Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis

Results of a Randomized Controlled Trial

Annette De Thurah, Kristian Stengaard-Pedersen, Mette Axelsen, Ulrich Fredberg, Liv M V Schougaard, Niels H I Hjollund, Mogens Pfeiffer-Jensen, Trine Bay Laurberg, Ulrik Tarp, Kirsten Lomborg, Thomas Maribo

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Abstract

Objective: To test the effect of patient-reported outcome (PRO)–based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses. Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis. Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare. Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.

Original languageEnglish
JournalArthritis Care & Research
Volume70
Issue number3
Pages (from-to)353–360
ISSN2151-464X
DOIs
Publication statusPublished - Mar 2018

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Randomized Controlled Trials
Health
Joints
Nurses
Rheumatology
Outpatients
Confidence Intervals
Self Efficacy
Ambulatory Care Facilities
Multivariate Analysis
Quality of Life
Physicians
Rheumatologists

Keywords

  • Aftercare/methods
  • Aged
  • Arthritis, Rheumatoid/diagnosis
  • Denmark
  • Female
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Nurses
  • Patient Reported Outcome Measures
  • Quality of Life
  • Remission Induction
  • Rheumatologists
  • Self Efficacy
  • Severity of Illness Index
  • Telemedicine/methods
  • Time Factors
  • Treatment Outcome

Cite this

Thurah, A. D., Stengaard-Pedersen, K., Axelsen, M., Fredberg, U., Schougaard, L. M. V., Hjollund, N. H. I., ... Maribo, T. (2018). Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial. Arthritis Care & Research, 70(3), 353–360. https://doi.org/10.1002/acr.23280
Thurah, Annette De ; Stengaard-Pedersen, Kristian ; Axelsen, Mette ; Fredberg, Ulrich ; Schougaard, Liv M V ; Hjollund, Niels H I ; Pfeiffer-Jensen, Mogens ; Laurberg, Trine Bay ; Tarp, Ulrik ; Lomborg, Kirsten ; Maribo, Thomas. / Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis : Results of a Randomized Controlled Trial. In: Arthritis Care & Research. 2018 ; Vol. 70, No. 3. pp. 353–360.
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title = "Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial",
abstract = "Objective: To test the effect of patient-reported outcome (PRO)–based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses. Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis. Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were −0.10 (90{\%} confidence interval [90{\%} CI] −0.30, 0.13) and −0.19 (90{\%} CI −0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare. Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.",
keywords = "Aftercare/methods, Aged, Arthritis, Rheumatoid/diagnosis, Denmark, Female, Health Status, Humans, Male, Middle Aged, Nurses, Patient Reported Outcome Measures, Quality of Life, Remission Induction, Rheumatologists, Self Efficacy, Severity of Illness Index, Telemedicine/methods, Time Factors, Treatment Outcome",
author = "Thurah, {Annette De} and Kristian Stengaard-Pedersen and Mette Axelsen and Ulrich Fredberg and Schougaard, {Liv M V} and Hjollund, {Niels H I} and Mogens Pfeiffer-Jensen and Laurberg, {Trine Bay} and Ulrik Tarp and Kirsten Lomborg and Thomas Maribo",
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month = "3",
doi = "10.1002/acr.23280",
language = "English",
volume = "70",
pages = "353–360",
journal = "Arthritis Care & Research",
issn = "2151-464X",
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Thurah, AD, Stengaard-Pedersen, K, Axelsen, M, Fredberg, U, Schougaard, LMV, Hjollund, NHI, Pfeiffer-Jensen, M, Laurberg, TB, Tarp, U, Lomborg, K & Maribo, T 2018, 'Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of a Randomized Controlled Trial', Arthritis Care & Research, vol. 70, no. 3, pp. 353–360. https://doi.org/10.1002/acr.23280

Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis : Results of a Randomized Controlled Trial. / Thurah, Annette De; Stengaard-Pedersen, Kristian; Axelsen, Mette; Fredberg, Ulrich; Schougaard, Liv M V; Hjollund, Niels H I; Pfeiffer-Jensen, Mogens; Laurberg, Trine Bay; Tarp, Ulrik; Lomborg, Kirsten; Maribo, Thomas.

In: Arthritis Care & Research, Vol. 70, No. 3, 03.2018, p. 353–360.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Tele-Health Followup Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis

T2 - Results of a Randomized Controlled Trial

AU - Thurah, Annette De

AU - Stengaard-Pedersen, Kristian

AU - Axelsen, Mette

AU - Fredberg, Ulrich

AU - Schougaard, Liv M V

AU - Hjollund, Niels H I

AU - Pfeiffer-Jensen, Mogens

AU - Laurberg, Trine Bay

AU - Tarp, Ulrik

AU - Lomborg, Kirsten

AU - Maribo, Thomas

N1 - © 2017, American College of Rheumatology.

PY - 2018/3

Y1 - 2018/3

N2 - Objective: To test the effect of patient-reported outcome (PRO)–based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses. Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis. Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare. Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.

AB - Objective: To test the effect of patient-reported outcome (PRO)–based tele-health followup for tight control of disease activity in patients with rheumatoid arthritis (RA), and the differences between tele-health followup performed by rheumatologists or rheumatology nurses. Methods: A total of 294 patients were randomized (1:1:1) to either PRO-based tele-health followup carried out by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or conventional outpatient followup by physicians. The primary outcome was a change in the Disease Activity Score in 28 joints (DAS28) after week 52. Secondary outcomes were physical function, quality of life, and self-efficacy. The noninferiority margin was a DAS28 score change of 0.6. Mean differences were estimated following per protocol, intent-to-treat (ITT), and multivariate imputation analysis. Results: Overall, patients had low disease activity at baseline and end followup. Demographics and baseline characteristics were similar between groups. Noninferiority was established for the DAS28. In the ITT analysis, mean differences in the DAS28 score between PRO-TR versus control were −0.10 (90% confidence interval [90% CI] −0.30, 0.13) and −0.19 (90% CI −0.41, 0.02) between PRO-TN versus control. When including 1 yearly visit to the outpatient clinic, patients in PRO-TN had mean ± SD 1.72 ± 1.03 visits/year, PRO-TR had 1.75 ± 1.03 visits/year, and controls had 4.15 ± 1.0 visits/year. This included extra visits due to inflammatory flare. Conclusion: Among RA patients with low disease activity or remission, a PRO-based tele-health followup for tight control of disease activity in RA can achieve similar disease control as conventional outpatient followup. The degree of disease control did not differ between patients seen by rheumatologists or rheumatology nurses.

KW - Aftercare/methods

KW - Aged

KW - Arthritis, Rheumatoid/diagnosis

KW - Denmark

KW - Female

KW - Health Status

KW - Humans

KW - Male

KW - Middle Aged

KW - Nurses

KW - Patient Reported Outcome Measures

KW - Quality of Life

KW - Remission Induction

KW - Rheumatologists

KW - Self Efficacy

KW - Severity of Illness Index

KW - Telemedicine/methods

KW - Time Factors

KW - Treatment Outcome

U2 - 10.1002/acr.23280

DO - 10.1002/acr.23280

M3 - Journal article

VL - 70

SP - 353

EP - 360

JO - Arthritis Care & Research

JF - Arthritis Care & Research

SN - 2151-464X

IS - 3

ER -