Victor Christina R, Triggs Eric, Ross Fiona, Lord Joanne, Axford John S
Department of Social Gerontology, St George's Hospital & Medical School, London, UK.
Clin Rheumatol. 2005 Aug;24(4):358-64. doi: 10.1007/s10067-004-1001-9. Epub 2005 Jun 4.
Osteoarthritis (OA) is the commonest cause of locomotor disability and forms a major element of the workload of the primary care team. There is evidence that patient education may improve quality of life, physical functioning, mental health and coping as well as reducing health service use. The aim of this study was to evaluate the effectiveness of a primary care-based patient education programme (PEP) using a randomised controlled trial. A cluster randomised controlled trial, involving 22 practices, was used to determine the efficacy of a nurse-led education programme. The programme consisted of a home visit and four 1-h teaching sessions. Patients were assessed at baseline and then 1, 3, 6 and 12 months post intervention using 36-item Short Form (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), arthritis helplessness index and a patient knowledge questionnaire. Direct interviews were used at baseline and at the 12-month follow-up. There were no differences in depression, OA knowledge, pain or physical ability at either 1 month or 1 year between the two groups. Control practices (65 patients from 12 practices) recruited significantly fewer patients than intervention practices (105 patients from ten practices, p = 0.02). Control practices had more doctors (p = 0.02), more non-white patients (p = 0.007), fewer patients living alone (p = 0.005) and lower levels of disability (p = 0.008). We detected a lack of benefit of PEP for people with OA of the knee. This was thought to be due in part to the short intervention time employed and the heterogeneous nature of the disease and the population studied.
骨关节炎（OA）是导致运动功能障碍的最常见原因，也是基层医疗团队工作量的主要组成部分。有证据表明，患者教育可能会改善生活质量、身体机能、心理健康和应对能力，同时减少医疗服务的使用。本研究旨在通过随机对照试验评估基于基层医疗的患者教育计划（PEP）的有效性。一项涉及22家医疗机构的整群随机对照试验被用于确定护士主导的教育计划的疗效。该计划包括一次家访和四次1小时的教学课程。在基线时以及干预后1、3、6和12个月，使用36项简明健康调查问卷（SF-36）、西安大略和麦克马斯特大学骨关节炎指数（WOMAC）、关节炎无助感指数和患者知识问卷对患者进行评估。在基线和12个月随访时进行直接访谈。两组在1个月或1年时的抑郁、OA知识、疼痛或身体能力方面均无差异。对照医疗机构（来自12家医疗机构的65名患者）招募的患者明显少于干预医疗机构（来自10家医疗机构的105名患者，p = 0.02）。对照医疗机构的医生更多（p = 0.02），非白人患者更多（p = 0.007），独居患者更少（p = 0.005），残疾水平更低（p = 0.008）。我们发现PEP对膝骨关节炎患者没有益处。这被认为部分是由于干预时间较短以及疾病和研究人群的异质性所致。
