Rheumatology, Vol 38, 303-308, Copyright © 1999 by British Society for Rheumatology
PS Helliwell, M O'Hara, J Holdsworth, A Hesselden, T King and P Evans
OBJECTIVE: In rheumatoid arthritis, education programmes successfully
impart knowledge but, notwithstanding 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 randomized
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. Assessments were made at entry, at 4 weeks and at 12 months.
The main outcome variables were the modified Larsen radiological score for
the hands and the SF-36 quality of life questionnaire. Secondary outcome
variables were the Health Assessment Questionnaire (HAQ), Ritchie Articular
Index (RAI), Patient Knowledge Questionnaire (PKQ), Compliance
Questionnaire (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.
ORIGINAL PAPERS
A 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis
Rheumatology Rehabilitation Research Unit, University of Leeds, UK.
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