Anna Molto1,2, Laure Gossec3,4, Serge Poiraudeau5, Pascal Claudepierre6, Martin Soubrier7, Françoise Fayet7, Daniel Wendling8, Philippe Gaudin9, Emmanuelle Dernis10, Sandrine Guis11, Sophie Pouplin12, Adeline Ruyssen-Witrand13, Gerard Chales14, Xavier Mariette15, Catherine Beauvais16, Bernard Combe17, René-Marc Flipo18, Pascal Richette19,20, Isabelle Chary-Valckenaere21, Alain Saraux22, Jean Sibilia23, Thierry Schaeverbeke24, Maxime Dougados1,2. 1. Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France. 2. Université de Paris, INSERM U-1153, CRESS, France. 3. Sorbonne Université, IPLESP, INSERM, France. 4. Pitié Salpêtrière Hospital, APHP, Rheumatology Department, France. 5. Rehabilitation and Physical Medicine Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 6. Rheumatology Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, and Université Paris Est Créteil, EA, 7379 - EpidermE, Créteil, France. 7. Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France. 8. Rheumatology Department, CHRU de BESANCON, University Teaching Hospital, and Université Bourgogne Franche-Comté, EA4266 (EPILAB), Besançon, France. 9. Rheumatology Department, CHU Grenoble, France. 10. Rheumatology Department, CH Le Mans, France. 11. Rheumatology Department, CHU Marseille, France. 12. Rheumatology Department, CHU Rouen, France. 13. Centre de Rhumatologie, Hôpital Purpan, et Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Inserm UMR1027, Toulouse, France. 14. Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France. 15. Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France. 16. Rheumatology Department, Saint Antoine Hospital, APHP, Paris, France. 17. Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France. 18. Rheumatology Department, CHU Roger Salengro Hospital, University of Lille, Lille, France. 19. Université Paris Diderot, UFR médicale, France. 20. APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France. 21. Department of Rheumatology, Nancy Hospital, Nancy, France. 22. Rheumatology Unit, UMR1227 (Lymphocytes B et Autoimmunité), Université de Brest, Inserm, CHU, Brest, LabEx IGO, Brest, France. 23. Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France. 24. Rheumatology Department, Pellegrin Hospital, Bordeaux, France.
Abstract
OBJECTIVE: To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis. METHODS: Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group). RESULTS: A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ). CONCLUSION: This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.
RCT Entities:
OBJECTIVE: To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis. METHODS: Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritispatients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group). RESULTS: A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ). CONCLUSION: This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.