Efficiency of teaching patients with early-stage rheumatoid arthritis
https://doi.org/10.14412/1996-7012-2014-4-25-32
Abstract
Education programs are an important part of the management of patients with rheumatoid arthritis (RA).
Objective: to develop a unified model of an education program for RA patients and to evaluate its efficiency at the early stage of the disease.
Material and methods. A group education program was worked out with the support of the All-Russian public organization of the disabled “The Russian rheumatology organization “Nadezhda” (Hope)” and encompassed 4 daily classes lasting 90 min. All information was presented by a multidisciplinary team of specialists (rheumatologists, a cardiologist, a psychologist, a physiotherapist, and a physical trainer). The study included 55 patients with early RA (89.1% of women aged 18 to 62 years; the duration of the disease was 2 to 22 months); of them 25 were taught using the education program (a study group); 30 received drug therapy only (a control group). Following 3 and 6 months, the number of tender and swollen joints, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and pain were determined applying a 100-ml VAS, DAS28, HAQ, and RAPID3. Adherence to non-drug treatments was assessed employing a special patient questionnaire.
Results. Three and six months after being taught, two patient groups showed increases in adherence to joint protection methods by 13 and 10 times (p<0.01), regular physical training by 4 and 3.25 times (p<0.01), uses of orthoses for the wrist joint by 2 times and 75% (p<0.01) and knee orthoses by 33.3 and 50.0% (p<0.01), and orthopedic insoles by 71.4 and 57.1% (p<0.01), respectively. Following 6 months, there were statistically significant differences between the two groups in most parameters (p<0.05), except for ESR, CRP, and DAS28 (p>0.05). Further more, a good response to treatment was significantly more common in these periods, as shown by the EULAR response criteria (DAS28): 56.3% versus 40% in the control group (p<0.05).
Conclusion. The education program decreases the intensity of pain syndrome and improves the functional status and quality of life of patients with early RA within 6 months. Patient education enhances adherence to non-drug treatments. The highest positive result was achieved just 3 months later; it slightly tailed off at 6 months. This necessitates re-education in succeeding 3–6 months.
Supporting agencies: early rheumatoid arthritis; patient education; education program
About the Authors
Evgenia Vladislavovna Orlova
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
D. E. Karateev
V.A. Nasonova Research Institute of Rheumatology
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
Russian Federation
34A, Kashirskoe Shosse, Moscow Russia 115552
References
1. Lorig K, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum. 1993;36(4):439–46. DOI: http://dx.doi.org/10.1002/art.1780360403.
2. Lorig K, Visser A. Arthritis patient education standards: a model for the future. Patient Educ Couns. 1994;24(1):3–7. DOI: http://dx.doi.org/10.1016/0738-3991(94)90023-X.
3. Schrieber L, Colley M. Patient education. Best Pract Res Clin Rheumatol. 2004;18(4):465–76. DOI: http://dx.doi.org/10.1016/j.berh.2004.03.008.
4. Taal E, Rasker JJ, Wiegman O. Patient education and self-management in the rheumatic diseases: a self-efficacy approach. Arthritis Care Res. 1996;9(3):229–38. DOI: http://dx.doi.org/10.1002/1529-0131(199606)9:3%3C229::AIDANR1790090312%3E3.0.CO;2-U.
5. Niedermann K, Fransen J, Knols R, et al. Gap between short and long term effects of patient education in rheumatoid arthritis patients: a systematic review. Arthritis Care Res. 2004;51(3):388–98. DOI: http://dx.doi.org/10.1002/art.20399.
6. Hawley DJ. Psychoeducational interventions in the treatment of arthritis. Bailliere Clin Rheumatol. 1995;9(4):803–23. DOI: http://dx.doi.org/10.1016/S0950-3579(05)80315-2.
7. Hirano PC, Laurent DD, Lorig K. Arthritis patient education studies, 1987-1991: a review of the literature. Patient Educ Couns. 1994;24(1):9–54. DOI: http://dx.doi.org/10.1016/0738-3991(94)90024-8.
8. Keefe JF, Van Horn Y. Cognitive-behavioral treatment of rheumatoid arthritis pain. Arthritis Care Res. 1993;6(4):213–22. DOI: http://dx.doi.org/10.1002/art.1790060408.
9. Оттева ЭН. Структурированная обучающая программа для пациентов с ревматоидным артритом. Научно-практическая ревматология. 2009;4:101–4. [Otteva EN. Structured education program for patients with rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2009;4:101–4. (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484-2009-1158.
10. Nell VP, Machold KP, Eberl G, et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43(7):906–14. DOI: http://dx.doi.org/10.1093/rheumatology/keh199.
11. Emery P, Breedveld FC, Hall S, et al. Comparison of methotrexate monotherapy with a combination of methotrexate and etanercept in active, early, moderate to severe rheumatoid arthritis (COMET): a randomised, double-blind, parallel treatment trial. Lancet. 2008;372(9636):375–82. DOI: http://dx.doi.org/10.1016/S0140-6736(08)61000-4.
12. Lard LR, Visser H, Speyer I, et al. Early versus delayed treatment in patients with recentonset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med. 2001;111(6):446–51. DOI: http://dx.doi.org/10.1016/S0002-9343(01)00872-5.
13. Emery P. Therapeutic approaches for early rheumatoid arthritis. How early? How aggressive? Br J Rheumatol. 1995;34(Suppl 2):87–90. DOI: http://dx.doi.org/10.1093/rheumatology/XXXIV.suppl_2.87.
14. Каратеев ДЕ. Ретроспективная оценка многолетней базисной терапии у больных ревматоидным артритом. Научно-практическая ревматология. 2003;3:32–6. [Karateev DE. Retrospective investigation of the results of longterm treatment with disease modifying drugs in rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2003;3:32–6 (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484- 2003-1357.
15. Vliet Vlieland TPM, Pattison D. Non-drug therapies in early rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2009;23(1):103–16. DOI: http://dx.doi.org/10.1016/j.berh.2008.08.004.
16. Helliwell PS, O'Hara M, Holdsworth JA, et al. 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis. Rheumatology (Oxford). 1999;38(4):303–8. DOI: http://dx.doi.org/10.1093/rheumatology/ 38.4.303.
17. Brodin N, Eurenius E, Jensen I, et al. Coaching patients with early rheumatoid arthritis to healthy physical activity: a multicenter, randomized, controlled study. Arthritis Rheum. 2008;59(3):325–31. DOI: http://dx.doi.org/10.1002/art.23327.
18. Barlow JH, Cullen LA, Rowe IF. Comparison of knowledge and psychological well-being between patients with a short disease duration (< or = 1 year) and patients with more established rheumatoid arthritis (> or = 10 years duration). Patient Educ Couns. 1999;38(3):195–203. DOI: http://dx.doi.org/10.1016/S0738-3991(98)00144-X.
19. Brus HL, van de Laar MA, Taal E, et al. Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis. Ann Rheum Dis. 1998;57(3):146–51. DOI: http://dx.doi.org/10.1136/ard.57.3.146.
20. Hennell SL, Brownsell C, Dawson JK. Development, validation and use of a patient knowledge questionnaire (PKQ) for patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43(4):467–71. DOI: http://dx.doi.org/10.1093/rheumatology/keh069.
21. Sjö quist ES, Almqvist L, Asenlö f P, et al. Physical-activity coaching and health status in rheumatoid arthritis: a person-oriented approach. Disabil Rehabil. 2010;32(10):816–25. DOI: http://dx.doi.org/10.3109/09638280903314069.
22. Ellard DR, Barlow JH, Paskins Z, et al. Piloting education days for patients with early rheumatoid arthritis and their partners: a multidisciplinary approach. Musculoskeletal Care. 2009;7(1):17–30. DOI: http://dx.doi.org/10.1002/msc.137.
23. Luqmani R, Hennell S, Estrach C, et al. British Society for Rheumatology and British Health Professionals in Rheumatology Guideline for the management of rheumatoid arthritis (the first 2 years). Rheumatology (Oxford). 2006;45(9):1167–9. DOI: http://dx.doi.org/10.1093/rheumatology/kel215a.
24. Combe B, Landewe R, Lukas C, et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66(1):34–45. DOI: http://dx.doi.org/10.1136/ard.2005.044354.
25. Gossec L, Pavy S, Pham T, et al. Nonpharmacological treatments in early rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion. Joint Bone Spine. 2006;73(4):396–402. DOI: http://dx.doi.org/10.1016/j.jbspin.2006.01.008.
26. Каратеев ДЕ, Олюнин ЮА. О классификации ревматоидного артрита. Научно-практическая ревматология. 2008;1:5–16. [Karateev DE, Olunin YA. About the classification of rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2008;1:5–16. (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484-2008-848.
27. De Wit MPT, Smolen JS, Gossec L, et al. Treating rheumatoid arthritis to target: the patient version of the international recommendations. Ann Rheum Dis. 2011;70(6):891–5. DOI: http://dx.doi.org/10.1136/ard.2010.146662.
28. Орлова ЕВ, Каратеев ДЕ, Булгакова НА. Лечение ревматоидного артрита до достижения цели (Treat to Target): российская версия международных рекомендаций для пациентов. Научно-практическая ревматология. 2013;51(3):246–54. [Orlova EV, Karateev DE, Bulgakova NA. Treating rheumatoid arthritis to target: russian version of international guidelines for patients. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2013;51(3):246–54. (In Russ.)]. DOI: http://dx.doi.org/10.14412/1995-4484-2013-1496.
29. Van den Berg MH, de Boer IG, le Cessie S, et al. Are patients with rheumatoid arthritis less physically active than the general population? J Clin Rheumatol. 2007;13(4):181–6. DOI: http://dx.doi.org/10.1097/RHU.0b013e318124a8c4.
30. Sokka T, Hä kkinen A, Kautiainen H. et al. QUEST-RA Group. Physical inactivity in patients with rheumatoid arthritis: data from twenty-one countries in a cross-sectional, international study. Arthritis Rheum. 2008;59(1):42–50. DOI: http://dx.doi.org/10.1002/art.23255.
31. Sjö quist ES, Brodin N, Lampa J, et al. Physical activity coaching of patients with rheumatoid arthritis in everyday practice: a longterm follow-up. Musculoskeletal Care. 2011;9(2):75–85. DOI: http://dx.doi.org/10.1002/msc.199
32. Breedland I., van Scheppingen C, Leijsma M, et al. Effects of a group-based exercise and educational program on physical performance and disease self-management in rheumatoid arthritis: a randomized controlled study. Phys Ther. 2011;91(6):879–93. DOI: http://dx.doi.org/10.2522/ptj.20090010.
33. Mathieux R, Marotte H, Battistini L, et al. Early occupational therapy programme increases hand grip strength at 3 months: results from a randomized, blind, controlled study in early rheumatoid arthritis. Ann Rheum Dis. 2009;68:400–3. DOI: http://dx.doi.org/10.1136/ard.2008.094532.
34. Hammond A, Freeman K. One-year outcomes of a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Rheumatology (Oxford). 2001;40(9):1044–51. DOI: http://dx.doi.org/10.1093/rheumatology/40.9.1044.
35. Hammond A, Freeman K. The long-term outcomes from a randomized controlled trial of an educational-behavioural joint protection programme for people with rheumatoid arthritis. Clin Rehabil. 2004;18(5):520–8. http://dx.doi.org/10.1191/0269215504cr766oa.
36. Nordenskiöld U, Grimby G, Dahlin-Ivanoff S. Questionnaire to evaluate the effects of assistive devices and altered working methods in women with rheumatoid arthritis. Clin Rheumatol. 1998;17(1):6–16. DOI: http://dx.doi.org/10.1007/BF01450952.
37. John H, Carroll D, Kitas GD. Cardiovascular education for people with rheumatoid arthritis: what can existing patient education programmes teach us? Rheumatology (Oxford). 2011;50(10):1751–9. DOI: http://dx.doi.org/10.1093/rheumatology/ker191.
38. Grоnning K, Skomsvoll JF, Rannestad T. et al. The effect of an educational programme consisting of group and individual arthritis education for patients with polyarthritis – a randomised controlled trial. Patient Educ Counsg. 2012;88(1):113–20. DOI: http://dx.doi.org/10. 1016/j.pec.2011.12.011.
39. John H., Hale ED, Treharne GJ, et al. A randomized controlled trial of a cognitive behavioural patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease. Rheumatology (Oxford). 2013;52(1):81–90. DOI: http://dx.doi.org/10.1093/rheumatology/kes237.
40. Kwoh CK, Anderson LG, Greene JM, et al. American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines. Guidelines for the management of rheumatoid arthritis: 2002 update. Arthritis Rheum. 2002;46(2):328–46. DOI: http://dx.doi.org/10.1002/art.10148.
41. Forestier R, Andre-Vert J, Guillez P, et al. Non-drug treatment (excluding surgery) in rheumatoid arthritis: clinical practice guidelines. Joint Bone Spine. 2009;76(6):691–8. DOI: http://dx.doi.org/10.1016/j.jbspin.2009.01.017.
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Orlova EV, Karateev DE. Efficiency of teaching patients with early-stage rheumatoid arthritis. Sovremennaya Revmatologiya=Modern Rheumatology Journal. 2014;8(4):25-32. (In Russ.) https://doi.org/10.14412/1996-7012-2014-4-25-32
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