術外,輔助科技是最常用於類風濕性關節炎患者的處置。對於類風濕性關節炎患者輔助科技的效果只有非常有限的證據。對於這些普遍使用的器具的效果需要高品質的研究。這篇回顧顯示在類風濕性關節炎病人身上,人工淚液輔具可以改善將人工淚液擠出的能力、對準眼睛以及控制數量。這個輔具可以預防人工淚液瓶碰到眼睛所造成的副作用。什麼是類風濕性關節炎而什麼是人工淚液輔具?當你罹患類風濕性關節炎,正常情況下對抗感染的免疫系統就會攻擊你的關節的周圍組織,造成發炎。發炎造成關節腫脹、僵硬、疼痛,並且造成功能喪失和殘障。目前類風濕性關節炎無法治癒,所以治療的目標為減少發炎、減輕疼痛和僵硬,以及改善日常生活的功能。人工淚液輔具是一項輔助科技,透過使瓶子更容易持拿、更容易擠、更容易對準眼睛,使你更容易將人工淚液滴入你的眼睛。將人工淚液擠出瓶子的能力是評估類風濕性關節炎患者使用人工淚液輔具的效果的指標。100人中有27人使用人工淚液輔具較容易將人工淚液擠出,100人中有35人在使用輔具的情況下將人工淚液擠出瓶子有困難,100人中有62人對於將人工淚液從一般的瓶子中擠出有困難。對於將人工淚液瞄準眼睛的能力:100人中有30人使用人工淚液輔具可以更輕易的將人工淚液瞄準眼睛,100人中有46人在使用輔具的情況下將人工淚液瞄準眼睛,100人中有76人在使用一般的瓶子下將人工淚液瞄準眼睛有困難。對於控制人工淚液滴數的能力:100人中有33人使用人工淚液輔具可以更輕易的控制人工淚液的滴數。

Plain language summary

Assistive technology for rheumatoid arthritis

This summary of a Cochrane review presents what we know from research about the effect of assistive technology in people with rheumatoid arthritis. Unfortunately, only one trial met the inclusion criteria for the review. The study deals with assistive technology used to administer eye drops. This is not a commonly used device.

Assistive technology devices are intended to make life with rheumatoid arthritis easier. It is defined as any equipment used to improve or maintain function in persons with disabilities. Assistive technology is one of the most frequent interventions used for persons with rheumatoid arthritis, besides medications and surgery.

There is very limited evidence for the effect of assistive technology for adults with rheumatoid arthritis. There is an urgent need for high-quality research investigating commonly used devices.

The review shows that in people with rheumatoid arthritis:

- An eye drop device may improve the ability to squeeze out drops, aim drops, and control the number of drops.
- An eye drop device may prevent side effects caused by the eye drop bottle touching the eye itself.

What is rheumatoid arthritis and what is an eye drop device?

When you have rheumatoid arthritis, your immune system, which normally fights infection, attacks the lining of your joints, making them inflamed.  Inflammation makes your joints swollen, stiff and painful and may lead to loss of function and disability. There is no cure for rheumatoid arthritis at present, so the treatments focus on reducing inflammation, relieving pain and stiffness, and improving function in daily life.

An eye drop device is an assistive technology that makes it easier to give yourself eye drops by making the bottle easier to hold, easier to squeeze and to get the drops right into your eye.

Best estimate of what happens to people with rheumatoid arthritis who use an eye drop device:

Ability to squeeze out drops

- 27 people out of 100 were able to squeeze out drops more easily from an eye drop device than when using a regular eye drop bottle. (27% absolute improvement)

- 35 people out of 100 had difficulty squeezing out drops from an eye drop device.

- 62 people out of 100 had difficulty squeezing out drops from a regular eye drop bottle.

Ability to aim drops
- 30 people out of 100 were able to aim drops more easily from an eye drop device than when using a regular eye drop bottle.  (30% absolute improvement)

- 46 people out of 100 had difficulty aiming drops from an eye drop device.

- 76 people out of 100 had difficulty aiming drops from a regular eye drop bottle.

Ability to control the number of drops
- 33 people out of 100 were able to control the number of drops more easily from an eye drop device than when using a regular eye drop bottle.  (33% absolute improvement)

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