***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Joint protection aims to reduce pain and local inflammation , preserve the integrity of joint structures and improve function . There is evidence that it can improve pain and function in the short term , but the long-term effects are uncertain . This study evaluated the effects of joint protection in early rheumatoid arthritis ( RA ) . METHODS A r and omized , controlled , assessor-blinded trial of duration 1 yr was conducted . Two interventions ( both 8 h ) were compared : st and ard arthritis education , including 2.5 h of joint protection education based on typical UK practice ; and a joint protection arthritis education programme , using educational-behavioural teaching methods . Assessment s were made at entry and 6 and 12 months . RESULTS Sixty-five people with RA attended the joint protection programme and 62 the st and ard programme . The groups were matched for age ( 51 and 49 yr ) , disease duration ( 21 and 17.5 months ) and use of non-steroidal anti-inflammatory drugs and disease-modifying anti-rheumatic drugs . In comparison with the st and ard group , the joint protection group significantly improved with respect to adherence to the joint protection programme ( P=0.001 ) , h and pain ( P=0.02 ) , general pain ( P=0.05 ) , early morning stiffness ( P=0.01 ) , self-reported number of disease flare-ups ( P=0.004 ) , visits to the doctor for arthritis ( P<0.01 ) , and the AIMS 2 ( Arthritis Impact Measurement Scales ) activities of daily living scale ( P=0.04 ) . A trend to improved swollen joint counts was identified ( P=0.07 ) . Within-group analyses also showed improvements in arthritis self-efficacy and perceived control . H and deformity scores continued to increase in both groups . CONCLUSION We found significant improvements in adherence , pain , disease status and functional ability amongst those attending the joint protection programme . Benefits became more apparent with time , suggesting that joint protection can help slow the progression of the effects of RA over and above the effects of drug therapy The present study examined the efficacy of a behavioral intervention design ed to increase adherence to fluid-intake restrictions among hemodialysis patients . Twenty intervention-group patients were compared with 20 matched control patients on an indicator of fluid-intake adherence at 3 time points . The Group x Time interaction was significant , indicating that patients in the 2 groups exhibited a differential pattern of change in fluid-intake adherence across the follow-up period . The intervention and control groups did not differ significantly in terms of adherence at the initial postintervention period but did differ at the 8-week follow-up . The observed group differences were , in part , due to a trend toward increasingly better adherence in the intervention group and poorer adherence in the control group across the follow-up period Developing more effective behavioural interventions requires an underst and ing of the mechanisms of behaviour change , and methods to rigorously test their theoretical basis . The delivery and theoretical basis of an intervention protocol were assessed in ProActive , a UK trial of an intervention to increase the physical activity of those at risk of Type 2 diabetes ( N = 365 ) . In 108 intervention sessions , behaviours of facilitators were mapped to four theories that informed intervention development and behaviours of participants were mapped to 17 theoretical components of these four theories . The theory base of the intervention specified by the protocol was different than that delivered by facilitators , and that received by participants . Of the intervention techniques delivered , 25 % were associated with  theory of planned behaviour ( TPB )  , 42 % with  self-regulation theory ( SRT )  , 24 % with  operant learning theory ( OLT )  and 9 % with  relapse prevention theory ( RPT ) .  The theoretical classification of participant talk showed a different pattern , with twice the proportion associated with OLT ( 48 % ) , 21 % associated with TPB , 31 % with SRT and no talk associated with RPT . This study demonstrates one approach to assessing the extent to which the theories used to guide intervention development account for any changes observed OBJECTIVE In rheumatoid arthritis , education programmes successfully impart knowledge but , notwithst and ing issues of empowerment , this knowledge has to be translated into behavioural change to have a chance of improving disease outcome . Arguably , behavioural change must also occur early if outcomes are to be improved . For these reasons , we planned a study of patient education in early disease , with radiological damage and quality of life as the main outcome variables . METHODS We performed a r and omized controlled trial in people with rheumatoid arthritis of < 5 yr duration . The main intervention was a 4 week education programme , each weekly session lasting 2 h. Assessment s were made at entry , at 4 weeks and at 12 months . The main outcome variables were the modified Larsen radiological score for the h and s and the SF-36 quality of life question naire . Secondary outcome variables were the Health Assessment Question naire ( HAQ ) , Ritchie Articular Index ( RAI ) , Patient Knowledge Question naire ( PKQ ) , Compliance Question naire ( CQ ) , plasma viscosity ( PV ) , pharmaceutical changes and consulting behaviour . RESULTS The patient numbers were 34 ( 10 male , 24 female ) for the control group and 43 ( 16 male , 27 female ) for the education group . The groups were matched for age ( 56.5 yr for control , 55 yr for education ) , disease duration ( 3.5 yr vs 3.0 yr ) and duration of second-line drug therapy ( 14 months vs 12 months ) . We found no significant difference between the groups for Larsen scores at 12 months , although scores for the education group were lower ( 39.5 vs 43.0 , P = 0.13 ) . The ' social functioning ' and ' general health perception ' subscales of the SF-36 showed a significant improvement in the education group , but no significant differences between groups were seen . No significant differences were found for the HAQ , RAI , PV and CQ , but the education group had more disease-specific knowledge than the control group at 12 months ( PKQ scores : 17 vs 21 , P = 0.0002 ) . No differences were found for out-patient visits and in-patient admissions , but the education group had slightly more changes in second-line drugs during the study ( 0.43 changes/person in the control group , 0.51 changes/person in the education group ) . CONCLUSIONS We found no significant difference between the groups in our primary outcome measures , but a trend in favour of the education group was found in radiological progression . Further studies of this kind , using larger patient numbers , are required since the difference may result from improved self-care , better compliance with joint protection strategies and , possibly , improved drug compliance Group counseling and education were studied in patients with rheumatoid arthritis ( RA ) . Patients were matched and r and omly assigned to a control ( CG ) or experimental ( EG ) group . Each group attended an educational session but only the EG participated in 12 weekly group counseling sessions . A test of knowledge about RA and psychological tests were administered before and after these sessions . The EG improved their scores in 2 areas of self-concept and in factual knowledge . There was no increase in depression level . These results provide evidence that formal educational sessions and group counseling may be important in the management of patients with RA The purpose of the study was to investigate the effects of supervised muscle relaxation training in individuals with rheumatoid arthritis ( RA ) . Sixty-eight participants were allocated at r and om either to a muscle relaxation training group or to a control group . Every participant was evaluated for health-related quality of life , muscle function , pain , and disease activity . The training group exercised 30 minutes , twice a week for 10 weeks , while no intervention was made in the control group . The results indicated improvements in the training group regarding self-care according to the Arthritis Impact Measurement Scales 2 , and in recreation and pastimes according to the Sickness Impact Profile-RA ( p < 0.05 ) directly after the intervention . Mobility and arm function ( p < 0.01 ) according to the Arthritis Impact Measurement Scales 2 , and muscle function of the lower limbs ( p < 0.05 ) were improved after six months . No improvements remained after twelve months . It thus seems that 10 weeks ' relaxation training might have some short-term influence in individuals with RA OBJECTIVE To investigate the effects of a 21-week concurrent strength and endurance training protocol on physical fitness profile in women with early or longst and ing rheumatoid arthritis ( RA ) compared with healthy subjects . METHODS Twenty-three female patients with RA volunteered for the study . Twelve had early RA and eleven had longst and ing RA . Twelve healthy women served as controls . Maximal strength of different muscle groups was measured by  dynamometers  , walking speed with light cells  , and  vertical squat jump  on the force platform to mirror explosive force . Maximal oxygen uptake was measured by gas analyzer . Six training sessions ( 3 strength training and 3 endurance training ) were carried out in a 2-week period for 21 weeks . RESULTS The training led to large gains in maximal strength both in women with RA and in healthy women ( P < 0.043 - 0.001 ) . The strength gains were accompanied by increases in walking speed ( P < 0.034 - 0.001 ) and vertical squat jump ( P < 0.034 - 0.001 ) . Significant improvements also occurred in maximal aerobic capacity in all groups ( P < 0.023 - 0.014 ) . CONCLUSIONS Both early and longst and ing RA patients with stable disease can safely improve all characteristics of their physical fitness profile using a progressive concurrent strength and endurance training protocol & NA ; This study examined the efficacy of a cognitive and behavioural intervention ( CBT ) for patients with recent onset , seropositive rheumatoid arthritis . Fifty‐three participants with a diagnosis of classical or definite rheumatoid arthritis , who were seropositive and had less than 2 years of disease history were recruited into the trial . All participants received routine medical management during the study , although half were r and omly allocated to receive an adjunctive psychological intervention . All pre‐ and post‐treatment assessment s were conducted blind to the allocation . Analyses were conducted of treatment completers and also by intention‐to‐treat . Significant differences were found between the groups at both post‐treatment and 6‐month follow‐up in depressive symptoms . While the CBT group showed a reduction in depressive symptoms , the same symptoms increased in the St and ard group . At outcome but not follow‐up , the CBT group also showed reduction in C‐reactive protein levels . However , the CBT group did show significant improvement in joint involvement at 6‐month follow‐up compared with the St and ard group , indicating physical improvements above those achieved with st and ard care . These results indicate that cognitive‐behavioural intervention offered as an adjunct to st and ard clinical management early in the course of RA is efficacious in producing reductions in both psychological and physical To examine the effectiveness of a  cognitive-behavioral pain management program for patients with rheumatoid arthritis , three patient groups were studied : a cognitive-behavioral group ( CB ) , an attention-placebo group , and a control group .  The CB group received a comprehensive , 12-month pain management program that taught coping strategies such as problem-solving techniques , relaxation training , strategies for attention diversion , and training in family dynamics and communication . Dependent measures included pain , coping strategies , psychological status , functional status , and disease status . Data analysis at 12 months revealed benefits for the CB group in the area of enhanced coping strategies . Specifically , the CB subjects showed significantly greater use of coping strategies and significantly more confidence in their ability to manage pain . The findings are discussed in terms of the importance of enhanced self-efficacy and personal control for patients with rheumatoid arthritis The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting OBJECTIVE To examine relationships among changes in self-efficacy and changes in other clinical ly relevant outcome measures . METHOD Subjects ( n = 44 ) were participants in a prospect i ve , r 
    Output:
    
Comparative analyses revealed that interventions utilizing more  self-regulation techniques reduced depressive symptoms and anxiety significantly more than interventions utilizing fewer such techniques .
Additionally , depressive symptoms were reduced significantly more among recently diagnosed RA patients than among those with longst and ing RA .
Psychological interventions are beneficial for many patients with RA , particularly when it comes to increasing physical activity levels .
Intervention techniques derived from self-regulation theory appear to play a role in reducing depressive symptoms and anxiety among patients with RA