Abstract
OBJECTIVES—To determine the effects of patient education on compliance and on health in patients with active, recent onset rheumatoid arthritis (RA). METHODS—A randomised, controlled, assessor blinded, one year trial. The experimental group followed an education programme. All patients started on sulphasalazine therapy. Compliance with sulphasalazine was measured by pill counting. Compliance rates with regimens of physical exercise, endurance activities, and energy conservation were measured by questionnaires. Compliance with prescriptions of joint protection was scored using a test for joint protection performance. Health was measured by a Disease Activity Score (function of erythrocyte sedimentation rate, Ritchie score, and number of swollen joints), C reactive protein, Dutch-AIMS scores, and M-HAQ scores, range of motion of shoulder, elbow, and knee joints. Parameters were scored at baseline and after three, six, and 12 months. RESULTS—Sixty of 65 patients gave informed consent, five of them withdrew from follow up. Compliance with sulphasalazine exceeded 80% with no differences between groups. Compliance with physical exercise (at three months), energy conservation (at three and at 12 months), and joint protection (at three months) improved significantly more in the experimental group. The improvements of health were not different in the groups. CONCLUSION—Compliance with sulphasalazine among patients with active, recent onset RA is high, whether formal patient education is followed or not. Compliance with physical exercise, energy conservation, and joint protection was increased by patient education. Formal patient education did not improve health status. Keywords: rheumatoid arthritis; compliance; health status; patient education
Full Text
The Full Text of this article is available as a PDF (117.5 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Arnett F. C., Edworthy S. M., Bloch D. A., McShane D. J., Fries J. F., Cooper N. S., Healey L. A., Kaplan S. R., Liang M. H., Luthra H. S. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324. doi: 10.1002/art.1780310302. [DOI] [PubMed] [Google Scholar]
- Barry M. A., Purser J., Hazleman R., McLean A., Hazleman B. L. Effect of energy conservation and joint protection education in rheumatoid arthritis. Br J Rheumatol. 1994 Dec;33(12):1171–1174. doi: 10.1093/rheumatology/33.12.1171. [DOI] [PubMed] [Google Scholar]
- Belcon M. C., Haynes R. B., Tugwell P. A critical review of compliance studies in rheumatoid arthritis. Arthritis Rheum. 1984 Nov;27(11):1227–1233. doi: 10.1002/art.1780271104. [DOI] [PubMed] [Google Scholar]
- Brooks P. M., Day R. O. Nonsteroidal antiinflammatory drugs--differences and similarities. N Engl J Med. 1991 Jun 13;324(24):1716–1725. doi: 10.1056/NEJM199106133242407. [DOI] [PubMed] [Google Scholar]
- Brus H., van de Laar M., Taal E., Rasker J., Wiegman O. Compliance in rheumatoid arthritis and the role of formal patient education. Semin Arthritis Rheum. 1997 Feb;26(4):702–710. doi: 10.1016/s0049-0172(97)80006-6. [DOI] [PubMed] [Google Scholar]
- Carpenter J. O., Davis L. J. Medical recommendations--followed or ignored? Factors influencing compliance in arthritis. Arch Phys Med Rehabil. 1976 May;57(5):241–246. [PubMed] [Google Scholar]
- Carpenter J. O., Davis L. J. Medical recommendations--followed or ignored? Factors influencing compliance in arthritis. Arch Phys Med Rehabil. 1976 May;57(5):241–246. [PubMed] [Google Scholar]
- Cash J. M., Klippel J. H. Second-line drug therapy for rheumatoid arthritis. N Engl J Med. 1994 May 12;330(19):1368–1375. doi: 10.1056/NEJM199405123301908. [DOI] [PubMed] [Google Scholar]
- Cramer J. A., Mattson R. H., Prevey M. L., Scheyer R. D., Ouellette V. L. How often is medication taken as prescribed? A novel assessment technique. JAMA. 1989 Jun 9;261(22):3273–3277. [PubMed] [Google Scholar]
- Deyo R. A., Inui T. S., Sullivan B. Noncompliance with arthritis drugs: magnitude, correlates, and clinical implications. J Rheumatol. 1981 Nov-Dec;8(6):931–936. [PubMed] [Google Scholar]
- Doyle D. V., Perrett D., Foster O. J., Ensor M., Scott D. L. The long-term use of D-penicillamine for treating rheumatoid arthritis: is continuous therapy necessary? Br J Rheumatol. 1993 Jul;32(7):614–617. doi: 10.1093/rheumatology/32.7.614. [DOI] [PubMed] [Google Scholar]
- Feinberg J. The effect of patient-practitioner interaction on compliance: a review of the literature and application in rheumatoid arthritis. Patient Educ Couns. 1988 Jun;11(3):171–187. doi: 10.1016/0738-3991(88)90018-3. [DOI] [PubMed] [Google Scholar]
- Ferguson K., Bole G. G. Family support, health beliefs, and therapeutic compliance in patients with rheumatoid arthritis. Patient Couns Health Educ. 1979 Winter-Spring;1(3):101–105. doi: 10.1016/s0738-3991(79)80026-9. [DOI] [PubMed] [Google Scholar]
- Furst G. P., Gerber L. H., Smith C. C., Fisher S., Shulman B. A program for improving energy conservation behaviors in adults with rheumatoid arthritis. Am J Occup Ther. 1987 Feb;41(2):102–111. doi: 10.5014/ajot.41.2.102. [DOI] [PubMed] [Google Scholar]
- Gerber L., Furst G., Shulman B., Smith C., Thornton B., Liang M., Cullen K., Stevens M. B., Gilbert N. Patient education program to teach energy conservation behaviors to patients with rheumatoid arthritis: a pilot study. Arch Phys Med Rehabil. 1987 Jul;68(7):442–445. [PubMed] [Google Scholar]
- Hammond A. Joint protection behavior in patients with rheumatoid arthritis following an education program: a pilot study. Arthritis Care Res. 1994 Mar;7(1):5–9. doi: 10.1002/art.1790070103. [DOI] [PubMed] [Google Scholar]
- Helewa A., Goldsmith C. H., Lee P., Bombardier C., Hanes B., Smythe H. A., Tugwell P. Effects of occupational therapy home service on patients with rheumatoid arthritis. Lancet. 1991 Jun 15;337(8755):1453–1456. doi: 10.1016/0140-6736(91)93138-y. [DOI] [PubMed] [Google Scholar]
- Kaye R. L., Hammond A. H. Understanding rheumatoid arthritis. Evaluation of a patient education program. JAMA. 1978 Jun 9;239(23):2466–2467. doi: 10.1001/jama.239.23.2466. [DOI] [PubMed] [Google Scholar]
- Lee P., Tan L. J. Drug compliance in outpatients with rheumatoid arthritis. Aust N Z J Med. 1979 Jun;9(3):274–277. doi: 10.1111/j.1445-5994.1979.tb04138.x. [DOI] [PubMed] [Google Scholar]
- Lindroth Y., Bauman A., Barnes C., McCredie M., Brooks P. M. A controlled evaluation of arthritis education. Br J Rheumatol. 1989 Feb;28(1):7–12. doi: 10.1093/rheumatology/28.1.7. [DOI] [PubMed] [Google Scholar]
- Lindroth Y., Bauman A., Brooks P. M., Priestley D. A 5-year follow-up of a controlled trial of an arthritis education programme. Br J Rheumatol. 1995 Jul;34(7):647–652. doi: 10.1093/rheumatology/34.7.647. [DOI] [PubMed] [Google Scholar]
- Lorig K., González V. The integration of theory with practice: a 12-year case study. Health Educ Q. 1992 Fall;19(3):355–368. doi: 10.1177/109019819201900307. [DOI] [PubMed] [Google Scholar]
- Lorig K., Lubeck D., Kraines R. G., Seleznick M., Holman H. R. Outcomes of self-help education for patients with arthritis. Arthritis Rheum. 1985 Jun;28(6):680–685. doi: 10.1002/art.1780280612. [DOI] [PubMed] [Google Scholar]
- Neuberger G. B., Smith K. V., Black S. O., Hassanein R. Promoting self-care in clients with arthritis. Arthritis Care Res. 1993 Sep;6(3):141–148. doi: 10.1002/art.1790060306. [DOI] [PubMed] [Google Scholar]
- Nicholas J. J., Gruen H., Weiner G., Crawshaw C., Taylor F. Splinting in rheumatoid arthritis: I. Factors affecting patient compliance. Arch Phys Med Rehabil. 1982 Feb;63(2):92–94. [PubMed] [Google Scholar]
- Owen S. G., Friesen W. T., Roberts M. S., Flux W. Determinants of compliance in rheumatoid arthritic patients assessed in their home environment. Br J Rheumatol. 1985 Nov;24(4):313–320. doi: 10.1093/rheumatology/24.4.313. [DOI] [PubMed] [Google Scholar]
- PARKER L. B., BENDER L. F. Problem of home treatment in arthritis. Arch Phys Med Rehabil. 1957 Jun;38(6):392–394. [PubMed] [Google Scholar]
- Pincus T., Callahan L. F., Brooks R. H., Fuchs H. A., Olsen N. J., Kaye J. J. Self-report questionnaire scores in rheumatoid arthritis compared with traditional physical, radiographic, and laboratory measures. Ann Intern Med. 1989 Feb 15;110(4):259–266. doi: 10.7326/0003-4819-110-4-259. [DOI] [PubMed] [Google Scholar]
- Potts M., Brandt K. D. Analysis of education-support groups for patients with rheumatoid arthritis. Patient Couns Health Educ. 1983;4(3):161–166. doi: 10.1016/s0190-2040(83)80007-x. [DOI] [PubMed] [Google Scholar]
- Pullar T., Peaker S., Martin M. F., Bird H. A., Feely M. P. The use of a pharmacological indicator to investigate compliance in patients with a poor response to antirheumatic therapy. Br J Rheumatol. 1988 Oct;27(5):381–384. doi: 10.1093/rheumatology/27.5.381. [DOI] [PubMed] [Google Scholar]
- Ritchie D. M., Boyle J. A., McInnes J. M., Jasani M. K., Dalakos T. G., Grieveson P., Buchanan W. W. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med. 1968 Jul;37(147):393–406. [PubMed] [Google Scholar]
- Spoorenberg A., Boers M., Van der Linden S. Wrist splints in rheumatoid arthritis: a question of belief? Clin Rheumatol. 1994 Dec;13(4):559–563. doi: 10.1007/BF02242994. [DOI] [PubMed] [Google Scholar]
- Taal E., Rasker J. J., Wiegman O. Patient education and self-management in the rheumatic diseases: a self-efficacy approach. Arthritis Care Res. 1996 Jun;9(3):229–238. doi: 10.1002/1529-0131(199606)9:3<229::aid-anr1790090312>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
- Taal E., Riemsma R. P., Brus H. L., Seydel E. R., Rasker J. J., Wiegman O. Group education for patients with rheumatoid arthritis. Patient Educ Couns. 1993 May;20(2-3):177–187. doi: 10.1016/0738-3991(93)90131-f. [DOI] [PubMed] [Google Scholar]
- Ytterberg S. R., Mahowald M. L., Krug H. E. Exercise for arthritis. Baillieres Clin Rheumatol. 1994 Feb;8(1):161–189. doi: 10.1016/s0950-3579(05)80230-4. [DOI] [PubMed] [Google Scholar]
- Zelen M. A new design for randomized clinical trials. N Engl J Med. 1979 May 31;300(22):1242–1245. doi: 10.1056/NEJM197905313002203. [DOI] [PubMed] [Google Scholar]
- van der Heijde D. M., van 't Hof M. A., van Riel P. L., Theunisse L. A., Lubberts E. W., van Leeuwen M. A., van Rijswijk M. H., van de Putte L. B. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis. 1990 Nov;49(11):916–920. doi: 10.1136/ard.49.11.916. [DOI] [PMC free article] [PubMed] [Google Scholar]
- van der Heijde D. M., van Riel P. L., Nuver-Zwart I. H., Gribnau F. W., vad de Putte L. B. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet. 1989 May 13;1(8646):1036–1038. doi: 10.1016/s0140-6736(89)92442-2. [DOI] [PubMed] [Google Scholar]