Background/Purpose: The objective of this study was to evaluate the impact of a nurse- led program of self-management and self-assessment for disease activity program in axSpA

Methods:

Study design: Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants 1/Patients: consecutive Axial SpA patients (according to rheumatologist) attending a clinic of the participating centers were invited .2/ Nurses :all participated at a 1 day meeting prior the start of the study.

Study treatment: a program including: 1) Self-management = a) a video explaining the disease, the interest of smoking cessation in axial SpA, the role of NSAIDs as cornerstone treatment in axSpA in the absence of contra-indications, the interest of physical activity and exercise, followed by a discussion with the nurse; b) physical examination by the nurse to check for the presence of spinal deformities suggesting a severe disease, and depending on the absence/presence of such deformities projection of a specific video of home-based exercises examples for patients with severe/not severe disease. 2) Self-assessment: Video presentation of the rationale of the use of a composite index such as ASDAS and BASDAI, followed by discussion with the nurse. Explanation by the nurse of the collection, calculation of BASDAI and ASDAS (via a calculator provided to the patient) and reports of the results on a sheet form. Monthly evaluation at home recommended by the nurse. Treatment allocation: after written informed consent, the treatment was allocated randomly via en electronic system (e.g. either this above program or an evaluation of potential co-morbidities (not reported here). Outcome variables: Primary: The level of coping (0-10, where 0= very well) after 12 months. Other variables: Successful smoking cessation, NSAID intake, Number of home-based or supervised exercise, international physical activity questionnaire (IPAQ)

Results: There was no difference in the baseline characteristics of the 502 recruited patients (250 and 252 in the active and control groups, respectively): Age: 46.7±12.2 years, male gender: 62.7%, disease duration: 13.7±11.0y, Xray sacroiliitis 62.8%, MRI sacroiliitis 65.7%, current biologic treatment: 78.3%, ASDAS-CRP: 1.9 ± 0.8, BASFI: 25.6±22.3. After the 1year follow-up period, the coping level was lower in the active group, but this difference was not significant (2.8±2.0 vs. 3.0±2.1, p=0.3). However, there was a significant decrease in the BASDAI in the active group (- 1.2 ± 15.8 vs. +1.4 ± 15.7, p=0.03), a significant increase in the number (6.1± 28.8 vs. -0.4±26.9, p=0.03) and duration (4.3±20.1 vs. -1.7±20.7, p<0.01) of the home-exercises in the active group, and a greater IPAQ score in the active group at the end of follow-up (138.4±227 vs. 95.6±173,p=0.02). Neither smoking cessations nor NSAID intake were different after one year in both groups.

Conclusion: This study highly suggests a short-term benefit of a nurse led program on the self-management and self-assessment for disease activity in a young axSpA population in particular with regard to the frequency and the duration of home exercises .

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/impact-of-a-nurse-led-program-of-patient-self-assessment-and-self-management-axial-spondyloarthritis-results-of-a-prospective-multicentre-randomized-controlled-trial/