Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial.

Autor: de Thurah A; Aarhus University, Herning, Denmark., Stengaard-Pedersen K; Aarhus University, Herning, Denmark., Axelsen M; Diagnostic Centre, Silkeborg Regional Hospital, Denmark., Fredberg U; Diagnostic Centre, Silkeborg Regional Hospital, Denmark, and Odense University Hospital, Denmark., Schougaard LMV; Liv M. V. Schougaard, MSc, Niels H. I. Hjollund, MD, PhD: WestChronic, Aarhus University, Herning, Denmark., Hjollund NHI; Liv M. V. Schougaard, MSc, Niels H. I. Hjollund, MD, PhD: WestChronic, Aarhus University, Herning, Denmark., Pfeiffer-Jensen M; Aarhus University, Herning, Denmark., Laurberg TB; Aarhus University, Herning, Denmark., Tarp U; Aarhus University, Herning, Denmark., Lomborg K; Aarhus University, Herning, Denmark., Maribo T; Aarhus University, Herning, Denmark, and DFACTUM Central Denmark Region, Aarhus, Denmark.
Jazyk: angličtina
Zdroj: Arthritis care & research [Arthritis Care Res (Hoboken)] 2018 Mar; Vol. 70 (3), pp. 353-360. Date of Electronic Publication: 2018 Jan 23.
DOI: 10.1002/acr.23280
Abstrakt: Objective: To test the effect of patient-reported outcome (PRO)-based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses.
Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis.
Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were -0.10 (90% confidence interval [90% CI] -0.30, 0.13) and -0.19 (90% CI -0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.
Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.
(© 2017, American College of Rheumatology.)
Databáze: MEDLINE
Externí odkaz: