This article has been corrected. See "Erratum: Effects of Individual Education Using a Treating-to-target Strategy in Patients with Rheumatoid Arthritis" in Volume 26 on page 85.
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Abstract
Objective
To examine effects of an individual education program using the treating rheumatoid arthritis to target (RA T2T) strategy in patients with moderate-severe rheumatoid arthritis.
Methods
Patients were assigned randomly to an educational intervention (n=33) or conventional care group (n=33). The intervention was a nurse-delivered 9-month educational program consisting of 3 monthly sessions and monthly telephone counseling. The assessments occurred at the baseline and every 3 months in both groups, but only the intervention group completed the 9-month education follow-up. The outcome variables included the disease activity (DAS28), functional disability (KHAQ), fatigue (FACIT-Fatigue), and quality of life (SF-36). Repeated measures ANOVA and a Bonferroni multiple comparison were used to evaluate the outcome variables comparing the groups and follow-up times.
Results
Significant interactions were observed between the groups and follow-up times in the disease activity (p=0.041), fatigue (p=0.042), and physical (p=0.006) and mental (p=0.031) health-related quality of life, but there was no significant interaction in the functional disability (p=0.110). Significant differences were noted between the groups at the 9-month period (p=0.048) in disease activity and fatigue, and at the 6-month (p=0.023) and 9-month periods (p=0.027) in the physical health-related quality of life.
Conclusion
This education program using the RA T2T strategy had significant benefits on the disease activity, fatigue, and quality of life in patients with moderate to severe rheumatoid arthritis, and the results suggested that this contributed to positive clinical outcomes as a good practical nursing intervention.
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Figure 1.
Mean scores on (A) disease activity, (B) functional disability, (C) fatigue. DAS28: disease activity score in 28 joints, KHAQ: Korean health assessment questionnaire, FACIT-F: functional assessment of chronic illness ther-apy-fatigue scale. Data are presented as mean±standard error. *p-value by repeated measures ANOVA. † p=0.048, Bonferroni corrected significance.
Figure 2.
Mean scores on (A) physical component summary, (B) mental component summary. Data are presented as mean±standard error. *p-value by repeated measures ANOVA. † p=0.023, ‡ p=0.027, Bonferroni corrected significance.
Table 1.
Education program using RA T2T strategy
Table 2.
Baseline characteristics of patients with rheumatoid arthritis
| Characteristics | Experimental group (n=33) | Control group (n=33) | t or χ2 | p-value |
|---|---|---|---|---|
| Age (yr) | 45.88±11.66 | 46.48±12.74 | −0.20 | 0.841 |
| Gender | * | 0.999 | ||
| Female | 30 (90.91) | 29 (87.88) | ||
| Male | 3 (9.09) | 4 (12.12) | ||
| Educational level | 0.00 | 0.999 | ||
| ≤ High school | 14 (42.42) | 15 (45.45) | ||
| ≥ College | 19 (57.58) | 18 (54.55) | ||
| Job | 0.00 | 0.999 | ||
| Yes | 19 (57.58) | 18 (54.55) | ||
| No | 14 (42.42) | 15 (45.45) | ||
| Regular exercise | 1.07 | 0.302 | ||
| Yes | 9 (27.27) | 14 (42.42) | ||
| No | 24 (72.73) | 19 (57.58) | ||
| Height (cm) | 160.58±6.29 | 160.48±5.76 | 0.06 | 0.951 |
| Weight (kg) | 56.76±10.80 | 59.18±12.12 | −0.86 | 0.394 |
| Disease duration (mo) Methotrexate use | 57.36±72.21 | 59.67±75.79 | −0.13 * | 0.900 0.999 |
| Yes | 31 (93.94) | 31 (93.94) | ||
| No | 2 (6.06) | 2 (6.06) | ||
| Steroid use | * | 0.258 | ||
| Yes | 31 (93.94) | 27 (81.82)) | ||
| No Rheumatoid factor | 2 (6.06) | 6 (18.18) | * | 0.999 |
| Positive | 33 (100) | 32 (96.97) | ||
| Negative | 0 (0) | 1 (3.03) | ||
| ESR (mm/h) | 42.00±15.97 | 40.76±19.60 | 0.28 | 0.779 |
| DAS28 (score) | 4.61±0.83 | 4.53±1.06 | 0.36 | 0.723 |
| KHAQ (score) | 0.70±0.56 | 0.76±0.63 | −0.39 | 0.701 |
| FACIT-F (score) | 32.42±12.32 | 33.03±10.07 | −0.22 | 0.828 |
| Quality of life (SF-36 score) | ||||
| Physical component summ | mary 38.21±7.26 | 39.04±7.86 | −0.44 | 0.658 |
| Mental component summ | mary 44.35±9.23 | 46.18±11.72 | −0.71 | 0.483 |
Table 3.
Remission achievement rate by the time point
| Time | Remission achievement | Experimental group (n=33) | Control group (n=33) | χ2 | p-value |
|---|---|---|---|---|---|
| 3 months | Yes | 8 (24.24) | 1 (3.03) | * | 0.027 |
| No | 25 (75.76) | 32 (96.97) | |||
| 6 months | Yes | 14 (42.42) | 4 (12.12) | 6.19 | 0.013 |
| No | 19 (57.58) | 29 (87.88) | |||
| 9 months | Yes | 15 (45.45) | 7 (21.21) | 3.34 | 0.068 |
| No | 18 (54.55) | 26 (78.79) |
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