Rheumatology Advance Access originally published online on March 25, 2009
Rheumatology 2009 48(6):658-664; doi:10.1093/rheumatology/kep049
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Do OA patients gain additional benefit from care from a clinical nurse specialist?—a randomized clinical trial
1Academic & Clinical Unit for Musculoskeletal Nursing (ACUMeN), 2Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Leeds and 3Arthritis Research Campaign National Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, UK.
Correspondence to: Jackie Hill, Academic & Clinical Unit for Musculoskeletal Nursing, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds, West Yorkshire LS7 4SA, UK. E-mail: j.hill{at}leeds.ac.uk
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Abstract |
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Objectives. To assess whether OA patients attending a clinical nurse specialist (CNS) clinic gain ‘additional benefit’ compared with those attending a traditional junior hospital doctor (JHD) clinic.
Methods. A total of 100 patients with OA attending rheumatology clinics at a UK teaching hospital were randomly allocated to a CNS or JHD clinic and seen at 0, 16, 32 and 48 weeks. The study assessed (i) non-inferiority of the CNS with respect to clinical outcomes (pain, morning stiffness, self-efficacy, physical function and psychological status) and (ii) superiority of the CNS in terms of patient knowledge and satisfaction.
Results. Average pain at follow-up was lower in the CNS group: unadjusted mean difference for the JHD group minus the CNS group was 5.3 (95% CI –4.6, 15.2); adjusted was 1.6 (95% CI –5.7, 8.9). The corresponding effect size estimates were 0.20 (95% CI –0.17, 0.57) and 0.06 (95% CI –0.21, 0.33), respectively. There were similar outcomes in morning stiffness, physical function and self-efficacy. Patient knowledge and satisfaction were statistically significant at the 5% level attaining moderate to large effect sizes in favour of the CNS.
Conclusions. Our findings demonstrate that the clinical outcome of CNS care is not inferior to that of JHD care, and patients attending CNS gain additional benefit in that they are better informed about their disease and significantly more satisfied with care than are their counterparts.
Trial registration. ISRCTN 65487167.
KEY WORDS: Osteoarthritis, Randomized controlled trial, Clinical nurse specialist clinic, Patient outcome
Submitted 1 December 2008;
revised version accepted 9 February 2009.
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