176. Multidisciplinary Care in the Management of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Methods: Patients with RA at 6 UK rheumatology departments were randomized to receive either ENAT-focused education (EG) or usual care (CG) from their clinical nurse specialist at weeks 0, 16 and 32. Self-efficacy (ASES), health status (AIMS2) and patients' knowledge of their RA (PKQ) were assessed at the same time points. Between-group and time effects were assessed using t-test and ANOVA as appropriate. All follow-up analyses were adjusted to baseline values. Results: The sample comprised 132 patients meeting 1987 ACR criteria for RA of whom 88 (66%) were female. Median age was 55 years and RA median disease duration 5.9 months. At week 16 there were no between-group differences in self-efficacy scores but at week 32, the mean scores were higher in the EG than the CG (ASES-Pain: F1,98 ¼ 9.13, P ¼ 0.003; ASES-Other symptoms: F1,98 ¼ 7.24, P ¼ 0.008). Over time, the EG saw significant improvements in their ASES scores which were not seen in the CG, suggesting that the ENAT helped improve patients' self-efficacy. No significant between-group differences were seen in the health status (AIMS2-SF) scores at week 16. At week 32, the treatment effects favoured the EG in AIMS2-SF symptoms and AIMS2-SF affect domains (F1,98 ¼ 7.41, P ¼ 0.008; and F1,98 ¼ 8.04, P ¼ 0.006 respectively). Over time, improvements in the two domains were seen in the EG but not in the CG. There were no differences in other AIMS2-SF domains. There were no significant between-group differences in the overall knowledge (total PKQ) score. Within-group analyses revealed a decrease in the overall knowledge in the EG at week 32 (no change in the CG), implying the ENAT's ability to target specific educational needs, rather than general knowledge of RA. Conclusion:We have demonstrated that the use of an easilycompleted and quick-to-use questionnaire (ENAT) to direct patient education would benefit patients in terms of self-efficacy and health status. Disclosure statement: The authors have declared no conflicts of interest. Background: Multidisciplinary team (MDT) care aims to improve disease activity, physical and psychosocial function and is considered the optimal management strategy for people with RA. Despite the widespread implementation of the MDT approach, there is a paucity of evidence for its effectiveness. This systematic review and metaanalysis evaluates the effectiveness of MDT care in the management of disability and disease activity in adults with RA. Methods: Data sources comprised 5 electronic databases, cross referencing from retrieved studies and expert review. Inclusion criteria were randomized controlled trials (RCTs) that included: (i) MDT care comprising two or more medical/allied health professionals working in a co-ordinated way, delivered in any setting; (ii) comparison groups of usual care, waiting list or interventions not involving an MDT; (iii) adults aged 18 years with RA; (iv) published or unpublished studies; (v) studies in any language between 1960-present; (vi) data available on disability and/or disease activity. Indep...