Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial
Objective To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses. Methods A total of 294 pat...
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| Veröffentlicht in: | Arthritis care & research (2010) 2018-03, Vol.70 (3), p.353-360 |
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| creator | Thurah, Annette Stengaard‐Pedersen, Kristian Axelsen, Mette Fredberg, Ulrich Schougaard, Liv M. V. Hjollund, Niels H. I. Pfeiffer‐Jensen, Mogens Laurberg, Trine B. Tarp, Ulrik Lomborg, Kirsten Maribo, Thomas |
| description | Objective
To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses.
Methods
A total of 294 patients were randomized (1:1:1) to either PRO‐based tele‐health followup carried out by a nurse (PRO‐TN) or a rheumatologist (PRO‐TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat (ITT), and multivariate imputation analysis.
Results
Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO‐TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO‐TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO‐TN had mean ± SD 1.72 ± 1.03 visits/year, PRO‐TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.
Conclusion
Among RA patients with low disease activity or remission, a PRO‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses. |
| doi_str_mv | 10.1002/acr.23280 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1899793723</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2007908524</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3880-ad4af97de7e7840ffd27fa6e94ece598c82efde065c61bdb23807a5596e6b96d3</originalsourceid><addsrcrecordid>eNp1kU1LXDEUhkNpqaIu_AMl0E1djCa5X0l3w_gxglCYTsFdyNycOJHcm2mSq0xX3XXb3-gvMeOoC8GzOefAcx4OvAgdUnJMCWEnqg3HrGCcfEC7jFZ0VNYV__g6l9c76CDGW5IrU7wQn9EO4xWledlF_-bg4OHv_ykol5b43Dvn74cV_pmCSnCzxsYHPLc3y4Qnvk_BO-wNPrURVAQ8bpO9s2mNbY9nSxg6lbzVeBzSMthk43c8gzi4FDdHCs9Ur31n_4B-kbk8zoNVbh99MspFOHjue-jX-dl8Mh1d_bi4nIyvRm3BORkpXSojGg0NNLwkxmjWGFWDKKGFSvCWMzAaSF21NV3oBSs4aVRViRrqhah1sYe-bb2r4H8PEJPsbGzBOdWDH6KkXIhGFA0rMvr1DXrrh9Dn7yQjpBGEV6zM1NGWaoOPMYCRq2A7FdaSErkJSOaA5FNAmf3ybBwWHehX8iWODJxsgXvrYP2-SY4ns63yEWT8nEk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2007908524</pqid></control><display><type>article</type><title>Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><creator>Thurah, Annette ; Stengaard‐Pedersen, Kristian ; Axelsen, Mette ; Fredberg, Ulrich ; Schougaard, Liv M. V. ; Hjollund, Niels H. I. ; Pfeiffer‐Jensen, Mogens ; Laurberg, Trine B. ; Tarp, Ulrik ; Lomborg, Kirsten ; Maribo, Thomas</creator><creatorcontrib>Thurah, Annette ; Stengaard‐Pedersen, Kristian ; Axelsen, Mette ; Fredberg, Ulrich ; Schougaard, Liv M. V. ; Hjollund, Niels H. I. ; Pfeiffer‐Jensen, Mogens ; Laurberg, Trine B. ; Tarp, Ulrik ; Lomborg, Kirsten ; Maribo, Thomas</creatorcontrib><description>Objective
To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses.
Methods
A total of 294 patients were randomized (1:1:1) to either PRO‐based tele‐health followup carried out by a nurse (PRO‐TN) or a rheumatologist (PRO‐TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat (ITT), and multivariate imputation analysis.
Results
Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO‐TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO‐TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO‐TN had mean ± SD 1.72 ± 1.03 visits/year, PRO‐TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.
Conclusion
Among RA patients with low disease activity or remission, a PRO‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.</description><identifier>ISSN: 2151-464X</identifier><identifier>EISSN: 2151-4658</identifier><identifier>DOI: 10.1002/acr.23280</identifier><identifier>PMID: 28511288</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aftercare - methods ; Aged ; Arthritis, Rheumatoid - diagnosis ; Arthritis, Rheumatoid - physiopathology ; Arthritis, Rheumatoid - psychology ; Arthritis, Rheumatoid - therapy ; Demography ; Denmark ; Disease control ; Female ; Health risk assessment ; Health Status ; Humans ; Inflammation ; Joint diseases ; Male ; Middle Aged ; Nurses ; Patient Reported Outcome Measures ; Quality of Life ; Remission ; Remission Induction ; Rheumatoid arthritis ; Rheumatologists ; Rheumatology ; Self Efficacy ; Severity of Illness Index ; Telemedicine - methods ; Time Factors ; Treatment Outcome</subject><ispartof>Arthritis care & research (2010), 2018-03, Vol.70 (3), p.353-360</ispartof><rights>2017, American College of Rheumatology</rights><rights>2017, American College of Rheumatology.</rights><rights>2018 American College of Rheumatology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3880-ad4af97de7e7840ffd27fa6e94ece598c82efde065c61bdb23807a5596e6b96d3</citedby><cites>FETCH-LOGICAL-c3880-ad4af97de7e7840ffd27fa6e94ece598c82efde065c61bdb23807a5596e6b96d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Facr.23280$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Facr.23280$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,45553,45554</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28511288$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Thurah, Annette</creatorcontrib><creatorcontrib>Stengaard‐Pedersen, Kristian</creatorcontrib><creatorcontrib>Axelsen, Mette</creatorcontrib><creatorcontrib>Fredberg, Ulrich</creatorcontrib><creatorcontrib>Schougaard, Liv M. V.</creatorcontrib><creatorcontrib>Hjollund, Niels H. I.</creatorcontrib><creatorcontrib>Pfeiffer‐Jensen, Mogens</creatorcontrib><creatorcontrib>Laurberg, Trine B.</creatorcontrib><creatorcontrib>Tarp, Ulrik</creatorcontrib><creatorcontrib>Lomborg, Kirsten</creatorcontrib><creatorcontrib>Maribo, Thomas</creatorcontrib><title>Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial</title><title>Arthritis care & research (2010)</title><addtitle>Arthritis Care Res (Hoboken)</addtitle><description>Objective
To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses.
Methods
A total of 294 patients were randomized (1:1:1) to either PRO‐based tele‐health followup carried out by a nurse (PRO‐TN) or a rheumatologist (PRO‐TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat (ITT), and multivariate imputation analysis.
Results
Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO‐TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO‐TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO‐TN had mean ± SD 1.72 ± 1.03 visits/year, PRO‐TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.
Conclusion
Among RA patients with low disease activity or remission, a PRO‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.</description><subject>Aftercare - methods</subject><subject>Aged</subject><subject>Arthritis, Rheumatoid - diagnosis</subject><subject>Arthritis, Rheumatoid - physiopathology</subject><subject>Arthritis, Rheumatoid - psychology</subject><subject>Arthritis, Rheumatoid - therapy</subject><subject>Demography</subject><subject>Denmark</subject><subject>Disease control</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Health Status</subject><subject>Humans</subject><subject>Inflammation</subject><subject>Joint diseases</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nurses</subject><subject>Patient Reported Outcome Measures</subject><subject>Quality of Life</subject><subject>Remission</subject><subject>Remission Induction</subject><subject>Rheumatoid arthritis</subject><subject>Rheumatologists</subject><subject>Rheumatology</subject><subject>Self Efficacy</subject><subject>Severity of Illness Index</subject><subject>Telemedicine - methods</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>2151-464X</issn><issn>2151-4658</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1LXDEUhkNpqaIu_AMl0E1djCa5X0l3w_gxglCYTsFdyNycOJHcm2mSq0xX3XXb3-gvMeOoC8GzOefAcx4OvAgdUnJMCWEnqg3HrGCcfEC7jFZ0VNYV__g6l9c76CDGW5IrU7wQn9EO4xWledlF_-bg4OHv_ykol5b43Dvn74cV_pmCSnCzxsYHPLc3y4Qnvk_BO-wNPrURVAQ8bpO9s2mNbY9nSxg6lbzVeBzSMthk43c8gzi4FDdHCs9Ur31n_4B-kbk8zoNVbh99MspFOHjue-jX-dl8Mh1d_bi4nIyvRm3BORkpXSojGg0NNLwkxmjWGFWDKKGFSvCWMzAaSF21NV3oBSs4aVRViRrqhah1sYe-bb2r4H8PEJPsbGzBOdWDH6KkXIhGFA0rMvr1DXrrh9Dn7yQjpBGEV6zM1NGWaoOPMYCRq2A7FdaSErkJSOaA5FNAmf3ybBwWHehX8iWODJxsgXvrYP2-SY4ns63yEWT8nEk</recordid><startdate>201803</startdate><enddate>201803</enddate><creator>Thurah, Annette</creator><creator>Stengaard‐Pedersen, Kristian</creator><creator>Axelsen, Mette</creator><creator>Fredberg, Ulrich</creator><creator>Schougaard, Liv M. V.</creator><creator>Hjollund, Niels H. I.</creator><creator>Pfeiffer‐Jensen, Mogens</creator><creator>Laurberg, Trine B.</creator><creator>Tarp, Ulrik</creator><creator>Lomborg, Kirsten</creator><creator>Maribo, Thomas</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>201803</creationdate><title>Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial</title><author>Thurah, Annette ; Stengaard‐Pedersen, Kristian ; Axelsen, Mette ; Fredberg, Ulrich ; Schougaard, Liv M. V. ; Hjollund, Niels H. I. ; Pfeiffer‐Jensen, Mogens ; Laurberg, Trine B. ; Tarp, Ulrik ; Lomborg, Kirsten ; Maribo, Thomas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3880-ad4af97de7e7840ffd27fa6e94ece598c82efde065c61bdb23807a5596e6b96d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Aftercare - methods</topic><topic>Aged</topic><topic>Arthritis, Rheumatoid - diagnosis</topic><topic>Arthritis, Rheumatoid - physiopathology</topic><topic>Arthritis, Rheumatoid - psychology</topic><topic>Arthritis, Rheumatoid - therapy</topic><topic>Demography</topic><topic>Denmark</topic><topic>Disease control</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Health Status</topic><topic>Humans</topic><topic>Inflammation</topic><topic>Joint diseases</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nurses</topic><topic>Patient Reported Outcome Measures</topic><topic>Quality of Life</topic><topic>Remission</topic><topic>Remission Induction</topic><topic>Rheumatoid arthritis</topic><topic>Rheumatologists</topic><topic>Rheumatology</topic><topic>Self Efficacy</topic><topic>Severity of Illness Index</topic><topic>Telemedicine - methods</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Thurah, Annette</creatorcontrib><creatorcontrib>Stengaard‐Pedersen, Kristian</creatorcontrib><creatorcontrib>Axelsen, Mette</creatorcontrib><creatorcontrib>Fredberg, Ulrich</creatorcontrib><creatorcontrib>Schougaard, Liv M. V.</creatorcontrib><creatorcontrib>Hjollund, Niels H. I.</creatorcontrib><creatorcontrib>Pfeiffer‐Jensen, Mogens</creatorcontrib><creatorcontrib>Laurberg, Trine B.</creatorcontrib><creatorcontrib>Tarp, Ulrik</creatorcontrib><creatorcontrib>Lomborg, Kirsten</creatorcontrib><creatorcontrib>Maribo, Thomas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis care & research (2010)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Thurah, Annette</au><au>Stengaard‐Pedersen, Kristian</au><au>Axelsen, Mette</au><au>Fredberg, Ulrich</au><au>Schougaard, Liv M. V.</au><au>Hjollund, Niels H. I.</au><au>Pfeiffer‐Jensen, Mogens</au><au>Laurberg, Trine B.</au><au>Tarp, Ulrik</au><au>Lomborg, Kirsten</au><au>Maribo, Thomas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial</atitle><jtitle>Arthritis care & research (2010)</jtitle><addtitle>Arthritis Care Res (Hoboken)</addtitle><date>2018-03</date><risdate>2018</risdate><volume>70</volume><issue>3</issue><spage>353</spage><epage>360</epage><pages>353-360</pages><issn>2151-464X</issn><eissn>2151-4658</eissn><abstract>Objective
To test the effect of patient‐reported outcome (PRO)–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses.
Methods
A total of 294 patients were randomized (1:1:1) to either PRO‐based tele‐health followup carried out by a nurse (PRO‐TN) or a rheumatologist (PRO‐TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat (ITT), and multivariate imputation analysis.
Results
Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO‐TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO‐TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO‐TN had mean ± SD 1.72 ± 1.03 visits/year, PRO‐TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare.
Conclusion
Among RA patients with low disease activity or remission, a PRO‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>28511288</pmid><doi>10.1002/acr.23280</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library - AutoHoldings Journals; MEDLINE |
| subjects | Aftercare - methods Aged Arthritis, Rheumatoid - diagnosis Arthritis, Rheumatoid - physiopathology Arthritis, Rheumatoid - psychology Arthritis, Rheumatoid - therapy Demography Denmark Disease control Female Health risk assessment Health Status Humans Inflammation Joint diseases Male Middle Aged Nurses Patient Reported Outcome Measures Quality of Life Remission Remission Induction Rheumatoid arthritis Rheumatologists Rheumatology Self Efficacy Severity of Illness Index Telemedicine - methods Time Factors Treatment Outcome |
| title | Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial |
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