Seventy patients with RA were randomly allocated to either a Rheumatology Nurse Practitioner (RNP) or Consultant Rheumatologist (CR) clinic. They were seen on six occasions in 1 year. Effectiveness and safety were assessed by biochemical, clinical, psychological and functional variables; patient knowledge and satisfaction were measured by questionnaire. At week 0 the groups were well matched clinically and demographically. By week 48 significant improvements had occurred in plasma viscosity and articular index within both groups. In patients managed by the RNP, pain, morning stiffness, psychological status, patient knowledge and satisfaction had all improved significantly (P = 0.001; P = 0.028; P = 0.0005; P < 0.0001; P < 0.0001 respectively), improvements not mirrored by the CR cohort. Between group comparisons also showed significant differences by the end of the study. Compared to the CR patients, the RNP suffered from lower levels of pain (P < 0.05), had acquired greater levels of knowledge (P < 0.0001) and were significantly more satisfied with their care (P < 0.0001).
A multi-choice Patient Knowledge Questionnaire (PKQ) was developed for use with patients with rheumatoid arthritis (RA). Test/re-test was used to test its stability (r = 0.81), and Kuder Richardson formula 20 (r = 0.72) for internal consistency. Seventy randomly selected RA patients then completed the PKQ in a rheumatology out-patient clinic of a large teaching hospital. There was a wide variation in total scores ranging from 3 to 28 out of 30. Total scores correlated with years of general education (P less than 0.05) but not with disease duration or age. Sixty-two per cent of patients knew that the cause of RA is, as yet, unknown but 27% thought it could be caused by injury and 11% by cold damp weather. Fifty-two per cent had no idea why they had blood tests. All but four patients were taking some form of medication but there was widespread confusion about disease-modifying drugs and non-steroidal anti-inflammatory drugs (NSAIDs). Exercise was reasonably well understood but many patients were unable to differentiate between methods of energy conservation and joint protection. This study highlights the need for careful individual knowledge assessment by use of tools such as the PKQ and effective patient education programmes.
The Arthritis Impact Measurement Scales (AIMS) is an American questionnaire designed to measure the health status of patients with arthritis. Its suitability for use with British patients with rheumatoid arthritis (RA) has been tested. A study on 30 patients high-lighted the need to anglicize the terminology and spelling. A further 30 patients found the modified questionnaire easier to complete than the original. The concurrent validity of this modified AIMS was then tested on 59 patients by comparison with two widely accepted standards. Physical function and pain scales were tested against the Stanford Health Assessment Questionnaire (HAQ). Because the HAQ has no psychological component, psychological status was compared with the Hospital Anxiety and Depression Scale (HAD). Results showed a good correlation between the scales and it is concluded that the modified version of the AIMS may be used with confidence in British patients with RA.
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