BACKGROUND: Joint protection (JP) education for people with rheumatoid arthritis (RA) is effective when applying psycho-educational teaching strategies. The Pictorial Representation of Illness and Self Measure (PRISM) was used to identify relevant JP education goals and life aspects, both supporting motivation and behaviour change. The objective of this study was to compare the effects of individual JP education, PRISM-based (PRISM-JP) versus conventional (C-JP), in people with rheumatoid arthritis (RA). METHODS: An assessor-blinded randomized controlled trial was conducted in four rheumatology centres. Patients were randomized to PRISM-JP or C-JP, consisting of five JP education sessions over three months. Primary outcome was JP behaviour at six and 12 months. RESULTS: A total of 53 RA patients participated. The PRISM-JP group (n = 26) demonstrated significantly more JP behaviour at six months (effect size ES 0.32; p = 0.02) and 12 months (ES 0.28; p = 0.04) than the C-JP (n = 27). Within-group analysis showed that the JP intervention was successful at six and 12 months in both groups (p < 0.001). At 12 months the PRISM-JP group had better JP self-efficacy (p = 0.02) and grip strength (p = 0.04) compared with baseline. CONCLUSION: PRISM-JP was more effective than C-JP in terms of long-term JP behaviour at six and 12 months.

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