Implementation of Rheumatic Exercise to Manage Chronic Pain in a Patient with Rheumatoid Arthritis: A Family Nursing Case Study

Asep Gunawan; Rizky Arif  Susilo Putra

doi:10.56359/kian.v5i1.994

Authors

Asep Gunawan STIKes Muhammadiyah Ciamis
Rizky Arif Susilo Putra STIKes Muhammadiyah Ciamis

DOI:

https://doi.org/10.56359/kian.v5i1.994

Keywords:

rheumatoid arthritis, chronic pain, rheumatic exercise, family nursing care, case study

Abstract

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by persistent joint inflammation, pain, stiffness, and decreased functional ability, significantly affecting patients' quality of life. Chronic pain is one of the primary nursing problems experienced by individuals with RA. Rheumatic exercise is a non-pharmacological intervention that can improve joint flexibility, muscle strength, and functional mobility while reducing pain intensity. Family involvement is essential in supporting the continuity of nursing interventions at home.

Objective: This case study aimed to describe the implementation of rheumatic exercise in managing chronic pain in a patient with rheumatoid arthritis through family nursing care.

Method: his descriptive case study applied the family nursing process, including assessment, nursing diagnosis, planning, implementation, and evaluation. The subject was a female patient diagnosed with rheumatoid arthritis who experienced chronic pain, joint stiffness, and limitations in daily activities. Rheumatic exercise was performed once daily for approximately 15 minutes over three consecutive days, accompanied by education and active family participation to encourage independent exercise practice at home.

Result: The patient's pain intensity gradually decreased from a Numeric Rating Scale (NRS) score of 5 before the intervention to 4 on the first day, 2 on the second day, and 0 on the third day. Improvements were also observed in joint mobility, physical function, and the patient's confidence in performing daily activities. Family members demonstrated adequate knowledge and skills to support the continuation of rheumatic exercise at home.

Conclusion: The implementation of rheumatic exercise within family nursing care effectively reduced chronic pain and improved functional mobility in a patient with rheumatoid arthritis. This intervention is simple, safe, cost-effective, and may serve as an effective complementary nursing strategy for chronic pain management in community and home care settings.

Downloads

Download data is not yet available.

References

England, B. R., Tiong, B. K., Bergman, M. J., Curtis, J. R., Kazi, S., Mikuls, T. R., O'Dell, J. R., Ranganath, V. K., Limanni, A., Suter, L. G., & Turner, A. S. (2023). 2022 American College of Rheumatology guideline for exercise, rehabilitation, diet, and additional integrative interventions for rheumatoid arthritis. Arthritis Care & Research, 75(6), 928–944. https://doi.org/10.1002/acr.25016

Indonesian National Nurses Association. (2018). Standar diagnosis keperawatan Indonesia: Definisi dan indikator diagnostik (1st ed.). Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.

Indonesian National Nurses Association. (2018). Standar intervensi keperawatan Indonesia: Definisi dan tindakan keperawatan (1st ed.). Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.

Indonesian National Nurses Association. (2019). Standar luaran keperawatan Indonesia: Definisi dan kriteria hasil keperawatan (1st ed.). Dewan Pengurus Pusat Persatuan Perawat Nasional Indonesia.

MacIver, A., Hollinger, H., & Carolan, C. (2021). Tele-health interventions to support self-management in adults with rheumatoid arthritis: A systematic review. Rheumatology International, 41(8), 1399–1418. https://doi.org/10.1007/s00296-021-04907-2

Marques, A., Santos, E., Nikiphorou, E., Bosworth, A., Carmona, L., & EULAR Task Force. (2021). Effectiveness of self-management interventions in inflammatory arthritis: A systematic review informing the 2021 EULAR recommendations for the implementation of self-management strategies in patients with inflammatory arthritis. RMD Open, 7(2), e001647. https://doi.org/10.1136/rmdopen-2021-001647

Roodenrijs, N. M. T., Hamar, A., Kedves, M., Nagy, G., van Laar, J. M., van der Heijde, D., & Welsing, P. M. J. (2021). Pharmacological and non-pharmacological therapeutic strategies in difficult-to-treat rheumatoid arthritis: A systematic literature review informing the EULAR recommendations for the management of difficult-to-treat rheumatoid arthritis. RMD Open, 7(1), e001512. https://doi.org/10.1136/rmdopen-2020-001512

Rausch Osthoff, A. K., Niedermann, K., Braun, J., Adams, J., Brodin, N., Dagfinrud, H., Duruöz, T., Esbensen, B. A., Günther, K.-P., Hurkmans, E., Juhl, C. B., Kennedy, N., Kiltz, U., Knittle, K., Nurmohamed, M., Pais, S., Severijns, G., Swinnen, T. W., Pitsillidou, I., … van der Esch, M. (2018). EULAR recommendations for physical activity in people with inflammatory arthritis and osteoarthritis. Annals of the Rheumatic Diseases, 77(9), 1251–1260. https://doi.org/10.1136/annrheumdis-2018-213585

Smolen, J. S., Landewé, R., Bergstra, S. A., Kerschbaumer, A., Sepriano, A., Aletaha, D., Caporali, R., Edwards, C. J., Hyrich, K. L., Pope, J. E., van der Heijde, D., et al. (2023). EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Annals of the Rheumatic Diseases, 82(1), 3–18. https://doi.org/10.1136/ard-2022-223356

World Health Organization. (2022). Package of interventions for rehabilitation: Rheumatoid arthritis. World Health Organization.

World Health Organization. (2023). Rheumatoid arthritis. https://www.who.int/news-room/fact-sheets/detail/rheumatoid-arthritis

World Health Organization. (2023). Rehabilitation in health systems: Guide for action. World Health Organization.

World Health Organization. (2023). World report on arthritis and musculoskeletal conditions. World Health Organization.

World Physiotherapy. (2023). Physical activity and exercise for people with rheumatoid arthritis: Evidence summary. World Physiotherapy.

Zangi, H. A., Ndosi, M., Adams, J., Andersen, L., Bode, C., Boström, C., van Eijk-Hustings, Y., Gossec, L., Korandová, J., Mendes, G., Primdahl, J., Stoffer, M., Voshaar, M., & van Tubergen, A. (2015). EULAR recommendations for patient education for people with inflammatory arthritis. Annals of the Rheumatic Diseases, 74(6), 954–962. https://doi.org/10.1136/annrheumdis-2014-206807