Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis

Thurah, Annette de; Esbensen, Bente Appel; Roelsgaard, Ida Kristiane; Frandsen, Tove Faber; Primdahl, Jette

doi:10.1136/rmdopen-2017-000481

Cited by 40 publications

(56 citation statements)

References 48 publications

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“…7,11,12,14 fragmentation, but also to assist patients in making feasible plans for improving their own health, 28 thus alleviating possible psychological difficulties. 7,11,12,14 fragmentation, but also to assist patients in making feasible plans for improving their own health, 28 thus alleviating possible psychological difficulties.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 With this model, a specialised nurse is responsible for the overall coordination, management and continuity of care for a specific episode of treatment or intervention. 11 Another study reported that NLCM did significantly minimise an RA patient's daily disability as assessed using the health assessment questionnaire-disability index. 9 As a consequence, there has been increased attention to the influence of nurse-led case management (NLCM) among arthritis patients.…”

Section: Introductionmentioning

confidence: 99%

“…9 As a consequence, there has been increased attention to the influence of nurse-led case management (NLCM) among arthritis patients. [11][12][13][14] Nurse-led case management studies thus far have been performed primarily with Western populations, 7,11,12,14 but the populations in these studies differ significantly in environmental, life style, physical setting and geographical characteristics from Asian populations, and, therefore, the findings may not directly apply to RA patients in Taiwan. 11 Another study reported that NLCM did significantly minimise an RA patient's daily disability as assessed using the health assessment questionnaire-disability index.…”

Section: Introductionmentioning

confidence: 99%

“…Some studies suggest that the implementation of NLCM is beneficial to the improvement of disease activity score by 28 joints (DAS28) level 10 and self-efficacy ability. 11 Another study reported that NLCM did significantly minimise an RA patient's daily disability as assessed using the health assessment questionnaire-disability index. 7 Nevertheless, several studies revealed a postive but statistically non-signficant effect of NLCM on DAS28 among RA patients.…”

Section: Introductionmentioning

confidence: 99%

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

Guo

Livneh

et al. 2019

Int J Clin Pract

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Background: Case management is a patient-centred approach which has shown efficacy in managing patients with chronic and life-threatening disease. Presently, the effect of case management delivered by nurses for rheumatoid arthritis (RA) patients remains unclear, especially for those subjects who reside in Asia. This study aimed to examine the effectiveness of nurse-led case management (NLCM) among RA patients in Taiwan. Methods:A quasi-experimental research design was utilised to recruit RA patients from a hospital in Taiwan. All patients who were diagnosed as having RA from January 2017 to June 2018 were free to opt to participate in the intervention. The experiment group (n = 50) received six sessions of NLCM over six months, while the control group (n = 46) received only standard care during the same time period. Effectiveness data were collected through the review of medical records and a structured questionnaire that included the Taiwanese Depression Questionnaire (TDQ), the arthritis self-efficacy scale and a disease activity score by 28 joints (DAS28) at three time points (T1: before NLCM; T2: three days after NLCM completion; and T3: six months after NLCM completion). The effects of NLCM were determined using a generalised estimating equations model. Results: After adjusting for several potential confounders, we found that the NLCM implementation decreased the levels of DAS28 (T1 = −0.78; T2 = −0.85; all at P = .01) and TDQ (T1 = −3.86; T2 = −10.57; all at P < .05) and enhanced ASES level for RA patients (T1 = 132.03; T2 = 484.69; all at P < .05). Conclusions:This study adopted a non-randomised, unblinded and uncontrolled intervention, and the findings supported the positive effects of NLCM following the use of a robust statistical method. The findings may serve as a reference for instituting more appropriate interventions for RA patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Guo

Livneh

et al. 2019

Int J Clin Pract

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“…In a recent review of seven randomized controlled trials (RCTs) (all but one based on patients with low disease activity or remission), it was shown that both disease activity and patient satisfaction improved more in the nurse‐led than the regular care groups after 2 years, although there was no difference between groups after 1 year (de Thurah, Esbensen, Roelsgaard, Frandsen, & Primdahl, ). The only previous study (Ndosi et al, ) which also included patients with moderate or high disease activity (mean DAS28 3.89 and 3.65 in nurse‐led and regular groups, respectively) showed a numerically but nonsignificantly larger improvement in the nurse‐led group, results that were in line with those of the present study.…”

Section: Discussionmentioning

confidence: 99%

A randomized study comparing regular care with a nurse‐led clinic based on tight disease activity control and person‐centred care in patients with rheumatoid arthritis with moderate/high disease activity: A 6‐month evaluation

Bergsten

Almehed

Baigi

et al. 2019

Musculoskeletal Care

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IntroductionA recent survey showed that 27% of rheumatoid arthritis (RA) patients had inadequately controlled disease activity. Hence, there is a need for new strategies aiming at improving patient outcomes. The aim of the present study was to evaluate the effect of a nurse‐led clinic with frequent visits, treat‐to‐target and person‐centred care of patients with established RA and moderate‐to‐high disease activity compared with patients receiving regular care.MethodsThe study was a randomized, controlled trial over 26 weeks, with a nonrandomized extension to week 50. Patients were randomized to an intervention group (IG; nurse‐led clinic) based on person‐centred care, frequent visits and “treat to target”, or to a control group (CG) which visited the clinic according to care as usual. The primary outcome was the difference in the DAS28 change between the IG and the CG groups.ResultsA total of 332 patients were screened for eligibility, of which 70 were randomly assigned to either the IG (n = 36) or the CG (n = 34) group. The primary outcome was not met, although patients in the IG group tended to improve more than those in the CG group (difference: 0.43 (95% confidence interval [CI] –0.27, 1.13). In both the IG and CG groups, delta‐DAS28 improved significantly. The European League Against Rheumatology moderate or good response was achieved by 76% (95% CI 58, 89) in the IG and 49% (95% CI 32, 65) in the CG group.ConclusionsDisease activity tended to improve more with the nurse‐led intervention compared with regular care, although the difference was not significant, probably partly due to the lack of statistical power.

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Nurse‐Led Consultation for Patients With Rheumatoid Arthritis at Low Disease Activity: A Randomized Noninferiority Trial

Kwok

Tang

Tsang

et al. 2022

Arthritis Care & Research

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Objective To determine the effectiveness of nurse‐led consultations in patients with stable rheumatoid arthritis (RA) in Hong Kong. Methods The present work was a single‐center, randomized, open‐label, noninferiority trial. Patients who had rheumatoid arthritis (RA) with low disease activity (LDA) were randomized at a 1:1 ratio to attend a nurse‐led consultation or rheumatologist follow‐up visit for 2 years. The primary end point was the proportion of patients whose RA remained at LDA. Secondary end points included the proportion of patients with RA in disease remission and the scores recorded on the Leeds Satisfaction Questionnaire at 2 years, changes from baseline on the Disease Activity Score in 28 joints using the C‐reactive protein level (DAS28‐CRP), modified Sharp/van der Heijde score (SHS), Health Assessment Questionnaire disability index (HAQ DI), Short Form 36 (SF‐36) physical component score, and 19‐item Compliance Questionnaire for Rheumatology (CQR‐19) score. Results Among 280 patients who were randomized equally to either attend nurse‐led consultations or rheumatologist follow‐up visits, 267 patients completed the study. In the nurse‐led consultation and rheumatologist follow‐up groups, 92.1% and 91.4% patients, respectively, remained at LDA at 2 years. The 95% confidence intervals (95% CIs) of the adjusted treatment difference were within the predefined noninferiority margin in both the intention‐to‐treat analysis (95% CI 5.75, 7.15) and the per‐protocol analysis (95% CI 1.67, 7.47). Although the changes in DAS28‐CRP score over 2 years were significantly different between the 2 treatment groups (P < 0.001), there were no significant changes from baseline in SHS, HAQ DI, SF‐36 physical component scores, and CQR‐19 scores. At the end of the study, more patients expressed satisfaction with nurse‐led consultations. Conclusion Nurse‐led consultations were not inferior to rheumatologist follow‐up visits in patients with stable RA.

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Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis

Cited by 40 publications

References 48 publications

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

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

A randomized study comparing regular care with a nurse‐led clinic based on tight disease activity control and person‐centred care in patients with rheumatoid arthritis with moderate/high disease activity: A 6‐month evaluation

Nurse‐Led Consultation for Patients With Rheumatoid Arthritis at Low Disease Activity: A Randomized Noninferiority Trial

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