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Annals of the Rheumatic Diseases logoLink to Annals of the Rheumatic Diseases
. 2003 Jul;62(7):624–629. doi: 10.1136/ard.62.7.624

Effectiveness of a measurement feedback system on outcome in rheumatoid arthritis: a controlled clinical trial

J Fransen 1, G Stucki 1, J Twisk 1, A Chamot 1, J Gerster 1, T Langenegger 1, M Seitz 1, B Michel 1, m the 1
PMCID: PMC1754606  PMID: 12810423

Abstract

Background: With the help of a measurement feedback system, the treatment strategy for individual patients with rheumatoid arthritis (RA) can be adjusted to achieve optimal control of disease activity.

Objective: To study whether a measurement feedback system is effective in reducing disease activity in patients with RA.

Methods: Forty eight rheumatologists and 264 patients participated in a controlled clinical trial. A three month control period was followed by a 12 month period, where feedback on disease activity, disability, and damage was provided to the rheumatologist. The primary outcome measure was the rheumatoid arthritis disease activity index (RADAI).

Results: The feedback system was used for 142/228 (62%) patients. Disease modifying antirheumatic drug changes occurred in 69/169 (41%) patients. In patients with high disease activity and feedback use (n=70), the RADAI decreased in the feedback period by –0.27 points per 30 days (p<0.05), as compared with the control period. Patients for whom the feedback system was used had a better outcome than non-users.

Conclusion: Much more training on the use of a feedback system and outcome measures, as well as the inclusion of explicit treatment guidelines will be necessary to increase the clinical use of measurement feedback and, possibly, to reduce disease activity for a larger number of patients with RA.

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Figure 1.

Figure 1

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The feedback report shown covers the serial visits of a patient with RA from 3 May 2000 to 10 February 2001. In the upper part of the report the courses over time of the DAS28, ESR, RADAI, pain (0–10 numerical rating scale), HAQ, and the Ratingen x ray score (x ray) are depicted. The HAQ is on a scale from 0 to 3; the other measures are (re)scaled to range from 0 to 10. The first table summarises the information of the measures shown in the graph. The second table contains information on concurrent drug prescriptions. It can be seen that in this patient the DAS and the HAQ decreased, whereas the x ray score did not increase further after changes in salazopyrin and infliximab treatment.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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