護理個案管理模式對台灣類風濕性關節炎患者疼痛與疲憊之成效探討

Effects of the Nurse-Led Case Management on the Sequent Pain and Fatigue Among Persons Afflicted with Rheumatoid Arthritis in Taiwan

類風濕性關節炎是一衝擊罹病者行動與生活功能之自體免疫疾病，對個案之疼痛和疲憊影響甚鉅。目前個案管理雖已逐漸於慢性疾病中推廣，然而此照護模式對類風濕性關節炎患者之成效仍未趨定論。本研究旨在檢視一為期六個月的護理個案管理模式對類風濕性關節炎之影響。首先採兩組前後測方式，於2017–2018年在台灣某醫院招募類風濕性關節炎個案，將參與者分為接受護理個案管理模式和接受常規照護方式兩組。評值指標為視覺化疼痛與疲憊量表，並於介入前後及介入後三個月施測，後再輔以混和線性模式進行評析。研究期間共收集50位接受護理個案管理模式以及46位採行常規照護之個案，經混和線性模式分析發現，若於常規照護中結合護理個案管理模式，可有效降低個案之疼痛與疲憊程度，介入後追蹤三個月仍可見成效（P < 0.05）。研究顯示，護理個案管理模式可明顯緩解類風濕性關節炎患者治療期間的疼痛與疲憊感，此結果應可作為健康照護提供者建構更契合風濕病患者需求之參考。

Rheumatoid arthritis (RA) is an autoimmune disease that significantly impacts an individual's overall function and mobility, potentially leading to interference with pain and fatigue. Presently, case management is recommended to enhance clinical outcomes for patients with chronic diseases. However, the effects of nurseled case management (NCM) in RA patients have shown inconsistent reports. This study aimed to evaluate the effects of a six-month NCM in RA patients using a two-group pre- and post-test approach. Participants were recruited from a teaching hospital in Taiwan between 2017 and 2018, and they were assigned to either an NCM program in addition to conventional care for six months or a control group receiving standard care within the same period. Primary outcomes included self-reported visual analog scales assessing pain and fatigue levels, collected at three time points: baseline, the third day after the completion of intervention, and three months after NCM completion. Effect comparisons were conducted using the linear mixed model (LMM) technique. In total, 50 patients in the NCM group and 46 in the control group completed the intervention. Results from the LMM model indicated that integrating NCM into conventional care significantly reduced levels of pain and fatigue (both with P < 0.05). Improvements in these parameters were still observed three months after the completion of the NCM program. The positive impact of NCM on the reduction of fatigue and pain for RA patients is noteworthy, serving as a reference for healthcare officials in providing tailored interventions for those affected by rheumatism.