PMID- 34741249
OWN - NLM
STAT- MEDLINE
DCOM- 20220517
LR  - 20220517
IS  - 1573-2649 (Electronic)
IS  - 0962-9343 (Linking)
VI  - 31
IP  - 6
DP  - 2022 Jun
TI  - Evaluation of a multidisciplinary care model to improve quality of life in 
      rheumatoid arthritis: a randomised controlled trial.
PG  - 1749-1759
LID - 10.1007/s11136-021-03029-3 [doi]
AB  - BACKGROUND AND PURPOSE: Health-Related Quality of Life (HR-QOL) is an important 
      patient-reported domain in patients with rheumatoid arthritis (RA). The uptake of 
      multidisciplinary team (MDT) care in RA is generally low, due to initial high 
      demand for resources. We hypothesised that whilst pharmacological treatments are 
      effective in controlling disease activity, a multipronged intervention in an MDT 
      may have a positive impact on HR-QOL. METHODS: This was a single-centre 
      randomized parallel group, single-blind controlled trial of MDT vs. usual care in 
      an established RA clinic. Data were collected through face-to-face 
      questionnaires, medical records review, and joint counts by a blinded assessor at 
      0, 3 and 6 months. Adult RA patients were randomly assigned in a single visit to 
      a 6-member MDT (rheumatologist, nurse, social worker, physiotherapist, 
      occupational therapist, and podiatrist) or usual care. MDT providers prescribed 
      medications and counselled patients on managing flares, medication adherence, 
      coping, joint protection, exercise, footwear. The primary outcome was minimal 
      clinically important difference (MCID) in HR-QOL (increase in European 
      QOL-5-Dimension-3-Level, EQ-5D-3L by 0.1) at six months. RESULTS: 140 patients 
      (86.3% female, 53.4% Chinese, median (IQR) age 56.6 (46.7, 62.4) years); 70 were 
      randomized to each arm. Median (IQR) disease duration was 5.5 (2.4, 11.0) years 
      and disease activity in 28 joints (DAS28) was 2.87 (2.08, 3.66). 123 patients 
      completed the study. Twenty-six (40.6%) MDT vs. 23 (34.3%) usual care patients 
      achieved an MCID in EQ-5D-3L, OR 1.3 (0.6, 2.7). In multivariable logistic 
      regression, baseline EQ-5D-3L was the only predictor of achieving MCID. There was 
      more disease modifying anti-rheumatic drug escalation in MDT (34.4% vs. 19.4%). 
      Patients with high disease activity were more likely to achieve MCID in the MDT 
      arm. CONCLUSIONS: A single visit by stable patients with low disease activity to 
      an MDT failed to achieve MCID in the EQ-5D-3L; however, did achieve small but 
      significant improvements in the EQ-5D-3L, DAS28, pain, coping and self-efficacy. 
      To be sustainable, MDT care should be targeted at patients with high disease 
      activity or those with a new diagnosis of RA. TRIAL REGISTRATION: The study is 
      registered on ClinicalTrials.gov, identifier: NCT03099668.
CI  - (c) 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.
FAU - Lahiri, Manjari
AU  - Lahiri M
AUID- ORCID: 0000-0002-3482-6017
AD  - Division of Rheumatology, Department of Medicine, National University Hospital, 
      Singapore, Singapore. manjari_lahiri@nuhs.edu.sg.
AD  - Department of Medicine, Yong Loo Lin School of Medicine, National University of 
      Singapore, Singapore, Singapore. manjari_lahiri@nuhs.edu.sg.
FAU - Cheung, Peter P M
AU  - Cheung PPM
AD  - Division of Rheumatology, Department of Medicine, National University Hospital, 
      Singapore, Singapore.
AD  - Department of Medicine, Yong Loo Lin School of Medicine, National University of 
      Singapore, Singapore, Singapore.
FAU - Dhanasekaran, Preeti
AU  - Dhanasekaran P
AD  - Department of Medicine, Yong Loo Lin School of Medicine, National University of 
      Singapore, Singapore, Singapore.
FAU - Wong, Su-Ren
AU  - Wong SR
AD  - Department of Rehabilitation, National University Hospital, Singapore, Singapore.
FAU - Yap, Ai
AU  - Yap A
AD  - Department of Rehabilitation, National University Hospital, Singapore, Singapore.
FAU - Tan, Daphne S H
AU  - Tan DSH
AD  - Department of Rehabilitation, National University Hospital, Singapore, Singapore.
FAU - Chong, Siew-Hwa
AU  - Chong SH
AD  - Division of Rheumatology, Department of Medicine, National University Hospital, 
      Singapore, Singapore.
FAU - Tan, Chiew-Hwa
AU  - Tan CH
AD  - Division of Rheumatology, Department of Medicine, National University Hospital, 
      Singapore, Singapore.
FAU - Santosa, Amelia
AU  - Santosa A
AD  - Division of Rheumatology, Department of Medicine, National University Hospital, 
      Singapore, Singapore.
AD  - Department of Medicine, Yong Loo Lin School of Medicine, National University of 
      Singapore, Singapore, Singapore.
FAU - Phan, Phillip
AU  - Phan P
AD  - Department of Medicine, Yong Loo Lin School of Medicine, National University of 
      Singapore, Singapore, Singapore.
AD  - Department of Medicine, Johns Hopkins University, Johns Hopkins School of 
      Medicine, Baltimore, MD, USA.
LA  - eng
SI  - ClinicalTrials.gov/NCT03099668
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20211106
PL  - Netherlands
TA  - Qual Life Res
JT  - Quality of life research : an international journal of quality of life aspects of 
      treatment, care and rehabilitation
JID - 9210257
SB  - IM
MH  - Adult
MH  - *Arthritis, Rheumatoid/drug therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pain
MH  - *Quality of Life/psychology
MH  - Single-Blind Method
MH  - Surveys and Questionnaires
OTO - NOTNLM
OT  - EQ5D
OT  - Health-related quality of life
OT  - Multidisciplinary care
OT  - Rheumatoid arthritis
EDAT- 2021/11/07 06:00
MHDA- 2022/05/18 06:00
CRDT- 2021/11/06 06:14
PHST- 2021/10/26 00:00 [accepted]
PHST- 2021/11/07 06:00 [pubmed]
PHST- 2022/05/18 06:00 [medline]
PHST- 2021/11/06 06:14 [entrez]
AID - 10.1007/s11136-021-03029-3 [pii]
AID - 10.1007/s11136-021-03029-3 [doi]
PST - ppublish
SO  - Qual Life Res. 2022 Jun;31(6):1749-1759. doi: 10.1007/s11136-021-03029-3. Epub 
      2021 Nov 6.