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Tele‐Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial
Author(s) -
Thurah Annette,
StengaardPedersen Kristian,
Axelsen Mette,
Fredberg Ulrich,
Schougaard Liv M. V.,
Hjollund Niels H. I.,
PfeifferJensen Mogens,
Laurberg Trine B.,
Tarp Ulrik,
Lomborg Kirsten,
Maribo Thomas
Publication year - 2018
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.23280
Subject(s) - medicine , rheumatoid arthritis , randomized controlled trial , physical therapy , rheumatology , confidence interval , outpatient clinic , quality of life (healthcare) , multivariate analysis , intention to treat analysis , nursing
Objective To test the effect of patient‐reported outcome ( PRO )–based tele‐health followup for tight control of disease activity in patients with rheumatoid arthritis ( RA ), and the differences between tele‐health followup performed by rheumatologists or rheumatology nurses. Methods A total of 294 patients were randomized (1:1:1) to either PRO ‐based tele‐health followup carried out by a nurse ( PRO ‐ TN ) or a rheumatologist ( PRO ‐ TR ), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints ( DAS 28) after week 52. Secondary outcomes were physical function, quality of life, and self‐efficacy. The noninferiority margin was a DAS 28 score change of 0.6. Mean differences were estimated following per protocol, intent‐to‐treat ( ITT ), and multivariate imputation analysis. Results Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS 28. In the ITT analysis, mean differences in the DAS 28 score between PRO ‐ TR versus control were −0.10 (90% confidence interval [90% CI ] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO ‐ TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO ‐ TN had mean ± SD 1.72 ± 1.03 visits/year, PRO ‐ TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare. Conclusion Among RA patients with low disease activity or remission, a PRO ‐based tele‐health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.