Peter P Cheung1, Maxime Dougados2, Vincent Andre3, Nathalie Balandraud4, Gérard Chalès5, Isabelle Chary-Valckenaere6, Emmanuelle Dernis3, Ghislaine Gill6, Melanie Gilson7, Sandrine Guis8, Gael Mouterde9, Stephan Pavy10, Francois Pouyol11, Thierry Marhadour12, Pascal Richette13, Adeline Ruyssen-Witrand14, Martin Soubrier15, Minh Nguyen2, Laure Gossec16. 1. Paris Descartes University, Medicine Faculty, UPRES-EA 4058, AP-HP, Rheumatology B, Cochin Hospital, Paris, France; Division of Rheumatology, National University Health System, Singapore. Electronic address: peter_cheung@nuhs.edu.sg. 2. Paris Descartes University, Medicine Faculty, UPRES-EA 4058, AP-HP, Rheumatology B, Cochin Hospital, Paris, France. 3. Centre hospitalier du Mans, Le Mans, France. 4. AP-HM, rhumatologie I, hôpital Sainte-Marguerite, 13009 Marseille, France. 5. CHU-hôpital Sud, Rennes, France. 6. CHU de Nancy, Nancy, France. 7. Department of rheumatology, University Hospital of Grenoble, Echirolles, France. 8. AP-HM, rhumatologie I, hôpital Sainte-Marguerite, 13009 Marseille, France; Aix-Marseille University, CRMBM UMR CNRS7339, 13385 Marseille, France. 9. Rheumatology Department, Lapeyronie Hospital, Montpellier-1 University, UMR 5535, Montpellier, France. 10. Hôpitaux universitaires Paris Sud, Le Kremlin Bicêtre, France. 11. Hôpital Roger-Salengro, CHU de Lille, Lille, France. 12. Hôpital de la Cavale-Blanche, Brest, France. 13. Pôle appareil locomoteur, fédération de rhumatologie, hôpital Lariboisière, AP-HP, 75010 Paris, France; University Paris-Diderot, Sorbonne Paris-Cité, 75205 Paris, France. 14. UMR 1027 Inserm, Université Paul Sabatier Toulouse III, centre de rhumatologie Hôpital Purpan, CHU de Toulouse, Toulouse, France. 15. Department of Rheumatology, CHU de Clermont-Ferrand, Clermont-Ferrand, France. 16. Paris Descartes University, Medicine Faculty, UPRES-EA 4058, AP-HP, Rheumatology B, Cochin Hospital, Paris, France; UPMC University, Pitié-Salpetrière Hospital, Paris, France.
Abstract
OBJECTIVES: In rheumatoid arthritis (RA), nurses are now increasingly involved in joint count assessment but training is not standardized. The aim was to evaluate and describe the learning curve of nurses for the assessment of swollen and tender joints in RA. METHOD: Twenty nurses from university rheumatology centres inexperienced with joint counts were allocated to a rheumatologist from their centre (teacher). Acquisition of skills consisted of Phase 1: (training), a centralized 4hour training session, with (a) lecture and demonstration, and (b) practical sessions on patients with their teachers, followed by Phase 2: (practice) involving further practice on 20 patients in their own hospitals. Primary outcome was achievement of adequate swollen joint agreement between nurse and their teacher ("gold standard") at the "joint" level defined by prevalence adjusted biased adjusted kappa (PABAK)>0.60. Agreement at the "patient" level of swollen joint count (SJC), tender joint count (TJC) as well as DAS28 between nurse and their teacher were assessed with intra-class correlation coefficients (ICC). RESULTS: During the training phase, 75% of nurses achieved a swollen joint PABAK>0.60 when compared with their teachers, which further improved to 89% after the 20 practice patients (Phase 2). Median swollen joint PABAK improved from 0.64 (Q1:Q3 0.55,0.86) to 0.83 (Q1:Q3 0.77,1) by the end of Phase 2. At the "patient" level, SJC agreement remained globally stable (ICC, 0.52 to 0.66), while TJC and DAS28 agreement remained excellent throughout. CONCLUSION: Nurses inexperienced in joint counts were able to achieve excellent agreement with their teachers in assessment of tender and swollen joints through a short training session; practice further enhanced this agreement. Larger longitudinal studies are required to assess skills retention.
OBJECTIVES: In rheumatoid arthritis (RA), nurses are now increasingly involved in joint count assessment but training is not standardized. The aim was to evaluate and describe the learning curve of nurses for the assessment of swollen and tender joints in RA. METHOD: Twenty nurses from university rheumatology centres inexperienced with joint counts were allocated to a rheumatologist from their centre (teacher). Acquisition of skills consisted of Phase 1: (training), a centralized 4hour training session, with (a) lecture and demonstration, and (b) practical sessions on patients with their teachers, followed by Phase 2: (practice) involving further practice on 20 patients in their own hospitals. Primary outcome was achievement of adequate swollen joint agreement between nurse and their teacher ("gold standard") at the "joint" level defined by prevalence adjusted biased adjusted kappa (PABAK)>0.60. Agreement at the "patient" level of swollen joint count (SJC), tender joint count (TJC) as well as DAS28 between nurse and their teacher were assessed with intra-class correlation coefficients (ICC). RESULTS: During the training phase, 75% of nurses achieved a swollen joint PABAK>0.60 when compared with their teachers, which further improved to 89% after the 20 practice patients (Phase 2). Median swollen joint PABAK improved from 0.64 (Q1:Q3 0.55,0.86) to 0.83 (Q1:Q3 0.77,1) by the end of Phase 2. At the "patient" level, SJC agreement remained globally stable (ICC, 0.52 to 0.66), while TJC and DAS28 agreement remained excellent throughout. CONCLUSION: Nurses inexperienced in joint counts were able to achieve excellent agreement with their teachers in assessment of tender and swollen joints through a short training session; practice further enhanced this agreement. Larger longitudinal studies are required to assess skills retention.