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Knudsen LR, Ndosi M, Hauge EM, Lomborg K, Dreyer L, Aaboe S, Kjær MB, Sørensen L, Volsmann L, Christensen HM, de Thurah A. Effectiveness of a novel digital patient education programme to support self-management of early rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford) 2024; 63:2547-2556. [PMID: 38498833 DOI: 10.1093/rheumatology/keae177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness of a novel digital patient education (PE) programme in improving self-management in patients newly diagnosed with rheumatoid arthritis (RA). METHODS This was a parallel, open-label, two-armed, randomized controlled trial with superiority design. Patients from five rheumatology clinics were randomized into digital PE (intervention) or face-to-face PE (control). The primary outcome was self-efficacy, measured by average difference in the Rheumatoid Arthritis Self-Efficacy (RASE) score from baseline to month 12. Secondary outcomes were RA knowledge, health literacy, adherence and quality of life. Healthcare utilization data and digital PE programme usage were recorded. Self-efficacy, knowledge and health literacy data were analysed using mixed-effects repeated measures modelling; adherence using logistic regression, and quality of life and healthcare utilization using descriptive statistics with the Wilcoxon rank-sum test. RESULTS Of the 180 patients randomized (digital PE, n = 89; face-to-face PE, n = 91), 175 had data available for analysis. Median age was 59.0 years and 61% were women. The average difference in self-efficacy between groups from baseline to month 12 was significant by a -4.34 difference in RASE score, favouring the intervention group (95% CI: -8.17 to -0.51; P = 0.026). RA knowledge, health literacy and quality of life showed minor improvements over time but no difference between groups, except out-patient clinic contacts, which were fewer in the intervention group. CONCLUSION The findings suggest that digital PE is effective in improving self-efficacy and therefore self-management in patients with early RA. This intervention has potential to lower healthcare costs by decreasing out-patient clinic contacts. TRIAL REGISTRATION NUMBER clinicaltrials.gov, NCT04669340.
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Affiliation(s)
- Line R Knudsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
- Rheumatology Unit, University Hospitals Bristol and Weston NHS Trust, Bristol, UK
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Dreyer
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Sidsel Aaboe
- Department of Rheumatology, Randers Regional Hospital, Randers, Denmark
| | - Marie B Kjær
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Lis Sørensen
- Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lena Volsmann
- Department of Rheumatology, Horsens Regional Hospital, Horsens, Denmark
| | | | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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2
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Corrêa LA, Mathieson S, Hancock M, Verhagen A, Nogueira LAC, Young A, Pate JW, French SD. Questionnaires assessing knowledge and beliefs about musculoskeletal conditions are potentially suitable for use, but further research is needed: a systematic review. J Clin Epidemiol 2024; 172:111398. [PMID: 38810841 DOI: 10.1016/j.jclinepi.2024.111398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 04/21/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Abstract
OBJECTIVES To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions. STUDY DESIGN AND SETTING A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM. RESULTS The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use. CONCLUSION No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties.
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Affiliation(s)
- Leticia Amaral Corrêa
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Stephanie Mathieson
- Sydney Musculoskeletal Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Mark Hancock
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Arianne Verhagen
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | | | - Annie Young
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Joshua W Pate
- University of Technology Sydney, Graduate School of Health, Physiotherapy, Ultimo, Australia
| | - Simon D French
- Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Mineiro L, Gallo da Silva TT, Valderramas SR, Kowalski SC, Dos Santos Paiva E, Gomes ARS. Translation, transcultural adaptation into Brazilian Portuguese and concurrent validity of the rheumatoid arthritis assessment scale (RAKAS-13/Brazil). Adv Rheumatol 2024; 64:5. [PMID: 38167406 DOI: 10.1186/s42358-023-00341-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 11/24/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Knowledge of patients about Rheumatoid Arthritis (RA) is a necessary aspect to better approach self-management support in a patient-centered manner. The research instrument known as the Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS), consisting of 13 items, is simple, reliable and reproducible, and can be applied in both clinical practice and research protocols. OBJECTIVE This study aimed to translate and culturally adapt the RAKAS vocabulary into Brazilian Portuguese and to evaluate its concurrent validity. METHODS The RAKAS was translated into Brazilian Portuguese and administered to 52 elderly women with RA recruited between May 2021 and May 2022. Concurrent validity was assessed using the Spearman's correlation coefficient between RAKAS and Patient Knowledge Questionnaire (PKQ). RESULTS The participants considered RAKAS-13/BRAZIL easy to understand and did not report any doubts in answering the final version. Concurrent validity of the RAKAS-13/BRAZIL was low compared to the PKQ (ρ = 0.283, p = 0.038). CONCLUSION The Brazilian Portuguese version of the RAKAS (RAKAS-13/BRASIL) proved to be a questionnaire that was easy and quick to administer to assess patient knowledge about Rheumatoid Arthritis, despite its low correlation with the PKQ in the present study.
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Affiliation(s)
- Lindomar Mineiro
- Physical Education Program, Federal University of Paraná, Curitiba, Paraná, Brazil.
| | | | - Silvia Regina Valderramas
- Internal Medicine and Health Sciences, Department of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | - Eduardo Dos Santos Paiva
- Rheumatology, Internal Medicine Department, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Anna Raquel Silveira Gomes
- Prevention and Rehabilitation in Physical Therapy Department, Masters and PhD Programs in Physical Education, Federal University of Paraná, Curitiba, Paraná, Brazil
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4
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Rodère M, Pereira B, Soubrier M, Fayet F, Piperno M, Pallot-Prades B, Pouplin S, Baudens G, Cohen JD, Coquerelle P, Grange L, Sordet C, Tropé S, Gossec L, Beauvais C. Development and validation of a self-administered questionnaire measuring essential knowledge in patients with rheumatoid arthritis. Rheumatol Int 2022; 42:1785-1795. [PMID: 35389078 PMCID: PMC9439984 DOI: 10.1007/s00296-022-05090-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/01/2022] [Indexed: 11/26/2022]
Abstract
To develop and validate a questionnaire assessing patient knowledge in rheumatoid arthritis (RA). Knowledge considered essential for patients with RA was identified through a series of Delphi rounds among rheumatologists, health professionals (HPs), patients, and then reformulated to construct the knowledge questionnaire. Cross-sectional multicenter validation was performed in 12 rheumatology departments to assess internal validity (Kuder–Richardson coefficient), external validity, acceptability, reproducibility (Lin’s concordance correlation coefficient) and sensitivity to change (difference in total score before and after patient education sessions). Associations between patient variables and knowledge levels were evaluated. RAKE (RA Knowledge questionnairE) is a self-administered 45-item questionnaire scored 0–100, with a 32-item short-form survey assessing knowledge of disease, comorbidity, pharmacological treatments, non-pharmacological treatments, self-care and adaptative skills. Of 130 patients included in the validation study, 108 were women. Acceptability was good with < 5% missing data. Internal validity coefficient was 0.90. Mean (standard deviation) long-form score was 72.8 ± 17.8, with lower scores in comorbidity and self-care and higher scores in adaptive skills. Reproducibility was good (0.86 [0.80; 0.92]). RAKE score was positively correlated with the patients’ level of education and the HPs’ opinion on the patients’ knowledge. RAKE score showed good sensitivity to change: 66.8 ± 16.4 then 83.8 ± 12.7, representing a hedges effect size of 1.14 [95% CI 0.73; 1.55]. RAKE is an updated questionnaire assessing essential knowledge for patients with RA to enhance self-management according to current guidelines and the patients’ perspective. RAKE can usefully inform patient education interventions, routine care and research.
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Affiliation(s)
- Malory Rodère
- Rheumatology Department, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France.
| | - Bruno Pereira
- Biostatistics Unit, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Martin Soubrier
- Rheumatology Department, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Françoise Fayet
- Rheumatology Department, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France
| | - Muriel Piperno
- Rheumatology Department, Centre Hospitalier Universitaire Lyon-Sud, Lyon, France
| | - Béatrice Pallot-Prades
- Rheumatology Department, Centre Hospitalier Universitaire de Saint Etienne, Fondation partage et vie, Centre médical de l'Argentière, Hôpital Bellevue, Saint Etienne, France
| | - Sophie Pouplin
- Rheumatology Department, Hôpital Universitaire de Rouen, Rouen, France
| | | | - Jean-David Cohen
- Rheumatology Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Laurent Grange
- Rheumatology Department, Centre Hospitalier Universitaire Grenoble Alpes, Echirolles, France
| | - Christelle Sordet
- Rheumatology Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sonia Tropé
- Association Nationale de Défense contre l'Arthrite Rhumatoïde, Paris, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Rheumatology, Pitié Salpêtrière Hospital, APHP, Sorbonne Université, Paris, France
| | - Catherine Beauvais
- Rheumatology Department, Sorbonne Université, Centre Hospitalier Universitaire Saint Antoine, Assistance Publique Hôpitaux de Paris, APHP, Paris, France
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Benlidayi I. Taking Good Care of Joints for Optimal Health in Rheumatology. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_242_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Raunsbæk Knudsen L, Lomborg K, Ndosi M, Hauge EM, de Thurah A. The effectiveness of e-learning in patient education delivered to patients with rheumatoid arthritis: The WebRA study-protocol for a pragmatic randomised controlled trial. BMC Rheumatol 2021; 5:57. [PMID: 34924034 PMCID: PMC8686289 DOI: 10.1186/s41927-021-00226-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022] Open
Abstract
Background Patient education is integral to the treatment and care of patients with rheumatoid arthritis. Change is taking place in the organisation of healthcare systems because of a demographic shift towards ageing populations, an increasing use of technology and advancements in digital technologies, allowing for new interventions. This study will aim to evaluate the effectiveness of a newly developed e-learning patient education programme based on self-management that targets patients with rheumatoid arthritis.
Methods A pragmatic multi-centre randomised controlled trial is planned. We intend to recruit approximately 200 patients with a new diagnosis (< 3 months) of rheumatoid arthritis. Participants will be randomised 1:1 to web-based patient education delivered through an e-learning programme at home or standard face-to-face patient education provided at the hospital. The primary outcome is self-efficacy. Secondary outcomes are improved knowledge of rheumatoid arthritis, adherence to medication, health literacy level and quality of life. Outcomes will be measured at baseline and follow-up occurring 1, 3, 6 and 12 months after enrolment. Furthermore, data on healthcare utilisation and utilisation of the e-learning programme will be assessed at the 12-month follow-up. Statistical analysis, including differences between groups, will be evaluated using the chi-square and Kruskal–Wallis tests. Statistical analysis will follow the intention-to-treat principle, and analysis of variance will be used to evaluate the within- and between-groups differences testing the hypothesis of the ‘superiority’ of web-based patient education over standard face-to-face education provided at the hospital. Per protocol analysis will be used to assess the impact of missing data. Enrolment started in February 2021 and will end in June 2022. Discussion The study is expected to contribute to the evidence on the effectiveness of web-based patient education within rheumatic diseases. If the e-learning programme is effective, it will be incorporated into existing services to improve the self-management of patients with rheumatoid arthritis. Further, this mode of providing patient education may impact the organisation of health care for both rheumatic diseases and other chronic diseases by offering different modes of delivering patient education based on the needs and preferences of patients. Trial registration: ClinicalTrials.gov identifier NCT04669340. Registered on November 27, 2020. https://www.clinicaltrials.gov/ct2/show/NCT04669340?term=e-learning&cond=Rheumatoid+Arthritis&draw=2&rank=1. See Additional file 1 for detailed information on the dataset according to the World Health Organization Trial Registration Data Set. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00226-y.
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Affiliation(s)
- Line Raunsbæk Knudsen
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark. .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mwidimi Ndosi
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK.,University Hospitals Bristol, Bristol, England
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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7
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Kaya T, Atıcı P, Karatepe AG, Günaydın R. Peer-led education or booklet for knowledge transfer about disease: A randomized-controlled trial with ankylosing spondylitis patients. Arch Rheumatol 2021; 36:560-569. [PMID: 35382377 PMCID: PMC8957762 DOI: 10.46497/archrheumatol.2021.8334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives
This study aims to investigate whether peer-led group education + booklet is superior to booklet only to increase ankylosing spondylitis (AS) patients’ knowledge about their disease. Patients and methods
A total of 56 patients (46 males, 10 females; mean age 41.9±9.2 years; range, 22 to 58 years) with a definite diagnosis of AS who were under follow-up in our outpatient clinic between August 2010 and January 2012 were included in this study. The patients were randomly allocated to the peer-led education + booklet (education group, n=27) and booklet only (control group, n=29). To assess the level of patients’ knowledge, a patient knowledge questionnaire containing four domains was used. Evaluations were made at baseline, four weeks, and six months. The variables were “number of correct choices” (NoCC), “number of correct items” (NoCI) and percent of correct choices for each domain; the later one was resembled by the name of that domain (area A, area B, etc.). Results
The variables that improved in both groups were NoCC, NoCI, and “pharmacotherapy and physical therapy area” (area C). These improvements were similar between the groups (respectively, p=0.915, p=0.830, p=0.791). Conclusion
Reading a booklet alone is as successful as peer-led education + booklet for knowledge transfer about their disease in patients with AS. In this study, the most knowledge gain was achieved in “drug treatment and physical therapy” area.
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Affiliation(s)
- Taciser Kaya
- Department of Physical Medicine and Rehabilitation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Pınar Atıcı
- Department of Physical Medicine and Rehabilitation, Nevşehir State Hospital, Nevşehir, Turkey
| | - Altınay Göksel Karatepe
- Department of Physical Medicine and Rehabilitation, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Rezzan Günaydın
- Department of Physical Medicine and Rehabilitation, Medical Park Izmir Hospital, Izmir, Turkey
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Lopez-Olivo MA, Lin H, Rizvi T, Barbo A, Ingleshwar A, des Bordes JKA, Jibaja-Weiss M, Volk RJ, Suarez-Almazor ME. Randomized Controlled Trial of Patient Education Tools for Patients With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2021; 73:1470-1478. [PMID: 32583971 PMCID: PMC10521328 DOI: 10.1002/acr.24362] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/16/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The present study was undertaken to evaluate the efficacy of 2 educational tools for patients with rheumatoid arthritis (RA) by comparing a newly developed video tool, including storylines and testimonials, combined with a written booklet to the same written booklet alone. METHODS We conducted a randomized controlled trial. Our primary outcome was disease knowledge. Secondary outcomes were decisional conflict, self-efficacy, effective health care management, and satisfaction. Outcomes were measured before and after reviewing the materials, and 3 and 6 months later. Linear mixed-effects models were performed to evaluate changes over time. RESULTS In total, 221 participants received an educational video and booklet (n = 111) or a booklet alone (n = 110). The mean age was 50.8 years, mean disease duration was 4.8 years, 85% were female, and 24% had limited health literacy levels. Within groups, most outcomes improved between baseline and follow-up, but there were no statistically significant differences across groups. Patients receiving the video and booklet were more likely than those receiving the booklet alone to rate the presentation as excellent for providing information about the impact of RA, medication options, evidence about medications, benefits of medication, and self-care options. Factors significantly associated with greater improvements in knowledge and decisional conflict from baseline to 6 months included limited health literacy, lower educational level, and shorter disease duration. CONCLUSION Regardless of the delivery method, outcomes were improved up to 6 months after educational materials were delivered. Our findings support the implementation of self-administered educational materials in clinical settings, as they can result in sustained improvements in disease knowledge and decisional conflict.
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Affiliation(s)
- Maria A. Lopez-Olivo
- Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Heather Lin
- Department of Biostatistics, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Tara Rizvi
- Houston Rheumatology & Arthritis Specialists, Memorial Hermann, Houston Texas, USA
| | - Andrea Barbo
- Center for Outcomes Research and Evaluation (CORE), Yale New Haven Hospital, New Haven, CT, USA
| | | | - Jude K. A. des Bordes
- Department of Family and Community Medicine, The University of Texas McGovern Medical School, Houston Texas, USA
| | - Maria Jibaja-Weiss
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Robert J. Volk
- Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Maria E. Suarez-Almazor
- Department of Health Services Research, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- General Internal Medicine - Rheumatology section, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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MacIver A, Hollinger H, Carolan C. Tele-health interventions to support self-management in adults with rheumatoid arthritis: a systematic review. Rheumatol Int 2021; 41:1399-1418. [PMID: 34132890 PMCID: PMC8245362 DOI: 10.1007/s00296-021-04907-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/29/2021] [Indexed: 11/26/2022]
Abstract
Rheumatoid arthritis (RA), a long-term auto-immune condition is a challenging condition for patients to manage. Goals of treatment include reducing pain, decreasing inflammation, and improving an individual's overall function. Increasingly technology is being utilised to support patients to self-manage their condition. The aim of this systematic narrative review was to synthesise and critically appraise published evidence concerning the effectiveness of tele-health interventions to support self-management in RA. Bibliographic databases searched from 2014 to March 2020 included MedLINE, Embase, Cochrane Library. Search strategy combined the following concepts: (1) rheumatoid arthritis, (2) tele-health interventions, and (3) self-management. Only randomised controlled trials (RCTs) involving adults with RA were included. Titles, abstracts, full-text articles were screened, any discrepancies were checked by a second reviewer. Risk of bias was assessed using Cochrane risk of bias tool and data were extracted utilising the Cochrane data collection form for RCT interventions along with the TiDier checklist. Due to high heterogeneity, results were not meta-analysed and instead data were synthesised narratively. The search identified 98 articles, seven were included. The completed RCTs varied in the nature of the interventions, duration/severity of RA, outcomes measured and effectiveness of the interventions. The completed RCTs included a total of 791 participants Disease duration was largely between 4 and 10 years and disease severity on average was moderate. There was extensive variation in intervention components, theories underpinning theories and outcomes measured. Five RCTs reported a positive effect on factors such as disease activity, medication adherence, physical activity and self-efficacy levels. This study suggests that tele-health interventions that are well-designed, tailored and multi-faceted can help to achieve positive self-management outcomes in RA. None of the studies showed evidence of harm.
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Affiliation(s)
- Alison MacIver
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
- NHS Western Isles, Stornoway, Scotland UK
| | - Hannah Hollinger
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
| | - Clare Carolan
- Department of Nursing and Midwifery, University of the Highlands and Islands, Inverness, UK
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Squiers M, Nelms NJ, Davis AT, Halsey DA, Slauterbeck JR, Blankstein M. A Poster Summarizing the American Academy of Orthopaedic Surgeons Knee Osteoarthritis Clinical Practice Guideline Is a Powerful Tool for Patient Education: A Randomized Controlled Trial. J Arthroplasty 2021; 36:102-106.e5. [PMID: 32863075 DOI: 10.1016/j.arth.2020.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 06/23/2020] [Accepted: 07/03/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In 2013, the American Academy of Orthopaedic Surgeons (AAOS) published an evidence-based clinical practice guideline (CPG) on conservative treatment options for patients with knee osteoarthritis (OA). The purpose of this study is to evaluate the effectiveness of a poster outlining the AAOS knee OA CPG on patient comprehension and satisfaction in the clinic. METHODS This is a prospective 2-armed randomized controlled trial. Patients were eligible if they were of age 40-85 years, had degenerative knee OA, and did not consent for surgery. Patients were randomized to nonposter (standard care) and poster rooms. Knee OA treatment options were described to the patient verbally and posters were used as a teaching tool when present. The main outcomes were comprehension and satisfaction scores on a survey. RESULTS Of the 105 patients enrolled, 51 (48.6%) were randomized to usual care (control) and 54 (51.4%) to the intervention (poster). Poster patients outperformed control patients with an average of 55.3% ± 16.7% (mean ± SD) compared to 39.5% ± 13.3% correct answers (P < .001). And 66.7% of poster patients and 29.4% of control patients achieved an adequately informed status of >50% correct answers (P < .001; 50.5% overall). With a maximum possible score of 10, visit satisfaction scores were 9.4 ± 1.0 in poster patients and 9.2 ± 1.7 in control patients (P = .50). CONCLUSION Patients educated using an AAOS knee CPG poster showed significant improvements in knowledge and were more likely to achieve an adequately informed status. No difference existed in visit satisfaction. A poster offers a low-cost, effective educational tool. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Monte Squiers
- Spectrum Health - Department of Orthopaedic Surgery Residency Program, Michigan State College of Human Medicine, Grand Rapids, MI; University of Vermont Medical Center, Department of Orthopaedic Surgery, Burlington, VT
| | - Nathaniel J Nelms
- University of Vermont Medical Center, Department of Orthopaedic Surgery, Burlington, VT
| | - Alan T Davis
- Spectrum Health - Department of Research & Scholarly Activity Support, Michigan State College of Human Medicine, Grand Rapids, MI
| | - David A Halsey
- University of Vermont Medical Center, Department of Orthopaedic Surgery, Burlington, VT
| | - James R Slauterbeck
- University of Vermont Medical Center, Department of Orthopaedic Surgery, Burlington, VT
| | - Michael Blankstein
- University of Vermont Medical Center, Department of Orthopaedic Surgery, Burlington, VT
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The adaptation of the Turkish version of the Assessment of Knowledge in Ankylosing Spondylitis Patients by a Self-Administered Questionnaire. Turk J Phys Med Rehabil 2020; 66:299-306. [PMID: 33089086 PMCID: PMC7557624 DOI: 10.5606/tftrd.2020.4013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 09/26/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives
The aim of this study was to adapt the Assessment of Knowledge in Ankylosing Spondylitis Patients by a Self-Administered Questionnaire for the Turkish ankylosing spondylitis (AS) patients. Patients and methods
Between May 2016 and December 2016, a total of 100 AS patients (72 males, 28 females; mean age 43.4 years; range, 21 to 73 years) were included in the study. A forward (into Turkish) and backward translation of the questionnaire was performed. Reliability was evaluated using the Cronbach alpha (α) value, test-retest reliability, and intra-class correlations (ICCs). The correlations with demographic data including age, sex, time since diagnosis, and education status and with the disease-specific assessments including Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire were investigated. Results
The Turkish version of the questionnaire showed a good reliability (Cronbach-α: >0.70, ICC: >0.90). A significant correlation was found with the education status (p<0.001). However, no significant correlation was observed between the questionnaire and the other parameters (p>0.05). Conclusion Our study results show that the Turkish version of the questionnaire seems to be reliable for use in Turkish AS patients.
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Spijk-de Jonge MJ, Oude Voshaar MAH, Renskers L, Huis AMP, van de Laar MAFJ, Hulscher MEJL, van Riel PLCM. Two parallel short forms to measure disease- and treatment-associated knowledge in rheumatoid arthritis: application of item response theory. Rheumatol Adv Pract 2020; 4:rkaa012. [PMID: 32704614 PMCID: PMC7368341 DOI: 10.1093/rap/rkaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/16/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
The aim was to develop two disease- and treatment-related knowledge about RA (DataK-RA) short forms using item response theory-based linear optimal test design.
Methods
We used the open source Excel add-in solver to program a linear optimization algorithm to develop two short forms from the DataK-RA item bank. The algorithm was instructed to optimize precision (i.e. reliability) of the scores for both short forms, subject to a number of constraints that served to ensure that each short form would include unique items and that the short forms would have similar psychometric properties. Agreement among item response theory scores obtained from the different short forms was assessed using the Bland–Altman method and Student’s paired t-test. Construct validity and relative efficiency of the short forms was evaluated by relating the score to age, sex and educational attainment.
Results
Two short forms were derived from the DataK-RA item bank that satisfied all content constraints. Both short forms included 15 unique items and yielded reliable scores (r > 0.70), with low ceiling and floor effects. The short forms yielded statistically indistinguishable mean scores according to Student’s paired t-test and Bland–Altman analysis. Scores on short forms 1 and 2 were associated with age, sex and educational attainment to a similar extent.
Conclusion
In this study, we developed two DataK-RA short forms with unique items, yet similar psychometric properties, that can be used to assess patients pre- and post-test interventions aimed at improving disease-related knowledge in RA patients.
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Affiliation(s)
- Marieke J Spijk-de Jonge
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Martijn A H Oude Voshaar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Lisanne Renskers
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Anita M P Huis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Mart A F J van de Laar
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
| | - Piet L C M van Riel
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen
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Naqvi AA, Hassali MA, Iffat W, Shakeel S, Zia M, Fatima M, Iqbal MS, Iqbal MZ, Imam MT, Hossain MA, Ali M, Haseeb A. Cross-culture adaptation and validation of English version of Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS) in patients with rheumatoid arthritis. Int J Rheum Dis 2020; 23:918-927. [PMID: 32525287 DOI: 10.1111/1756-185x.13860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 11/30/2022]
Abstract
AIM To carry out cross-culture adaptation and validation of the English version of Rheumatoid Arthritis Knowledge Assessment Scale (RAKAS) in patients with rheumatoid arthritis (RA). METHODS A cross-sectional study was conducted for 2 months in 2 tertiary care hospitals in Karachi, Pakistan. Sample size was calculated based on item-subject ratio. The translation was carried out using standard procedures for translation and cross-culture adaptation. The validation process included estimation of discrimination power, item difficulty index, factorial, convergent, construct and known group validities and reliability. Reliability of the scale was estimated using Kuder-Richardson Formula 20 and a value of σ2 ≥ 0.6 was acceptable. SPSS v23, Remark Classic OMR v6 software and MedCalc Statistical Software v16.4.3, were used to analyze the data. The study was approved by the relevant ethics committee (IRB#NOV:15). RESULTS The mean score was 7.68 ± 2.52 (95% CI: 7.31-8.05) for 177 patients. The σ2 = 0.601, that is, >0.6, test-retest reliability ρ = .753, P < .05. The average discrimination power = 47.27, average Item Difficulty Index = 0.557. The fit indices were acceptable in a range that established its factorial validity and average factor loading was ≥0.7 which established convergent validity. A significant association (χ2 = 33.074, P < .01) between score interpretation and previous counseling by pharmacists established its construct validity. A significant association (χ2 = 19.113, P < .05) between score interpretation and patient occupation established known group validity. CONCLUSION The English version of RAKAS was deemed a reliable and validated tool to measure knowledge about disease in Pakistani patients with RA.
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Affiliation(s)
- Atta Abbas Naqvi
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Wajiha Iffat
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Sadia Shakeel
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.,Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Madiha Zia
- Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustajab Fatima
- Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Muhammad Zahid Iqbal
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, AIMST University, Bedong, Malaysia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Mohammad Akbar Hossain
- Department of Pharmacology and Toxicology, College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia
| | - Majid Ali
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia
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Kamruzzaman AKM, Chowdhury MR, Islam MN, Sultan I, Ahmed S, Shahin A, Alam MM, Azad MA, Hassan MM, Amin MZ, Sinha S, Ahmad HI, Shazzad MN, Ahmad SN, Haq SA, Rasker JJ. The knowledge level of rheumatoid arthritis patients about their disease in a developing country. A study in 168 Bangladeshi RA patients. Clin Rheumatol 2019; 39:1315-1323. [PMID: 31828544 DOI: 10.1007/s10067-019-04859-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/29/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess disease-related knowledge of rheumatoid arthritis (RA) patients PATIENTS AND METHODS: Consecutive RA patients were invited from the rheumatology departments of BSMM University, Dhaka, Bangladesh. The Bangla version of the Patient Knowledge Questionnaire (B-PKQ) was used. Correlations between the B-PKQ scores and clinical-demographic data were measured using Pearson's correlation coefficient. Impact of independent variables on the level of knowledge about RA was analyzed through multiple regression analysis. Possible explanatory variables included the following: age, disease duration, formal education level, and Bangla Health Assessment Questionnaire (B-HAQ) score. Analysis of variance (ANOVA) was used to test the difference between demographical, clinical, and socioeconomic variables. For statistical analysis, SPSS statistics version 20 was used. RESULTS A total of 168 RA patients could be included. The mean B-PKQ score was 9.84 (range 1-20) from a possible maximum of 30. The mean time for answering the questionnaire was 24.3 min (range 15-34). Low scores were observed in all domains but the lowest were in medications and joint protection/energy conservation. Knowledge level was higher (15.5) in 6 patients who had RA education before enrollment. B-PKQ showed positive correlation with education level (r = 0.338) and negative correlation with HAQ (r = -0.169). The B-PKQ showed no correlation with age, disease duration, having first degree family member with RA, education from other sources (neighbor, RA patient, nurses), or information from mass media. CONCLUSIONS Disease-related knowledge of Bangladeshi RA patients was poor in all domains. Using these findings, improved education and knowledge will result in better disease control.Key Points• Little is known about the knowledge of RA patients regarding their disease and its treatment in Bangladesh and in developing countries in general.• We found that the knowledge of Bangladeshi RA patients regarding their disease was poor in all domains; it correlated positive with education level and negative with function (HAQ), but showed no correlation with age or disease duration.• The findings of this study can be used for improving current patient education programs by health professionals and through mass media.• Better disease control of RA may be achieved by improving patient knowledge in a developing country like Bangladesh, but also in other parts of the world.
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Affiliation(s)
- A K M Kamruzzaman
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Minhaj Rahim Chowdhury
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Nazrul Islam
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Imtiaz Sultan
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Shamim Ahmed
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Abu Shahin
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Mohammad Mahbubul Alam
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Ak Azad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - M Masudul Hassan
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Zahid Amin
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Sudeshna Sinha
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Habib Imtiaz Ahmad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Md Nahiduzzamane Shazzad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Sonia Nasreen Ahmad
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Syed Atiqul Haq
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands
| | - Johannes Jacobus Rasker
- Faculty of Behavioral, Management and Social Sciences, Department Psychology, Health and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, The Netherlands.
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Beauvais C, Rodère M, Pereira B, Legoupil N, Piperno M, Pallot Prades B, Castaing P, Wendling D, Grange L, Costantino F, Carton L, Soubrier M, Coquerelle P, Pham T, Poivret D, Cohen JD, Tavares I, Nataf H, Pouplin S, Sordet C, Gossec L. Essential knowledge for patients with rheumatoid arthritis or spondyloarthritis: Results of a multicentric survey in France among health professionals and patients. Joint Bone Spine 2019; 86:747-752. [DOI: 10.1016/j.jbspin.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/05/2019] [Indexed: 12/13/2022]
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16
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Naqvi AA, Hassali MA, Iffat W, Zia M, Fatima M, Shakeel S, Khan I, Jahangir A, Kachela B, Nadir MN, Qureshi I, Bangash U. Development and validation of a novel rheumatoid arthritis knowledge assessment scale in Pakistani patients with rheumatoid arthritis. Int J Rheum Dis 2019; 22:2031-2044. [PMID: 31595667 DOI: 10.1111/1756-185x.13721] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 09/07/2019] [Accepted: 09/07/2019] [Indexed: 11/30/2022]
Abstract
AIM Rheumatoid arthritis (RA) is a chronic progressive disabling disease that mainly affects joints. Studies documenting Pakistani patients' knowledge regarding RA disease are lacking and there is a need for such endeavor. The purpose of this study was to develop and validate a novel research tool to document patient knowledge about RA disease. METHODS A novel research instrument known as the rheumatoid arthritis knowledge assessment scale (RAKAS) which consisted of 13 items, was formulated by a rheumatology panel and used for this study. This study was conducted in rheumatology clinics of three tertiary care hospitals in Karachi, Pakistan. The study was conducted in March-April 2018. Patients were recruited using a randomized computer-generated list of appointments. Sample size was calculated based on item-to-respondent ratio of 1:15. The validities, factor structure, sensitivity, reliability and internal consistency of RAKAS were assessed. The study was approved by the institutional Ethics Committee. RESULTS A total of 263 patients responded to the study. Content validity was 0.93 and response rate was 89.6%. Factor analysis revealed a 3-factor structure. Fit indices, namely normed fit index (NFI), Tucker Lewis index (TLI), comparative fit index (CFI) and root mean square of error approximation (RMSEA) were calculated with satisfactory results, that is, NFI, TLI and CFI > 0.9, and RMSEA < 0.06. Internal consistency (α) was 0.62, that is, acceptable. All items had a high discrimination index, that is, >19 and difficulty index <0.95. Sensitivity and specificity of RAKAS were above 90%. The tool established construct and known group validities. CONCLUSION A novel tool to document disease knowledge in patients with RA was formulated and validated.
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Affiliation(s)
- Atta Abbas Naqvi
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Wajiha Iffat
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Madiha Zia
- Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Mustajab Fatima
- Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan
| | - Sadia Shakeel
- Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Irfanullah Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Amnah Jahangir
- Department of Pharmacy, Ziauddin University Hospital, Karachi, Pakistan
| | - Bharti Kachela
- Faculty of Pharmacy, Ziauddin University, Karachi, Pakistan
| | | | - Imran Qureshi
- Department of Pharmacy, Ziauddin University Hospital, Karachi, Pakistan
| | - Umair Bangash
- Department of Pharmacy, Ziauddin University Hospital, Karachi, Pakistan
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17
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Lai X, Zhu H, Huo X, Li Z. Polypharmacy in the oldest old (≥80 years of age) patients in China: a cross-sectional study. BMC Geriatr 2018; 18:64. [PMID: 29499639 PMCID: PMC5834886 DOI: 10.1186/s12877-018-0754-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background The oldest old generally have worse health and more comorbidities than the general population of older adults, and they are more likely to be exposed to polypharmacy. Reliable investigation of polypharmacy among the oldest old (≥80 years of age) in China are lacking. So this study aims to describe the polypharmacy status of oldest old patients ≥80 years of age and to assess the factors influencing medication compliance. Methods This was a cross-sectional study of 258 oldest old patients ≥ 80 years of age and hospitalized at a tertiary hospital in Beijing between December 1, 2014 and June 30, 2015. They completed three validated questionnaires to assess their pre-admission status (general demographics, medication knowledge, and medication adherence). Potentially inappropriate medications (PIM) use was evaluated by physicians. Results The majority of the patients (55.4%) took < 10 types of drugs. The numbers of drugs taken ranged from 8 to 60 drugs (median of 22.9). Patients taking 11–20 drugs accounted for 46.1% of the patients. Subjects with a history of adverse drug reactions accounted for 40.3%. The proportion of PIMs was 27.1%. Compliance was only 32.6% among the oldest old patients with polypharmacy. Age and medication classes were independently negatively associated with compliance, and medication knowledge was independently positively associated with compliance. Conclusion Oldest old patients (≥ 80 years of age) had a poor medication knowledge. Age, medication classes, and medication knowledge were independently associated with medication compliance. Electronic supplementary material The online version of this article (10.1186/s12877-018-0754-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoxing Lai
- Department of Health Care, Peking Union Medical College Hospital, Beijing, 100730, China.
| | - Hongwei Zhu
- Department of Health Care, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Xiaopeng Huo
- Department of Health Care, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Zheng Li
- School of Nursing, Peking Union Medical College, Beijing, 100730, China.
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18
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Lopez-Olivo MA, Ingleshwar A, Volk RJ, Jibaja-Weiss M, Barbo A, Saag K, Leong A, Suarez-Almazor ME. Development and Pilot Testing of Multimedia Patient Education Tools for Patients With Knee Osteoarthritis, Osteoporosis, and Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:213-220. [PMID: 28464546 PMCID: PMC6442741 DOI: 10.1002/acr.23271] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 04/25/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We developed and tested multimedia patient education tools (video tools) for patients with knee osteoarthritis (OA), osteoporosis (OP), and rheumatoid arthritis (RA). METHODS We followed an "edutainment" model, incorporating educational patient story lines. The goals were designed to make the programs both didactic and entertaining, with navigation and graphic user interfaces as simple as possible. We created both English and Spanish language versions. Once the video tool was finalized, 60 patients, 20 per disease, were shown the tool and interviewed. Disease knowledge was our primary outcome, and decision conflict, disease management, and acceptability were secondary outcomes. RESULTS We observed statistically significant differences in pre- to postintervention knowledge questionnaire scores (before and after viewing the video tool) (OA: P = 0.03, OP: P = 0.01, and RA: P < 0.0001). Most participants felt they gained "clarity" on disease duration, symptoms, and the time medication takes to start acting; were "encouraged to see their doctor regularly"; and were more aware about taking their medications. In terms of acceptability, most patients in all disease groups found the length and amount of information presented in the video tools to be "just right," and the presentation to be "balanced." In terms of comprehension, all participants provided a favorable evaluation of the video tool; all found the video easy to use, the vocabulary easy to understand, and the materials to be well organized. CONCLUSION Multimedia tools that incorporate videos may help patients better understand and manage their disease. Patient involvement in the development process is essential to ensure relevant content and usability.
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Affiliation(s)
| | | | - Robert J. Volk
- The University of Texas MD Anderson Cancer Center, Houston, Texas (, , , )
| | - Maria Jibaja-Weiss
- Baylor College of Medicine, Dan L Duncan Comprehensive Cancer Center, Houston, Texas ()
| | - Andrea Barbo
- The University of Texas MD Anderson Cancer Center, Houston, Texas (, , , )
| | - Kenneth Saag
- The University of Alabama at Birmingham School of Public Health ()
| | - Amye Leong
- Healthy Motivation and the Global Alliance for Musculoskeletal Health of the Bone and Joint Decade ( )
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de Jonge MJ, Oude Voshaar MAH, Huis AMP, van de Laar MAFJ, Hulscher MEJL, van Riel PLCM. Development of an item bank to measure factual disease and treatment related knowledge of rheumatoid arthritis patients in the treat to target era. PATIENT EDUCATION AND COUNSELING 2018; 101:67-73. [PMID: 28811047 DOI: 10.1016/j.pec.2017.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/21/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To develop a Disease and treatment associated Knowledge in RA item bank (DataK-RA) based on item response theory. METHODS Initial items were developed from a systematic review. Rheumatology professionals identified relevant content trough a RAND modified Delphi scoring procedure and consensus meeting. RA patients provided additional content trough a focus group. Patients and professionals rated readability, feasibility and comprehensiveness of resulting items. Cross-sectional data were collected to evaluate psychometric properties of the items. RESULTS Data of 473 patients were used for item reduction and calibration. Twenty items were discarded based on corrected item-total point biserial correlation <0.30. Confirmatory factor analysis with weighted least squares estimation on the polychoric correlation matrix suggested good fit for a unidimensional model for the remaining 42 items (CFI 0.97 TLI=0.97, RMSEA=0.02, WRMR=0.97), supporting the proposed scoring procedure. Scores were highly reliable and normally distributed with minimal ceiling (1.8%) and no floor effects. 75% of tested hypotheses about the association of DataK-RA scores with related constructs were supported, indicating good construct validity. CONCLUSION DataK-RA is a psychometrically sound item bank. PRACTICE IMPLICATIONS DataK-RA provides health professionals and researchers with a tool to identify and target patients' information needs or to assess effects of educational efforts.
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Affiliation(s)
- Marieke J de Jonge
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Martijn A H Oude Voshaar
- University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands.
| | - Anita M P Huis
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Mart A F J van de Laar
- University of Twente, Department of Psychology, Health and Technology, Enschede, The Netherlands.
| | - Marlies E J L Hulscher
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands.
| | - Piet L C M van Riel
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands; Bernhoven, Department of Rheumatology, Uden, The Netherlands.
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20
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THE LEVEL OF KNOWLEDGE ABOUT THE RHEUMATOID ARTHRITIS IN TURKISH PATIENTS. ANADOLU KLINIĞI TIP BILIMLERI DERGISI 2018. [DOI: 10.21673/anadoluklin.325831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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21
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Wang J, Zou X, Cong L, Liu H. Clinical effectiveness and cost-effectiveness of nurse-led care in Chinese patients with rheumatoid arthritis: A randomized trial comparing with rheumatologist-led care. Int J Nurs Pract 2017; 24. [PMID: 29072362 DOI: 10.1111/ijn.12605] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 09/22/2017] [Accepted: 09/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM The concept of nurse-led care (NLC) was not familiar in China. This study was designed to evaluate the clinical effectiveness and cost-effectiveness of NLC versus rheumatologist-led care (RLC) in Chinese patients with rheumatoid arthritis (RA). METHODS Patients of either gender (aged ≥18 years) with RA were enrolled at Wenhai Central Hospital, China (January 2015 to December 2015). The participants were then randomized to NLC or RLC. Outcomes of both the groups were compared in terms of effectiveness by measuring the Disease Activity Score 28, visual analogue scores pertaining to pain and fatigue, and duration of morning stiffness. Costs associated with resource use for RA were assessed and compared between both groups. RESULTS A total of 214 RA patients in 2 groups (n = 107 in each group) were enrolled and analysed. Improvements in clinical outcomes (disease activity, pain, fatigue, and morning stiffness) over 12 months were significantly greater in the NLC group compared to RLC (P < 0.001). Overall, costs associated with resource use were higher in the RLC group compared to the NLC group (P < 0.05). CONCLUSIONS Our preliminary finding suggested that RA patients managed by NLC compared to RLC may have better clinical outcomes and more cost-effective care in China.
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Affiliation(s)
- Junru Wang
- Department of Orthopedic Surgery, Wenhai Central Hospital, Wenhai, China
| | - Xiulan Zou
- Department of Orthopedic Surgery, Wenhai Central Hospital, Wenhai, China
| | - Ling Cong
- Department of Respiratory Medicine, Wenhai Central Hospital, Wenhai, China
| | - Huina Liu
- Department of Orthopedic Surgery, Wenhai Central Hospital, Wenhai, China
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Martin RW, Enck RD, Tellinghuisen DJ, Eggebeen AT, Birmingham JD, Head AJ. Comparison of the Effects of a Pharmaceutical Industry Decision Guide and Decision Aids on Patient Choice to Intensify Therapy in Rheumatoid Arthritis. Med Decis Making 2017; 37:577-588. [PMID: 28590834 PMCID: PMC5466141 DOI: 10.1177/0272989x17696995] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 12/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the effects a pharmaceutical industry decision guide and International Patient Decision Aids Standard (IPDAS) compliant patient decision aids (PtDA) on patient medication beliefs and choice to intensify therapy. METHODS Rheumatoid arthritis (RA) patients, who had never taken etanercept (Enbrel), took part in a mail survey. They were presented with a hypothetical decision scenario where they were asked to consider adding etanercept to their current regimen. Each patient was randomized to review 1 of 3 forms of an etanercept-specific decision support: a long PtDA (LONG DA), a short PtDA (SHORT DA), or the manufacturer's Enbrel decision guide (Pharm Booklet). RESULTS We had 402 RA patients participate in the study (response rate, 52%). Of the patients randomized to the Pharm Booklet, 30.6% elected to initiate etanercept. Only 14.6% and 14.0% of patients who reviewed the LONG DA or SHORT DA choose to take etanercept (χ2 = 15.7; P < 0.001). Patients who reviewed the LONG DA or SHORT DA had a greater increase in knowledge about etanercept than those who reviewed the Pharm Booklet. There was no difference in decisional conflict among the groups. A logistic regression model explained 44.2% (R2 = 0.442) of patient choice to intensify therapy by initiating etanercept. The strongest predictor of choice to intensify therapy were beliefs about etanercept's ability to improve symptoms (OR = 2.56, 96%CI [1.71, 3.80]), and its use by others like the respondent (OR = 2.24, 95%CI [1.49, 3.35]). Mediation analysis confirmed the presence of a partial mediating effect of decision support on patients' intent to take etanercept (OR = 0.59, 95%CI [0.39, 0.89]). CONCLUSIONS Patients supported by the Pharm Booklet were twice as likely to choose to intensify therapy. The Pharm Booklet's effects are partially mediated through persuasive communication techniques that influence patients' beliefs that symptoms will improve, and increase social normative beliefs, rather than by increasing the relevant knowledge, clarifying patient values about positive or negative treatment outcomes, or increasing their self-efficacy.
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Affiliation(s)
- Richard W. Martin
- Richard W. Martin, Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI 49546, USA; e-mail:
| | - Ryan D. Enck
- Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI, USA (RWM, ATE, JDB, AJH)
- Michigan State University College of Human Medicine, Grand Rapids, Grand Rapids, MI, USA (RDE)
- Department of Psychology, Calvin College, Grand Rapids, MI, USA (DJT)
| | - Donald J. Tellinghuisen
- Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI, USA (RWM, ATE, JDB, AJH)
- Michigan State University College of Human Medicine, Grand Rapids, Grand Rapids, MI, USA (RDE)
- Department of Psychology, Calvin College, Grand Rapids, MI, USA (DJT)
| | - Aaron T. Eggebeen
- Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI, USA (RWM, ATE, JDB, AJH)
- Michigan State University College of Human Medicine, Grand Rapids, Grand Rapids, MI, USA (RDE)
- Department of Psychology, Calvin College, Grand Rapids, MI, USA (DJT)
| | - James D. Birmingham
- Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI, USA (RWM, ATE, JDB, AJH)
- Michigan State University College of Human Medicine, Grand Rapids, Grand Rapids, MI, USA (RDE)
- Department of Psychology, Calvin College, Grand Rapids, MI, USA (DJT)
| | - Andrew J. Head
- Department of Medicine, Rheumatology, Michigan State University, College of Human Medicine Grand Rapids, Grand Rapids, MI, USA (RWM, ATE, JDB, AJH)
- Michigan State University College of Human Medicine, Grand Rapids, Grand Rapids, MI, USA (RDE)
- Department of Psychology, Calvin College, Grand Rapids, MI, USA (DJT)
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Garner S, Lopatina E, Rankin JA, Marshall DA. Nurse-led Care for Patients with Rheumatoid Arthritis: A Systematic Review of the Effect on Quality of Care. J Rheumatol 2017; 44:757-765. [DOI: 10.3899/jrheum.160535] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
Objective.In the nurse-led care (NLC) model, nurses take on the primary responsibility for patient management. We systematically assessed the effect of NLC for patients with rheumatoid arthritis (RA) on multiple dimensions of quality of care from the Alberta Quality of Care Matrix for Health.Methods.We searched MEDLINE, EMBASE, and CINAHL from 1950 to January 2015. English-language studies were included if they reported on NLC for patients with RA and assessed 1 or more dimensions of quality (effectiveness, acceptability, efficiency, accessibility, appropriateness, and safety). Data were synthesized using narrative analysis.Results.We included 10 studies. The NLC models varied in terms of nurses’ professional designation (clinical nurse specialists or nurse practitioners); however, their role in the clinic was fairly consistent. Disease activity was the most common measure of effectiveness, with NLC being equal (n = 2) or superior (n = 3) to the comparator. NLC was equal (n = 1) or superior (n = 5) versus the comparator in terms of patient satisfaction (i.e., acceptability of care). NLC was equally safe as other models (n = 2). Regarding efficiency, results varied across studies (n = 6) and did not allow for conclusions about models’ cost-effectiveness. In qualitative studies, patients found NLC to be superior in terms of accessibility [i.e., continuity of care (n = 3) and appropriateness measured with education and support (n = 4)]; however, no quantitative measures were found.Conclusion.NLC for patients with RA is effective, acceptable, and safe as compared with other models. However, current evidence is insufficient to draw conclusions about its efficiency, accessibility, and appropriateness.
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Hammond A, Lincoln N. The Joint Protection Knowledge Assessment (JPKA): Reliability and Validity. Br J Occup Ther 2016. [DOI: 10.1177/030802269906200307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to design and test a multiple-choice questionnaire to assess the joint protection knowledge of people with rheumatoid arthritis. The questionnaire content was generated from a literature review and face validity was established. The correct answers for the items included in the Joint Protection Knowledge Questionnaire (JPKA) were identified in an inter-rater agreement study with 31 rheumatology occupational therapists. All the questions achieved significant agreement using Kendall's coefficient of concordance (p<0.01 for all items). The content validity was partially established using a panel of 18 rheumatology occupational therapists. A test-retest reliability study with 20 people with rheumatoid arthritis showed no significant difference on two tests at 2 month intervals (median JPKA score test 1 = 78.75%; test 2 = 85%: z = 1.39; p = 0.16). The JPKA is a reliable and valid assessment which can be used to evaluate the effectiveness of joint protection education programmes.
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Hammond A, Jeffreson P, Jones N, Gallagher J, Jones T. Clinical Applicability of an Educational-Behavioural Joint Protection Programme for People with Rheumatoid Arthritis. Br J Occup Ther 2016. [DOI: 10.1177/030802260206500903] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Joint protection is a major part of rheumatology occupational therapy. Recent research emphasises that an educational-behavioural approach is more effective than current practice in enabling people with rheumatoid arthritis (RA) to increase their use of joint protection and benefit from reduced pain and inflammation and improved function. The aim of this study was to evaluate whether occupational therapists, following a 2-day training course in delivering an educational-behavioural joint protection programme, could enable people with RA to improve use of joint protection significantly and obtain similar results to previous clinical trials. This tested whether it would be feasible to introduce the programme into clinical practice. Three occupational therapists attended a ‘Looking After Your Joints’ training course for leaders. A single-blind crossover trial was conducted. Three centres participated, with each therapist delivering two or three joint protection programmes. Thirty participants with RA attended: 27 women and 3 men, with a mean age of 52.3 years (SD 12.08) and a mean disease duration of 6.76 years (SD 7.02). The primary outcome measure was an observational assessment of use of joint protection, the Joint Protection Behaviour Assessment (JPBA; Hammond and Lincoln 1999b). The median baseline JPBA score for all 30 participants was 15.39% (IQR 11.45–26.82%), which rose significantly to 35% (IQR 25–42.40%) (Z = −3.97; p = 0.0001) at 6 months following the programme. Both participants and therapists expressed positive views of the efficacy of this training approach. Sixteen participants increased use of joint protection by 20% or more. The findings highlight that the 2-day training course facilitated therapists in delivering the programme effectively and they could gain similar behavioural improvements to previous clinical trials.
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Orlandi A, Brumini C, Jones A, Natour J. Translation to Brazilian Portuguese, cultural adaptation and reproducibility of the questionnaire "Ankylosing Spondylitis: What do you know?". SAO PAULO MED J 2016; 134:0. [PMID: 27680218 PMCID: PMC10871845 DOI: 10.1590/1516-3180.2016.0084310516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 04/07/2016] [Accepted: 05/31/2016] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE: Ankylosing spondylitis (AS) generates inflammation and pain in entheses, peripheral joints and the spine. Education regarding AS can improve patients' disability. Thus, it is important to assess patients' knowledge. There is no instrument in the literature for assessing knowledge of AS in Portuguese. The aim here was to translate to the Brazilian Portuguese language, culturally adapt and test the reliability of the questionnaire "Ankylosing Spondylitis: What do you know?" and to correlate the findings with other factors. DESIGN AND SETTING: Original article regarding validation of questionnaire, produced at the Federal University of Sao Paulo (Unifesp). METHODS: For translation and cultural adaptation, Guilleman methodology was used. After the first phase, the reliability was tested on 30 patients. Correlations between these scores and other factors were examined. RESULTS: In the interobserver assessment, the Pearson correlation coefficient and Cronbach's alpha were 0.831 and 0.895, respectively. In the intraobserver evaluation, the intraclass correlation coefficient and Cronbach's alpha were 0.79 and 0.883, respectively. At this stage, the score for area of knowledge A showed correlations with ethnicity and education; the score for area D, with age; the total score and scores for areas A and B with "social aspects" of SF-36; and the score for area D with "pain", "vitality" and "emotional aspects" of SF-36. CONCLUSION: The Brazilian version of the questionnaire "Ankylosing Spondylitis: What do you know?" was created. It is reproducible and correlates with education level, ethnicity and the SF-36 domains "social aspects" and "emotional aspects".
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Affiliation(s)
- Aline Orlandi
- PT. Postgraduate Student, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
| | - Christine Brumini
- PT, MSc. Postgraduate Student, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
| | - Anamaria Jones
- PT, PhD. Affiliate Professor, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
| | - Jamil Natour
- MD, PhD. Associate Professor, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
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Watts RA, Mooney J, Barton G, MacGregor AJ, Shepstone L, Irvine L, Scott DGI. The outcome and cost-effectiveness of nurse-led care in the community for people with rheumatoid arthritis: a non-randomised pragmatic study. BMJ Open 2015; 5:e007696. [PMID: 26307614 PMCID: PMC4550717 DOI: 10.1136/bmjopen-2015-007696] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the outcome and cost-effectiveness of nurse-led care in the community for people with rheumatoid arthritis (RA). DESIGN Non-randomised pragmatic study. SETTING Primary (7 primary care practices) and secondary care (single centre) in the UK. METHODS In a single area, pragmatic non-randomised study, we assessed the outcome, cost-effectiveness of community-based nurse-led care (NLC) compared with rheumatologist-led outpatient care (RLC). Participants were 349 adults (70% female) with stable RA assessed at baseline, 6 and 12 months. In the community NLC arm there were 192 participants. Outcome was assessed using Stanford Health Assessment Questionnaire (HAQ). The economic evaluation (healthcare perspective) estimated cost relative to change in HAQ and quality-adjusted life years (QALY) derived from EQ-5D-3L. We report complete case and multiple imputation results from regression analyses. RESULTS The demographics and baseline characteristics of patients in the community group were comparable to those under hospital care apart from use of biological disease-modifying antirheumatic drugs (DMARDS), which were adjusted for in the analysis. The mean incremental cost was estimated to be £224 less for RLC compared to the community NLC, with wide CIs (CI -£213 to £701, p=0.296). Levels of functional disability were not clinically significantly higher in the community NLC group: HAQ 0.096 (95% CI -0.026 to 0.206; p=0.169) and QALY 0.023 (95% CI -0.059 to 0.012; p=0.194). CONCLUSIONS The results suggest that community care may be associated with non-significant higher costs with no significant differences in clinical outcomes, and this suggests a low probability that it is cost-effective.
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Affiliation(s)
- Richard A Watts
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Janice Mooney
- School of Nursing Sciences University of East Anglia, Norwich, UK
| | - Garry Barton
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Lee Shepstone
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Lisa Irvine
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - David G I Scott
- Norwich Medical School, University of East Anglia, Norwich, UK
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Allam A, Kostova Z, Nakamoto K, Schulz PJ. The effect of social support features and gamification on a Web-based intervention for rheumatoid arthritis patients: randomized controlled trial. J Med Internet Res 2015; 17:e14. [PMID: 25574939 PMCID: PMC4296094 DOI: 10.2196/jmir.3510] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 10/16/2014] [Accepted: 11/08/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is chronic systematic disease that affects people during the most productive period of their lives. Web-based health interventions have been effective in many studies; however, there is little evidence and few studies showing the effectiveness of online social support and especially gamification on patients' behavioral and health outcomes. OBJECTIVE The aim of this study was to look into the effects of a Web-based intervention that included online social support features and gamification on physical activity, health care utilization, medication overuse, empowerment, and RA knowledge of RA patients. The effect of gamification on website use was also investigated. METHODS We conducted a 5-arm parallel randomized controlled trial for RA patients in Ticino (Italian-speaking part of Switzerland). A total of 157 patients were recruited through brochures left with physicians and were randomly allocated to 1 of 4 experimental conditions with different types of access to online social support and gamification features and a control group that had no access to the website. Data were collected at 3 time points through questionnaires at baseline, posttest 2 months later, and at follow-up after another 2 months. Primary outcomes were physical activity, health care utilization, and medication overuse; secondary outcomes included empowerment and RA knowledge. All outcomes were self-reported. Intention-to-treat analysis was followed and multilevel linear mixed models were used to study the change of outcomes over time. RESULTS The best-fit multilevel models (growth curve models) that described the change in the primary outcomes over the course of the intervention included time and empowerment as time-variant predictors. The growth curve analyses of experimental conditions were compared to the control group. Physical activity increased over time for patients having access to social support sections plus gaming (unstandardized beta coefficient [B]=3.39, P=.02). Health care utilization showed a significant decrease for patients accessing social support features (B=-0.41, P=.01) and patients accessing both social support features and gaming (B=-0.33, P=.03). Patients who had access to either social support sections or the gaming experience of the website gained more empowerment (B=2.59, P=.03; B=2.29, P=.05; respectively). Patients who were offered a gamified experience used the website more often than the ones without gaming (t91=-2.41, P=.02; U=812, P=.02). CONCLUSIONS The Web-based intervention had a positive impact (more desirable outcomes) on intervention groups compared to the control group. Social support sections on the website decreased health care utilization and medication overuse and increased empowerment. Gamification alone or with social support increased physical activity and empowerment and decreased health care utilization. This study provides evidence demonstrating the potential positive effect of gamification and online social support on health and behavioral outcomes. TRIAL REGISTRATION International Standard Randomized Controlled Trial Number (ISRCTN): 57366516; http://www.controlled-trials. com/ISRCTN57366516 (Archived by webcite at http://www.webcitation.org/6PBvvAvvV).
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Affiliation(s)
- Ahmed Allam
- Institute of Communication and Health, Faculty of Communication Sciences, University of Lugano (Università della Svizzera italiana), Lugano, Switzerland.
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Mooney J, Spalding N, Poland F, Grayson P, Leduc R, McAlear CA, Richesson RL, Shereff D, Merkel PA, Watts RA. The informational needs of patients with ANCA-associated vasculitis-development of an informational needs questionnaire. Rheumatology (Oxford) 2014; 53:1414-21. [PMID: 24625507 DOI: 10.1093/rheumatology/keu026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the study was to compare the informational needs of patients with ANCA-associated vasculitis (AAV). METHODS We developed a Vasculitis Informational Needs Questionnaire that was distributed to members of Vasculitis UK (VUK) by mail and registrants of the Vasculitis Clinical Research Consortium (VCRC) online registry with self-reported AAV. Patients were asked to use a 5-point scale (1 = not important, 5 = extremely important) to rank aspects of information in the following domains: disease, investigations, medication, disease management and psychosocial care. The source and preferred method of educational delivery were recorded. RESULTS There were 314 VUK and 273 VCRC respondents. Respondents rated information on diagnosis, prognosis, investigations, treatment and side effects as extremely important. Information on patient support groups and psychosocial care was less important. There was no difference in the ratings of needs based on group, sex, age, disease duration, disease or method of questionnaire delivery. The most-preferred methods of providing information for both groups were by a doctor (with or without written material) or web based; educational courses and compact disc/digital video disc (CD/DVD) were the least-preferred methods. CONCLUSION This study demonstrates that people with AAV seek specific information concerning their disease, treatment regimes and side effects and the results of investigations. Individuals preferred to receive this information from a doctor. Patients with AAV should be treated in a similar manner to patients with other chronic illnesses in which patient education is a fundamental part of care.
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Affiliation(s)
- Janice Mooney
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK.
| | - Nicola Spalding
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fiona Poland
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter Grayson
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Renee Leduc
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Carol A McAlear
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rachel L Richesson
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Denise Shereff
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Peter A Merkel
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard A Watts
- School of Nursing Sciences, School of Allied Health Professionals, University of East Anglia, Norwich, UK, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, Pediatrics Epidemiology Center, University of South Florida, Tampa, FL, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA, Duke University School of Nursing, Duke University, Durham, NC, USA and Norwich Medical School, University of East Anglia, Norwich, UK
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Kesänen J, Leino-Kilpi H, Arifulla D, Siekkinen M, Valkeapää K. Knowledge tests in patient education: a systematic review. Nurs Health Sci 2013; 16:262-73. [PMID: 24256595 DOI: 10.1111/nhs.12097] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 09/03/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Abstract
This study describes knowledge tests in patient education through a systematic review of the Medline, Cinahl, PsycINFO, and ERIC databases with the guidance of the PRISMA Statement. Forty-nine knowledge tests were identified. The contents were health-problem related, focusing on biophysiological and functional knowledge. The mean number of items was 20, with true-false or multiple-choice scales. Most of the tests were purposely designed for the studies included in the review. The most frequently reported quality assessments of knowledge tests were content validity and internal consistency. The outcome measurements for patient-education needs were comprehensive, validating knowledge tests that cover multidimensional aspects of knowledge. Besides the measurement of the outcomes of patient education, knowledge tests could be used for several purposes in patient education: to guide the content of education as checklists, to monitor the learning process, and as educational tools. There is a need for more efficient content and health problem-specific knowledge-test assessments.
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Affiliation(s)
- Jukka Kesänen
- Department of Nursing Science, University of Turku, Turku, Finland; Hospital Orton, Helsinki, Finland
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Deng W, Hu J. The effects of a pilot intervention for community-dwelling adults with rheumatoid arthritis in wuhan, china. Front Public Health 2013; 1:43. [PMID: 24350212 PMCID: PMC3860135 DOI: 10.3389/fpubh.2013.00043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022] Open
Abstract
This study examined the effects of a pilot educational intervention program on knowledge, perceived self-efficacy, and health-related quality of life (HRQoL) of community-dwelling adults with rheumatoid arthritis (RA). A convenience sample of 16 participants with RA completed the program in Wuhan, China. Data were collected in face-to-face interviews using questionnaires at baseline, post-test, and 1 month follow-up. Knowledge scores were significantly increased over time. Significant differences were found in pain self-efficacy, symptoms self-efficacy, bodily pain, social functioning, and role emotional functions. Community health providers should provide educational programs to improve HRQoL for adults with RA.
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Affiliation(s)
- Wenfang Deng
- Hope School of Nursing, Wuhan University , Wuhan , China
| | - Jie Hu
- School of Nursing, The University of North Carolina at Greensboro , Greensboro, NC , USA
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Keegan D, McDermott E, Byrne K, Moloney D, Doherty GA, Mulcahy HE. Development, validation and clinical assessment of a short questionnaire to assess disease-related knowledge in inflammatory bowel disease patients. Scand J Gastroenterol 2013. [PMID: 23181503 DOI: 10.3109/00365521.2012.744090] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Only two inflammatory bowel disease (IBD) knowledge scales are available, both primarily aimed at evaluating the effectiveness of clinical education programs. The aim of this study was to develop and validate a short knowledge questionnaire for clinical and academic research purposes. MATERIAL AND METHODS Following initial development, the questionnaire was tested on junior doctors, nurses and administrative staff to assess validity. The questionnaire was then assessed and compared with a previous questionnaire in 31 IBD patients. Three hundred and three further patients completed the questionnaire to establish reliability and determine factors independently associated with disease-related knowledge. RESULTS Doctors answered more questions correctly than nurses who scored better than administrative staff (p < 0.001). There was a fair correlation in scores between the short knowledge questionnaire and a previously validated long survey (r = 0.488; p = 0.005). The short knowledge questionnaire was quicker to complete (p < 0.001), was rated as less difficult to understand (p = 0.004) and induce less anxiety (p = 0.004). Both questionnaires were rated similarly with regard to relevance (p = 0.71). Internal consistency was demonstrated with a Cronbach's alpha of 0.73. In clinical testing on 301 patients, the final multivariate model identified young age, Crohn's disease, higher educational status and the presence of a first-degree family member with IBD as being independently and significantly associated with disease-related knowledge. CONCLUSIONS The short knowledge questionnaire is a simple, valid, reliable and easy to understand research instrument for rapidly assessing knowledge in IBD patients.
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Affiliation(s)
- Denise Keegan
- Department of Gastroenterology, Centre for Colorectal Disease, St Vincent's University Hospital/University College Dublin, Elm Park, Dublin, Ireland
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Meesters J, de Boer I, van den Berg M, Fiocco M, Vliet Vlieland T. Unmet information needs about the delivery of rheumatology health care services: a survey among patients with rheumatoid arthritis. PATIENT EDUCATION AND COUNSELING 2011; 85:299-303. [PMID: 21051173 DOI: 10.1016/j.pec.2010.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 08/27/2010] [Accepted: 10/03/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To measure patient-perceived knowledge and information need regarding regional health care services and their determinants among 400 patients with rheumatoid arthritis (RA) and to identify the preferred method of information provision. METHODS Postal survey on knowledge and information need (content and accessibility) of 18 regional health care services and preferences for the mode of delivery of information. Logistic regression analyses determined which factors were associated with insufficient knowledge and information need. RESULTS Two-hundred and thirty-seven (94%) patients reported insufficient knowledge about the contents and 235 (94%) about the accessibility of at least one health care services, whereas 172 patients (69%) reported an information need about the content and 154 (61%) on the accessibility. Age was significantly associated with knowledge whereas both age and physical functioning were significantly associated with information need. Seventy-nine percent of the patients mentioned written information, 21% the Internet and 12% personal contact with a professional as a preferred method of information delivery. CONCLUSION Many RA patients reported a lack of knowledge or information need concerning the contents and accessibility of regional health care services. PRACTICE IMPLICATIONS Active strategies to provide practical information about health care services are needed for RA patients.
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Affiliation(s)
- Jorit Meesters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
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Ndosi M, Vinall K, Hale C, Bird H, Hill J. The effectiveness of nurse-led care in people with rheumatoid arthritis: a systematic review. Int J Nurs Stud 2011; 48:642-54. [PMID: 21392764 DOI: 10.1016/j.ijnurstu.2011.02.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2010] [Revised: 01/18/2011] [Accepted: 02/06/2011] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this systematic review was to determine the effectiveness of nurse-led care in rheumatoid arthritis. DESIGN Systematic review of effectiveness. DATA SOURCES Electronic databases (AMED, CENTRAL, CINAHL, EMBASE, HMIC, HTA, MEDLINE, NHEED, Ovid Nursing and PsycINFO) were searched from 1988 to January 2010 with no language restrictions. Inclusion criteria were: randomised controlled trials, nurse-led care being part of the intervention and including patients with RA. REVIEW METHODS Data were extracted by one reviewer and checked by a second reviewer. Quality assessment was conducted independently by two reviewers using the Cochrane Collaboration's Risk of Bias Tool. For each outcome measure, the effect size was assessed using risk ratio or ratio of means (RoM) with corresponding 95% confidence intervals (CI) as appropriate. Where possible, data from similar outcomes were pooled in a meta-analysis. RESULTS Seven records representing 4 RCTs with an overall low risk of bias (good quality) were included in the review. They included 431 patients and the interventions (nurse-led care vs usual care) lasted for 1-2years. Most effect sizes of disease activity measures were inconclusive (DAS28 RoM=0.96, 95%CI [0.90-1.02], P=0.16; plasma viscosity RoM=1 95%CI [0.8-1.26], p=0.99) except the Ritchie Articular Index (RoM=0.89, 95%CI [0.84-0.95], P<0.001) which favoured nurse-led care. Results from some secondary outcomes (functional status, stiffness and coping with arthritis) were also inconclusive. Other outcomes (satisfaction and pain) displayed mixed results when assessed using different tools making them also inconclusive. Significant effects of nurse-led care were seen in quality of life (RAQoL RoM=0.83, 95%CI [0.75-0.92], P<0.001), patient knowledge (PKQ RoM=4.39, 95%CI [3.35-5.72], P<0.001) and fatigue (median difference=-330, P=0.02). CONCLUSIONS The estimates of the primary outcome and most secondary outcomes showed no significant difference between nurse-led care and the usual care. While few outcomes favoured nurse-led care, there is insufficient evidence to conclude whether this is the case. More good quality RCTs of nurse-led care effectiveness in rheumatoid arthritis are required.
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Affiliation(s)
- Mwidimi Ndosi
- Academic and Clinical Unit for Musculoskeletal Nursing, Leeds Institute of Molecular Medicine, University of Leeds, Leeds, UK.
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Development and validation of Fibromyalgia Knowledge Questionnaire: FKQ. Rheumatol Int 2010; 32:655-62. [PMID: 21132552 DOI: 10.1007/s00296-010-1627-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 11/13/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED The objective of this study is to develop and validate a questionnaire for evaluating patients' specific knowledge regarding fibromyalgia. The development of items and questions of the questionnaire was done using four focus group that included physicians, physical therapists, a nurse, and patients with fibromyalgia. Other 30 consecutive patients were recruited to evaluate the questionnaire's reproducibility (intra- and inter-observer). In order to construct validity, the questionnaire was applied to healthcare professionals with knowledge on fibromyalgia and 20 other patients. To investigate sensitivity to change, the questionnaire was applied to 56 patients before and after an educational program (intervention group) or a waiting list (control group). Eighteen questions fulfilled the inclusion criteria and were understandable for more than 90% of the participants. The intraclass correlation coefficients for inter-observer and intra-observer reproducibility ranged from 0.65 to 0.90 and from 0.86 to 0.96, respectively (P < 0.01). For construct validation, healthcare professionals obtained significant higher scores than the patients (P < 0.01). On the sensitivity to change evaluation, the intervention group obtained higher scores than the control group after the educational program (P < 0.01). CONCLUSION The Fibromyalgia Knowledge Questionnaire was developed and it is reliable, valid, and sensitive to changes, for evaluating disease-specific knowledge in patients with fibromyalgia.
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Severo M, Gaio R, Lucas R, Barros H. Assessment of the general public's knowledge about rheumatic diseases: evidence from a Portuguese population-based survey. BMC Musculoskelet Disord 2010; 11:211. [PMID: 20846429 PMCID: PMC2950394 DOI: 10.1186/1471-2474-11-211] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 09/16/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To identify incorrect beliefs and common knowledge about rheumatic diseases in the general population. METHODS Participants were selected during the follow-up of a representative cohort of adult population of Porto, Portugal; 1626 participants completed a questionnaire that included general knowledge items about rheumatic diseases.Discrete and continuous latent variable models were used to identify knowledge flaws and the target groups. Odds ratios (OR) estimated by multinomial logistic regression, and 95% confidence intervals (95%CI) were computed to evaluate magnitude of associations. RESULTS A continuous latent variable model identified two dimensions: one related to general beliefs (latent 1) and another concerning characteristics, treatment and impact of rheumatic diseases (latent 2). A 3-class latent variable model refined these results: the first class presented the lowest probabilities of correct answer for items associated with the first latent (mean of 39%), and the second class presented the lowest probabilities of correct answer for items with the second latent (mean of 62%). The third class showed the highest probability of a correct answer for almost all the items (mean of 79%). The age and sex standardized prevalence of the classes was 25.7%, 30.8% and 43.5%.Taking class 2 as reference, class 1 was positively associated with the presence of rheumatic diseases (OR = 2.79; CI95% = (2.10-3.70)), with females (OR = 1.28 CI95% = (0.99-1.67)) and older individuals (OR = 1.04; CI95% = (1.03-1.05)), and was negatively associated with education (OR = 0.84; CI95% = (0.81-0.86)); class 3 was positively associated with education (OR = 1.03; CI95% = (1.00-1.05)) and the presence of rheumatic diseases (OR = 1.29; CI95% = (0.97-1.70)). CONCLUSIONS There are several knowledge flaws about rheumatic diseases in the general public. One out of four participants considered false general beliefs as true and approximately 30% did not have detailed knowledge on rheumatic disease. Higher education and the presence of disease contributed positively to the overall knowledge. These results suggest some degree of effectiveness of patient education, either conducted by health professionals or self-driven.
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Affiliation(s)
- Milton Severo
- Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal.
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Abourazzak F, El Mansouri L, Huchet D, Lozac’hmeur R, Hajjaj-Hassouni N, Ingels A, Chalès G, Perdriger A. Long-term effects of therapeutic education for patients with rheumatoid arthritis. Joint Bone Spine 2009; 76:648-53. [DOI: 10.1016/j.jbspin.2009.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2009] [Indexed: 10/20/2022]
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John H, Treharne GJ, Hale ED, Panoulas VF, Carroll D, Kitas GD. Development and initial validation of a heart disease knowledge questionnaire for people with rheumatoid arthritis. PATIENT EDUCATION AND COUNSELING 2009; 77:136-143. [PMID: 19395226 DOI: 10.1016/j.pec.2009.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 02/19/2009] [Accepted: 03/16/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To develop and validate two parallel versions of the Heart Disease Fact Questionnaire-Rheumatoid Arthritis (HDFQ-RA), a modified and RA-specific version of the HDFQ. METHODS The questionnaire was composed of generic questions from the original HDFQ with additional RA-specific questions added. Cognitive interviewing was performed and the questionnaire piloted to generate two parallel questionnaires. For psychometric validation, 130 patients with RA completed the questionnaires at baseline and 2 weeks later. RESULTS Parallel form reliability of both questionnaires was established; the median score for both questionnaires was 9/13 with no statistical difference in scores. Kuder-Richardson-20 formula was 0.65 and 0.67 for both questionnaires. Test-retest stability showed constant median scores of 9/13 and no statistical difference in scores between baseline and follow-up. Known groups comparison revealed that patients who had self-educated themselves about heart disease, or who were taking CVD medications, had significantly higher scores on the questionnaires. CONCLUSION The two parallel forms of the HDFQ-RA have been shown to be equivalent measures of CVD knowledge and evidence supporting their reliability and validity is presented. PRACTICE IMPLICATIONS The HDFQ-RA is an appropriate tool for application in clinical and research settings, e.g., assessing novel educational interventions or tracking participants' progress on an education course.
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Affiliation(s)
- Holly John
- Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK.
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Mäkeläinen P, Vehviläinen-Julkunen K, Pietilä AM. Change in knowledge and self-efficacy of patients with rheumatoid arthritis: A six-month follow-up study. Int J Nurs Pract 2009. [DOI: 10.1111/j.1440-172x.2009.01792.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Meesters JJL, Vliet Vlieland TPM, Hill J, Ndosi ME. Measuring educational needs among patients with rheumatoid arthritis using the Dutch version of the Educational Needs Assessment Tool (DENAT). Clin Rheumatol 2009; 28:1073-7. [PMID: 19449083 PMCID: PMC2721136 DOI: 10.1007/s10067-009-1190-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/17/2009] [Accepted: 04/24/2009] [Indexed: 11/04/2022]
Abstract
The Educational Needs Assessment Tool (ENAT) was developed in the United Kingdom (UK) to systematically assess the educational needs of patients with arthritis. The aim of the present study was to describe the educational needs of Dutch patients with rheumatoid arthritis (RA) by using the Dutch version of the ENAT (DENAT). The original UK version of the ENAT, comprising 39 items grouped into seven domains, was translated into Dutch according to international guidelines for cross-cultural translation and adaptation. The DENAT was then sent to a random sample of 319 RA patients registered at the outpatient clinic of a university hospital. For each domain (score range 1–5, equalling low–high educational needs), a median score with the inter-quartile range was computed. The Kruskal–Wallis test was used to determine possible associations between educational needs and age, disease duration, gender and educational background. The response rate was 165 out of 319 (52%). The median educational needs scores were 2.5 for “managing pain”, 3.0 for “movement”, 2.0 for “feelings”, 4.0 for “arthritis process”, 4.0 for “treatments from health professionals”, 3.5 for “self-help measures” and 2.5 for “support systems”. Lower age and shorter disease duration were associated with more educational needs in the domain “support systems”. In addition, younger patients had more educational needs regarding managing pain and feelings than older patients. There were no associations between gender or educational background and educational needs. The DENAT has demonstrated its ability to identify individual educational needs of Dutch patients with RA. The lower age and shorter disease duration were associated with more educational needs. The practical applicability of the DENAT needs further research.
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Affiliation(s)
- Jorit J L Meesters
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
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Mäkeläinen P, Vehviläinen-Julkunen K, Pietilä AM. Rheumatoid arthritis patients' knowledge of the disease and its treatments: a descriptive study. Musculoskeletal Care 2009; 7:31-44. [PMID: 18697184 DOI: 10.1002/msc.138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The purpose of rheumatoid arthritis (RA) patient education is to increase patients' knowledge levels. However, there are only a limited number of studies available concerning these patients' knowledge of their disease and its various treatments. The purpose of this study was to describe RA patients' understanding of their disease and its treatments. METHODS A total of 252 RA patients participated in this survey in August 2004 (response rate 53.2%). The knowledge levels of the patients and their physical functioning were measured using self-reported questionnaires. The data were analysed using descriptive and non-parametric statistical methods. RESULTS RA patients' knowledge of the disease and its treatments was, on average, good. However, the total scores of the Patient Knowledge Questionnaire ranged from 2 to 29 (maximum score 30). The patients knew well the aetiology and symptoms of RA, the blood tests and the physical exercise; they knew moderately well the facts relating to joint protection, energy conservation and how to use anti-rheumatic drugs and non-steroidal anti-inflammatory drugs. Young patients, women and patients with a long disease duration knew the most. There was a weak correlation between patient knowledge and physical functioning: the weaker the patient's functioning, the higher the knowledge level. CONCLUSIONS RA patients' knowledge of their disease and its treatments varied from poor to good in this group. These results can be used for advancing RA patient education. However, more research is needed to evaluate RA patients' knowledge levels.
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Affiliation(s)
- P Mäkeläinen
- Department of Nursing Science, University of Kuopio, Finland.
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Maciel SC, Jennings F, Jones A, Natour J. The development and validation of a Low Back Pain Knowledge Questionnaire - LKQ. Clinics (Sao Paulo) 2009; 64:1167-75. [PMID: 20037704 PMCID: PMC2797585 DOI: 10.1590/s1807-59322009001200006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 09/08/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The objective of this study was to develop and validate a questionnaire on specific knowledge about low back pain entitled "The Low Back Pain Knowledge Questionnaire". INTRODUCTION There is a need for instruments to assess patient knowledge regarding chronic illness. Such methods can contribute to the education of patients. METHODS The Low Back Pain Knowledge Questionnaire was developed through five focus groups. The questionnaire was distributed to 50 patients to assess their comprehension of the terms. To assess the reproducibility, 20 patients were surveyed by two different interviewers on the same day and twice by a single interviewer with a one-to-two week interval. For the construct validation, the Low Back Pain Knowledge Questionnaire was given to 20 healthcare professionals with knowledge on low back pain and 20 patients to determine whether the questionnaire would discriminate between the two different populations. To assess the sensitivity of the questionnaire to changes in the knowledge level of the patients, it was given to 60 patients who were randomly assigned to the Intervention Group and the Control Group. The Intervention Group answered the questionnaire both before and after attending a chronic back pain educational program (back school), whereas the Control Group answered the questionnaire twice with an interval of one month and no educational intervention. RESULTS The focus groups generated a questionnaire with 16 items. The Spearman's correlation coefficient and the intra-class correlation coefficients ranged from 0.61 to 0.95 in the assessments of the intra-observer and inter-observer reproducibility (p< 0.01). In the construct validation, the healthcare professionals and patients showed statistically different scores (p< 0.001). In the phase regarding the sensitivity to change, the Intervention Group exhibited a significant increase in their specific knowledge over the Control Group (p< 0.001). CONCLUSION The Low Back Pain Knowledge Questionnaire was validated and proved to be reproducible, valid and sensitive to changes in patient knowledge.
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Affiliation(s)
| | - Fabio Jennings
- Division of Rheumatology, Federal University of São Paulo - São Paulo Paulo/SP, Brazil
| | - Anamaria Jones
- Division of Rheumatology, Federal University of São Paulo - São Paulo Paulo/SP, Brazil
| | - Jamil Natour
- Division of Rheumatology, Federal University of São Paulo - São Paulo Paulo/SP, Brazil
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Mäkeläinen P, Vehviläinen-Julkunen K, Pietilä AM. Rheumatoid arthritis patients' education - contents and methods. J Clin Nurs 2008; 16:258-67. [PMID: 17931319 DOI: 10.1111/j.1365-2702.2007.01953.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study is to describe the contents and methods used by rheumatology nurses when they educate their patients with rheumatoid arthritis. BACKGROUND Rheumatology nurses have an important role in educating patients with rheumatoid arthritis. However, there is a lack of knowledge on the content provided and the methods used by rheumatology nurses. DESIGN AND METHODS The sample was drawn in using stratified random sampling and the data were collected from 80 rheumatology nurses with a questionnaire in 2003-2004 (response rate was 65.2%). The data were analysed using descriptive and non-parametric statistical tests. RESULTS Medical treatment was the most commonly taught issue, as 76% of rheumatology nurses gave information on anti-rheumatic drugs prescribed to the rheumatoid arthritis patients and blood tests (64%) which must be taken as follow-up controls. Only 45% of the nurses discussed self care at home. Individual oral patient education (88%) and written materials by the local hospitals or drug industries (71%), were the most commonly used methods. Patients with rheumatoid arthritis were educated mostly in special health care units. A rheumatology nursing course did not have an effect on the chosen contents or methods when educating rheumatoid arthritis patients. CONCLUSIONS It is important that rheumatology nurses teach more self-care abilities to patients with rheumatoid arthritis and use also the other teaching methods than oral individual method such as group sessions, teleinformatics and internet. The contents of rheumatology nursing course should be developed further to stress the importance of appropriate teaching methods and to point out the importance of self care abilities for patients. RELEVANCE TO CLINICAL PRACTICE The results provided useful insight into education of patients with rheumatoid arthritis. Nurses should avoid the routine teaching programmes. They should take time to discuss with their patients and plan together the contents and methods, that education of patients with rheumatoid arthritis is based on patients' information needs and their individual learning capabilities.
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Witney AG, Treharne GJ, Tavakoli M, Lyons AC, Vincent K, Scott DL, Kitas GD. The relationship of medical, demographic and psychosocial factors to direct and indirect health utility instruments in rheumatoid arthritis. Rheumatology (Oxford) 2006; 45:975-81. [PMID: 16461437 DOI: 10.1093/rheumatology/kel027] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cost-effectiveness analysis (CEA) is essential for the comparison of treatments for rheumatoid arthritis (RA). CEA centres on accurate measurement of health utility (HU) preferences. Direct measures of HU in RA patients demonstrate weaker correlations with health status (functional disability and pain) than indirect measures. We examined whether demographic and psychosocial factors relate to HU in RA patients. METHODS HU was measured for 142 RA patients (76% women; mean age 58.75 yr) directly through standard gamble (SG) and time trade-off (TTO), and indirectly on the EuroQol (EQ-5D). Current pain (100 mm visual analogue scale) and recent functional disability (Health Assessment Questionnaire; HAQ) were assessed. A subsample of 48 provided demographic and psychosocial information (education, employment, marital/family status, knowledge about RA, medication beliefs, desirable responding, social support, optimism, and the Hospital Anxiety and Depression Scale; HADS). RESULTS Direct HU had higher means (SG = 0.88, TTO = 0.86) than indirect HU (EQ-5D = 0.52). HAQ functional disability correlated with SG (r = - 0.28), TTO (r = - 0.31) and EQ-5D (r = - 0.67). Current pain correlated with TTO (r = - 0.19) and EQ-5D (r = - 0.36). HADS depression correlated with TTO (r = - 0.35) and EQ-5D (r = - 0.64); HADS anxiety also correlated with EQ-5D (r = - 0.46). CONCLUSIONS Demographic and psychosocial factors cannot completely explain either the significant differences between direct and indirect HUs in RA patients or the moderate correlations of direct HUs with health status. Characteristics of the SG and TTO may make them inappropriate for HU assessment and CEA among RA patients.
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Affiliation(s)
- A G Witney
- Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Dudley, UK
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Fautrel B, Pham T, Gossec L, Combe B, Flipo RM, Goupille P, Le Loët X, Mariette X, Puéchal X, Wendling D, Schaeverbeke T, Sibilia J, Sany J, Dougados M. Role and modalities of information and education in the management of patients with rheumatoid arthritis: development of recommendations for clinical practice based on published evidence and expert opinion. Joint Bone Spine 2005; 72:163-70. [PMID: 15797498 DOI: 10.1016/j.jbspin.2004.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Accepted: 09/12/2004] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To develop recommendations for the information and education of patients with rheumatoid arthritis (RA) seen in everyday practice, using evidence from the literature, supplemented with expert opinion when needed. METHODS A scientific committee developed eight questions using the Delphi consensus procedure. A task force reviewed the literature for answers to these questions, using the PubMed Medline database (1980-2004) and the 2002-2004 databases of the annual meetings held by the French Society for Rheumatology (SFR), the European League Against Rheumatism (EULAR), and the American College of Rheumatology (ACR); the indexing terms for the search were rheumatoid, arthritis, patient, education, information, knowledge, general practitioner, family doctor, and continuing medical education. Only articles in French or English were included. A panel of rheumatologists used the evidence thus compiled to develop recommendations for each question; gaps in evidence were filled by calling on the panelists' expert opinion. For each recommendation, the level of evidence and extent of agreement among panelists were specified. RESULTS There were four general questions about the objectives, supports, and mode of delivery (group or one-on-one) of patient information and education, as well as on evaluating knowledge, and four specific questions on program content. The search identified 1235 articles; 144 were selected on the title and 118 of those on the abstract. Three abstracts presented at meetings were also kept. The evidence from the literature was presented to the panelists during interactive workshops. The panelists then developed eight recommendations, all of which were grade D because no published studies specifically addressed everyday clinical practice. Agreement among panelists ranged across recommendations from 85.7% to 100%. CONCLUSION Recommendations about educating and informing patients with RA in everyday practice were developed. They should increase practice uniformity and ultimately optimize the management of patients with RA.
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Affiliation(s)
- Bruno Fautrel
- Service de rhumatologie, groupe hospitalier Pitié-Salpêtrière, Paris, France
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Neame R, Hammond A, Deighton C. Need for information and for involvement in decision making among patients with rheumatoid arthritis: A questionnaire survey. ACTA ACUST UNITED AC 2005; 53:249-55. [PMID: 15818715 DOI: 10.1002/art.21071] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To measure the need for information about rheumatoid arthritis (RA) and the level of desire for involvement in treatment decisions among patients with RA. To examine the relationship between these preferences and what factors (sociodemographic, disease, treatment, level of disability, and level of knowledge about RA) associate with these preferences. METHODS Questionnaire surveys were mailed to a randomly selected group of 600 patients with RA. Need for information and desire for involvement in decision making were measured using a validated tool (the Autonomy Preference Index). RESULTS The response rate was 57.3%. The need for information was very high. Information seeking preference scores (median 82.5, interquartile range 80.0-92.5) were significantly higher (P < 0.001) than decision making preference scores (mean +/- SD 56.4 +/- 13.6). Need for information and for decision making were both higher in women than men, and associations with these needs differed in men and women. However, younger age and greater knowledge of RA predicted greater need for decision making. There was no correlation between need for information and for involvement in treatment decisions for either sex (women: r(s) = 0.09, P = 0.19; men: r(s) = -0.06, P = 0.54). CONCLUSION There was a high level of need for information among patients with RA. Desire for involvement in treatment decision making was significantly lower and did not correlate with need for information. Associations with these needs differed for men and women.
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Affiliation(s)
- Rebecca Neame
- Department of Rheumatology, King's Mill Hospital, Nottinghamshire, United Kingdom.
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Treharne GJ, Hale ED, Lyons AC, Booth DA, Banks MJ, Erb N, Douglas KM, Mitton DL, Kitas GD. Cardiovascular disease and psychological morbidity among rheumatoid arthritis patients. Rheumatology (Oxford) 2004; 44:241-6. [PMID: 15522922 DOI: 10.1093/rheumatology/keh441] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine whether patients with rheumatoid arthritis (RA) with co-morbid cardiovascular disease (CVD) have different psychological morbidity (and psychosocial risk factors for it) compared with RA patients without co-morbid CVD. METHODS Patients with RA and co-morbid CVD (n = 44; hypertension alone for n = 27) were compared with RA patients without CVD (n = 110). Differences in psychological morbidity (depression and anxiety) and psychosocial risk factors for this (arthritis self-efficacy, acceptance, social support and optimism) were examined while controlling statistically for medical and demographic covariates. RESULTS Groups did not differ on RA duration, RA activity, marital status or socioeconomic status, but RA patients with co-morbid CVD were older, less likely to be female and less likely to be in employment than those without CVD. RA patients with co-morbid CVD had significantly higher depression and were more likely to score above cut-offs for depression than RA patients without CVD. No differences existed in anxiety, although anxiety appeared to be more common than depression. Low optimism was identified as a possible psychosocial risk factor for depression. CONCLUSIONS RA patients with co-morbid CVD have higher depression than RA patients without CVD; low optimism is a potentially modifiable risk factor that may mediate this difference. RA patients with co-morbid CVD may benefit from systematic screening for depression and targeted intervention if necessary.
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Affiliation(s)
- G J Treharne
- University of Birmingham, School of Psychology, UK.
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Claudepierre P, Flipo RM, Sibilia J, Berthelot JM, Goupille P, Cortinovis S, Cunin P, Chevalier X, Wendling D. Patient knowledge of their disease: a French multicenter study in ankylosing spondylitis. Joint Bone Spine 2004; 71:550-6. [PMID: 15589438 DOI: 10.1016/j.jbspin.2004.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess knowledge of ankylosing spondylitis (AS) by patients and to identify factors associated with knowledge. METHODS Ninety patients receiving follow-up in France for AS completed a disease knowledge auto-questionnaire yielding a correct answer score [CAS] and a correct item score [CIS]. Correlations between these scores and other factors were examined. RESULTS Mean CAS was 16.4/25 (SD = 4.8) and mean CIS 7.3 +/- 3.1/14. Female gender, higher educational level, having read about AS, being aware of AS support groups, and having received longer tertiary-care hospital management were associated with better knowledge. In the multivariate analysis, only three factors were independently associated with the level of knowledge in this population: "reading about AS", "level of general education", and "awareness of an AS support group". CONCLUSION Knowledge of AS by French patients was lower than previously reported in a British population. Although education should be offered to all AS patients, the need may be greater in those with limited formal schooling. Booklets on the disease and contact with patient groups seem to be useful tools for improving knowledge of the disease.
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