Effects of needs-based patient education on self-efficacy and health outcomes in people with rheumatoid arthritis: a multicentre, single blind, randomised controlled trial

Abstract

ObjectivesThe Educational Needs Assessment Tool (ENAT) is a self-completed questionnaire, which allows patients with arthritis to prioritise their educational needs. The aim of this study was to evaluate the effects of needs-based patient education on self-efficacy, health outcomes and patient knowledge in people with rheumatoid arthritis (RA).MethodsPatients with RA were enrolled into this multicentre, single-blind, parallel-group, pragmatic randomised controlled trial. Patients were randomised to either the intervention group (IG) where patients completed ENAT, responses of which were used by the clinical nurse specialist to guide patient education; or control group (CG) in which they received patient education without the use of ENAT. Patients were seen at weeks 0, 16 and 32. The primary outcome was self-efficacy (Arthritis Self Efficacy Scale (ASES)-Pain and ASES-Other symptoms). Secondary outcomes were health status (short form of Arthritis Impact Measurement Scale 2, AIMS2-SF) and patient knowledge questionnaire-RA. We investigated between-group differences using analysis of covariance, adjusting for baseline variables.ResultsA total of 132 patients were recruited (IG=70 and CG=62). Their mean (SD) age was 54 (12.3) years, 56 (13.3) years and disease duration 5.2 (4.9) years, 6.7 (8.9) years for IG and CG, respectively. There were significant between-group differences, in favour of IG at week 32 in the primary outcomes, ASES-Pain, mean difference (95% CI) −4.36 (1.17 to 7.55), t=−2.72, p=0.008 and ASES-Other symptoms, mean difference (95% CI) −5.84 (2.07 to 9.62), t=−3.07, p=0.003. In secondary outcomes, the between-group differences favoured IG in AIMS2-SF Symptoms and AIMS2-SF Affect. There were no between-group differences in other secondary outcomes.ConclusionsThe results suggest that needs-based education helps improve patients’ self-efficacy and some aspects of health status.Trial registration numberISRCTN51523281.

The effectiveness of nurse‐led case management for patients with rheumatoid arthritis in Taiwan

“…This finding differed from several earlier reports, which showed that implementation of NLCM did reduce DAS28 scores, however failed to reach statistical significance. 15,16 Echoing previous studies conducted in Western populations,29 this study found that NLCM enhanced levels of self-care efficacy in RA patients. In a longitudinal or repeated measures study design, the utilisation of a traditional analysis of variance or a t-test may fail to specifically ascertain variation in outcome variables that were derived from intervention programs only, or it may be confounded by the effects of maturation.…”

The clinical application of teaching people about pain

“…It is proposed that this may be where many physical therapists falter. They might do a haphazard, quick examination that may undermine the therapistpatient relationship (Ndosi et al, 2016). The opposite may occur with an overly focused examination on small details, which may not be relevant (i.e., pelvic obliquity and leg length discrepancy) in the face of a patient struggling with widespread pain (Nijs et al, 2012).…”

“…This develops confidence and trust, key components of PNE, especially since people struggling with pain may have seen many health care providers for their pain, some of whom have dismissed or marginalized the patient's pain experience. By enhancing the therapeutic relationship, the patient may be more receptive to treatment interventions, including PNE (Ndosi et al, 2016). The "low tech" physical examination typically takes 10 minutes.…”

Patient education in rheumatoid arthritis: is the needs-based approach the way forward?

“…This needsbased approach is likely to enhance patients' engagement, shared decision-making and improve their selfmanagement skills. This is validated by a recent randomised controlled trial which has shown that needs-based patient education in RA helps to improve self-efficacy and some aspects of health status [18].…”

“…This validates the underlying latent construct (the educational needs) and enables quantification as well as an accurate estimation of the education needs of people with rheumatic diseases. This has been shown to be useful both in research [13][14][15][16][17][18] and in clinical settings [19]. The ENAT has been shown to help enable patients to effectively identify their educational needs and think of questions which they would not have otherwise considered, before their consultation with the clinician [19].…”