Lack of benefit of a primary care-based nurse-led programme for people with osteoarthritis of the knee

Department of Social Gerontology, St George's Hospital & Medical School, London, UK.
Clinical Rheumatology (Impact Factor: 1.7). 09/2005; 24(4):358-64. DOI: 10.1007/s10067-004-1001-9
Source: PubMed


Osteoarthritis (OA) is the commonest cause of locomotor disability and forms a major element of the workload of the primary care team. There is evidence that patient education may improve quality of life, physical functioning, mental health and coping as well as reducing health service use. The aim of this study was to evaluate the effectiveness of a primary care-based patient education programme (PEP) using a randomised controlled trial. A cluster randomised controlled trial, involving 22 practices, was used to determine the efficacy of a nurse-led education programme. The programme consisted of a home visit and four 1-h teaching sessions. Patients were assessed at baseline and then 1, 3, 6 and 12 months post intervention using 36-item Short Form (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), arthritis helplessness index and a patient knowledge questionnaire. Direct interviews were used at baseline and at the 12-month follow-up. There were no differences in depression, OA knowledge, pain or physical ability at either 1 month or 1 year between the two groups. Control practices (65 patients from 12 practices) recruited significantly fewer patients than intervention practices (105 patients from ten practices, p = 0.02). Control practices had more doctors (p = 0.02), more non-white patients (p = 0.007), fewer patients living alone (p = 0.005) and lower levels of disability (p = 0.008). We detected a lack of benefit of PEP for people with OA of the knee. This was thought to be due in part to the short intervention time employed and the heterogeneous nature of the disease and the population studied.


Available from: Fiona Ross, Oct 19, 2015
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    • "The osteoarthritis RCTs demonstrated better nurse-led care effects in pain control (Hill et al., 2009) and no difference in coping with arthritis (Victor et al., 2005). In diagnosing fibromyalgia, nurse-led diagnosis showed excellent agreement with that of the rheumatologist and this agreement was maintained over 24 months (Kroese et al., 2008). "
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    ABSTRACT: The rise in the number of patients with arthritis coupled with understaffing of medical services has seen the deployment of Clinical Nurse Specialists in running nurse-led clinics alongside the rheumatologist clinics. There are no systematic reviews of nurse-led care effectiveness in rheumatoid arthritis. Few published RCTs exist and they have shown positive results for nurse-led care but they have several limitations and there has been no economic assessment of rheumatology nurse-led care in the UK. This paper outlines the study protocol and methodology currently being used to evaluate the outcomes and cost effectiveness for patients attending rheumatology nurse-led clinics. A multi-centred, pragmatic randomised controlled trial with a non-inferiority design; the null hypothesis being that of 'inferiority' of nurse-led clinics compared to physician-led clinics. The primary outcome is rheumatoid arthritis disease activity (measured by DAS28 score) and secondary outcomes are quality of life, self-efficacy, disability, psychological well-being, satisfaction, pain, fatigue and stiffness. Cost effectiveness will be measured using the EQ-5D, DAS28 and cost profile for each centre. POWER CALCULATIONS: In this trial, a DAS28 change of 0.6 is considered to be the threshold for clinical distinction of 'inferiority'. A sample size of 180 participants (90 per treatment arm) is needed to reject the null hypothesis of 'inferiority', given 90% power. Primary analysis will focus on 2-sided 95% confidence interval evaluation of between-group differences in DAS28 change scores averaged over 4 equidistant follow up time points (13, 26, 39 and 52 weeks). Cost effectiveness will be evaluated assessing the joint parameterisation of costs and effects. The study started in July 2007 and the results are expected after July 2011. The International Standard Randomised Controlled Trial Number ISRCTN29803766.
    International journal of nursing studies 02/2011; 48(8):995-1001. DOI:10.1016/j.ijnurstu.2011.01.010 · 2.90 Impact Factor
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    • "Despite the emphasis on self management initiatives and community nurses’ potential role with patients with long-term conditions, few studies were identified of community nurses working with patients with musculoskeletal disorders. Victor et al. conducted a RCT on the effectiveness of a primary care based nurse-led education program in the UK for people with OA of the knee [32]. This nurse-led intervention consisted of a home visit and four one hour teaching sessions. "
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    • "Also, the intervention itself might have been too simple to detect differences in these outcome measures. However, our results are consistent with a study similar to ours in the same time period [26]. The intervention in this study was slightly more extensive, and their follow-up was 6 months longer; but their findings were that a nurse-led education programme for patients with osteoarthritis (40 years or older) did not benefit these patients. "
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    ABSTRACT: Supporting self-management intends to improve life-style, which is beneficial for patients with mild osteoarthritis (OA). We evaluated a nurse-based intervention on older OA patients' self-management with the aim to assess its effects on mobility and functioning. Randomized controlled trial of patients (> or = 65 years) with mild hip or knee OA from nine family practices in the Netherlands. Intervention consisted of supporting patients' self-management of OA symptoms using a practice-based nurse. Outcome measures were patients' mobility, using the Timed Up and Go test (TUG), and patient reported functioning, using an arthritis specific scale (Dutch AIMS2 SF). Fifty-one patients were randomized to the intervention group and 53 to the control group. Patient-reported functioning improved on four scales in the intervention group compared to one scale in the control group. However, this result was not significant. Mobility improved in both groups, without a significant difference between the two groups. There were no differences between the groups regarding consultations with family physicians or physiotherapists, or medication use. A nurse-based intervention on older OA patients' self-management did not improve self-reported functioning, mobility or patients' use of health care resources.
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