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Abstract Number: 1187

Impact of a Nurse-Led Program of Patient Self-Assessment and Self-Management Axial Spondyloarthritis: Results of a Prospective, Multicentre, Randomized, Controlled Trial

Anna Molto1, Adrien Etcheto2, Serge Poiraudeau3, Laure Gossec4, Pascal Claudepierre5, Martin Soubrier6, Françoise Fayet7, Daniel Wendling8, Philippe Gaudin9, Emmanuelle Dernis10, Sandrine Guis11, Sophie Pouplin12, Adeline Ruyssen-Witrand13 and Maxime Dougados14, 1Rheumatology, Cochin Hospital, Paris, France, 2Department of Rheumatology, Paris Descartes University, Hôpital Cochin, Paris, France, 3Univ. Paris Descartes, PRES Sorbonne Paris, INSERM UMR-S 1153 et Institut fédératif de recherche sur le handicap, Paris, France, Paris, France, 4Rheumatology, Pitié Salpêtrière Hospital, Paris, France, 5Universite Paris Est Creteil, Paris, France, 6Rheumatology, Department of Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France, 7CHU Gabriel Montpied, Clermont Ferrand, France, 8Rheumatology, University Hospital - Bourgogne Franche Comté University, Besançon, France, 9Grenoble University Hospital, France, Grenoble, France, 10Service de Rhumatologie, CH du Mans, Le Mans, France, 11Rheumatology Department, CHU, Marseile, France, 12Rheumatology Department & Inserm 905, Department of Rheumatology, Rouen University Hospital & Inserm 905, Institute for Biomedical Research, University of Rouen, Rouen, France, 13Rheumatology, Purpan Hospital, Toulouse III University, Toulouse, France, 14Paris Descartes University, Hôpital Cochin, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: educational innovation, exercise, nurse practitioners, self-management and spondylarthritis

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Session Information

Date: Monday, October 22, 2018

Session Title: Health Services Research Poster II – ACR/ARHP

Session Type: ACR/ARHP Combined Abstract Session

Session Time: 9:00AM-11:00AM

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 .


Disclosure: A. Molto, None; A. Etcheto, None; S. Poiraudeau, None; L. Gossec, Lilly France, BMs France, Pfizer France, Orange IMT, 2; P. Claudepierre, None; M. Soubrier, None; F. Fayet, None; D. Wendling, None; P. Gaudin, None; E. Dernis, None; S. Guis, None; S. Pouplin, None; A. Ruyssen-Witrand, None; M. Dougados, Abbvie, Pfizer, Eli Lilly and Company, Novartis, UCB, Merck, Roche, BMS , UCB, 2, 5.

To cite this abstract in AMA style:

Molto A, Etcheto A, Poiraudeau S, Gossec L, Claudepierre P, Soubrier M, Fayet F, Wendling D, Gaudin P, Dernis E, Guis S, Pouplin S, Ruyssen-Witrand A, Dougados M. Impact of a Nurse-Led Program of Patient Self-Assessment and Self-Management Axial Spondyloarthritis: Results of a Prospective, Multicentre, Randomized, Controlled Trial [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). 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/. Accessed January 28, 2023.
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