Present address: Aeilko Zwinderman, Department of Medical Statistics of the Academic Medical Center of Amsterdam, Amsterdam, The Netherlands.
Two-year follow-up of a randomized controlled trial of a clinical nurse specialist intervention, inpatient, and day patient team care in rheumatoid arthritis
Version of Record online: 10 JAN 2003
Journal of Advanced Nursing
Volume 41, Issue 1, pages 34–43, January 2003
How to Cite
Tijhuis, G. J., Zwinderman, A. H., Hazes, J. M.W., Breedveld, F. C. and Vlieland, P.M. T. V. (2003), Two-year follow-up of a randomized controlled trial of a clinical nurse specialist intervention, inpatient, and day patient team care in rheumatoid arthritis. Journal of Advanced Nursing, 41: 34–43. doi: 10.1046/j.1365-2648.2003.02503.x
Present address: Johanna Hazes, Department of Rheumatology of the University Hospital of Rotterdam, Rotterdam, The Netherlands.
- Issue online: 10 JAN 2003
- Version of Record online: 10 JAN 2003
- Submitted for publication 18 January 2002 Accepted for publication 7 October 2002
- rheumatoid arthritis;
- chronic conditions;
- clinical nurse specialist;
- advanced nursing;
- nurse clinics;
- multidisciplinary team care;
- day patient;
- randomized trial
Aim. To compare the long-term effectiveness of care delivered by a clinical nurse specialist (CNS) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations.
Background. The role of CNSs in the management of patients with rheumatoid arthritis (RA) is evolving, and their effectiveness in comparison with care provided by a rheumatologist alone has been established. However, long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care, such as multidisciplinary team care, are lacking.
Methods. Two hundred and ten patients rheumatoid arthritis patients were randomized to care delivered by a CNS in a rheumatology outpatient clinic (12 weeks), inpatient team care (2 weeks) and day patient team care (3 weeks). Clinical assessments recorded on study entry, weeks 12, 26, 52, 78 and 104 comprised the health assessment questionnaire (HAQ) and MacMaster Toronto Arthritis (MACTAR) patient preference interview as primary outcome measures. Grip strength, walk test, RAND-36, Rheumatoid Arthritis Quality of Life questionnaire and disease activity score (DAS) were applied as secondary outcome measures.
Results. No significant differences in medical treatment, use of services of other health professionals, introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up, except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group. A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences. Within all three groups functional status, quality of life and disease activity improved significantly ( P < 0·05). In general, the results obtained after 12 weeks remained stable until 104 weeks after the start of the study.
Conclusion. Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis. A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis.