Arthritis education: the integration of patient-reported outcome measures and patient self-management

Yasser El Miedany, Maha El Gaafary, Nadia El Arousy, Ihab Ahmed, Sally Youssef, Deborah Palmer
Clinical and Experimental Rheumatology 2012, 30 (6): 899-904

OBJECTIVES: To assess the integration of PROMs and patient education, using the joint-fitness programme, and the effectiveness of this combined approach on disease activity and adherence to therapy.

METHODS: This was a double-blind randomised controlled study which included 147 arthritic patients monitored over 18 months. Every patient completed a PROMs questionnaire. By the 6th month of treatment, the patients were randomly allocated to an active group (74 patients) that was able to view former self-reported PROMs scores and discuss the implementation of the joint fitness programme as a tool for psycho-educational interventions. The control group (73 patients) continued their treatment and management based on viewing their recorded PROMs and clinical assessment. The patients were assessed at 3 monthly intervals for another 12 months. The primary outcome was the change in the patients' adherence to their medications, disease activity score (DAS-28) and PROMs domains.

RESULTS: The integration of patient education and PROMs led to a significant greater reduction of disease activity parameters, DAS-28 score, as well as improvement of the patients' adherence to therapy (p<0.01). The improvement of disease activity parameters was associated with the improvement in functional disability and quality of life scores. At 18-month-follow-up, both the self-management and cognitive behavioural therapy intervention demonstrated improvement for disease activity (effect size 1.4 and 1.2 respectively).

CONCLUSIONS: The integration of patient education and PROMs succeeded in improving self-perceived health as well as disease activity. The patient education for patients with inflammatory arthritis is feasible in the standard clinical practice.

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