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Rheumatoid arthritis
Original article
Efficacy of embedded nurse-led versus conventional physician-led follow-up in rheumatoid arthritis: a systematic review and meta-analysis
  1. Annette de Thurah1,2,
  2. Bente Appel Esbensen3,4,
  3. Ida Kristiane Roelsgaard5,
  4. Tove Faber Frandsen6 and
  5. Jette Primdahl7,8,9
  1. 1Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
  2. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
  3. 3Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
  4. 4Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  5. 5Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
  6. 6Department of Design and Communication, University of Southern Denmark, Kolding, Denmark
  7. 7King Christian X’s Hospital for Rheumatic Diseases, Graasten, Denmark
  8. 8Hospital of Southern Jutland, Aabenraa, Denmark
  9. 9Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Dr Annette de Thurah; annethur{at}rm.dk

Abstract

Objective To compare the efficacy of embedded nurse-led versus conventional physician-led follow-up on disease activity in patients with rheumatoid arthritis (RA).

Methods In a systematic literature search, we identified randomised controlled trials (RCTs) reporting on the efficacy of nurse-led follow-up on disease control in patients with RA compared with physician-led follow-up. Primary outcome was disease activity indicated by Disease Activity Score (DAS)-28. Secondary outcomes were: patient satisfaction, physical disability, fatigue, self-efficacy and quality of life. Outcomes were assessed after 1-year and 2 year follow-ups.

Results Seven studies representing five RCTs, including a total of 723 participants, were included. All but one study included stable patients in low disease activity or remission at baseline. No difference in DAS-28 was found after 1 year (mean difference (MD) −0.07 (95% CI −0.23 to 0.09)). After 2 years, a statistically significant difference was seen in favour of nurse-led follow-up (MD −0.28 (95% CI −0.53 to −0.04)). However, the difference did not reach a clinically relevant level.

No difference was found in patient satisfaction after 1 year (standard mean difference (SMD) −0.17 (95 % CI −1.0 to 0.67), whereas a statistical significant difference in favour of nurse-led follow-up was seen after 2 years (SMD: 0.6 (95% CI –0.00 to 1.20)).

Conclusion After 1 year no difference in disease activity, indicated by DAS-28, were found between embedded nurse-led follow-up compared with conventional physician-led follow-up, in RA patients with low disease activity or remission.

  • rheumatoid arthritis
  • nursing
  • DAS28

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000481

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    Footnotes

    • Contributors All authors fulfil the ICMJE authorship criteria, and all have read and approved the final draft.

    • Funding No specific funding was received from any funding bodies in the public, commercial or non-profit sectors to carry out the work described in this manuscript.

    • Competing interests None declared.

    • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement This study involved only published reports and no unpublished information. No database was used for this study