Randomized comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis

Abstract

Results. Twenty-eight patients were assigned to the intervention group (mean age 53.9 years, 15 of 28 with diffuse SSc) and 25 were assigned to the control group (mean age 51.7 years, 15 of 25 with diffuse SSc). Twenty-five patients (89%) in the intervention group completed the treatment program. At 12 weeks, there was a significantly greater improvement in grip strength (2.2 versus ؊1.8 kg; P ‫؍‬ 0.001), MMO (1.4 versus ؊0.9 mm; P ‫؍‬ 0.011), 6MWD (42.8 versus 3.9 meters; P ‫؍‬ 0.021), and HAQ score (؊0.18 versus 0.13; P ‫؍‬ 0.025) in the intervention group, whereas differences for the other outcome measures did not reach significance. At 24 weeks, the effect on grip strength persisted. Conclusion. In patients with SSc, a 12-week multidisciplinary day patient treatment program was more effective than regular outpatient care with respect to 6MWD, grip strength, MMO, and HAQ score, but not for VO 2max , HAMIS test, CIS-20, SF-36, and visual analog scale for pain. This study provides a first step in quantifying the effect of a multidisciplinary team care program and warrants the conduct of further intervention studies.

Effectiveness of Nonpharmacologic Interventions in Systemic Sclerosis: A Systematic Review

“…Three studies, all RCTs, met the predefined score for high quality (Table 2) (24,25,29,42). At least half of the study-reporting items were met in 87% of the studies (n 5 20), with item 8, relating reporting of important adverse events, being scored less frequently (n 5 4).…”

“…Schouffoer et al (29) reported that a 12-week multidisciplinary team-care program compared to usual outpatient care resulted in medium to large significant positive effects in limitations in activities, measured with the 6-minute walking test and the Scleroderma Health Assessment Questionnaire, medium effects on maximal mouth opening, and large effects on grip strength.…”

“…The intervention duration ranged from 2 days (26) to 1 year (38). Of the included studies, 9 were home-based interventions (24,25,28,31,32,(38)(39)(40)46,47), 5 were clinic/hospitalbased interventions (26,30,34,37,42), 5 were combined home/hospital-based interventions (27,29,33,35,36), and 4 studies did not report the setting of the intervention (41,(43)(44)(45).…”

“…Three studies, all RCTs, met criteria for methodologic high quality. These RCTs reported that a multifaceted oral health intervention is effective in improving mouth hygiene and that orofacial exercises are not effective in improving maximal mouth opening (24,25), that a multidisciplinary team-care program is effective in improving limitations in activities, maximal mouth opening, and hand grip strength (29), and that manual lymph drainage is effective in improving hand function, limitations in activities, and quality of life (42). Findings should be interpreted with caution, however, given that only a single RCT was conducted for each intervention, each had a small sample size, and there was a lack of predefined primary outcome measures.…”

Nonpharmacological Treatment in Systemic Sclerosis

“…Results showed that the 12-week daily multidisciplinary care program was more effective than regular outpatient care with regard to significant improvement in grip strength, mouth opening, gait, and quality of life after 12 weeks, whereas the results in other followed parameters showed no difference between the intervention and control group. At the end of the follow-up period, after 24 weeks, only improvement in grip strength was maintained [18].…”