Leiden University Medical Center, Leiden, The Netherlands.
Arthritis Care Res (Hoboken). 2010 Jun;62(6):865-72. doi: 10.1002/acr.20138.
To evaluate the implementation of an intensive group exercise program in patients with rheumatoid arthritis (RA).
In 4 regions in The Netherlands, the Rheumatoid Arthritis Patients In Training exercise program was implemented on a limited scale. Evaluation using the RE-AIM model included: Reach, the proportion of the target population participating; Efficacy, effects on muscle strength, aerobic capacity, functional ability, and psychological functioning; Adoption, program adoption by stakeholders; Implementation, intervention quality (quality audits); and Maintenance, stakeholders' willingness to continue the program in the future.
Twenty-five physical therapists from 14 practices were trained to provide the program. In total, 150 RA patients were recruited (by estimation, 2% of the target population). Of the 81 patients who had finished the 12-month intervention and were available for followup directly after the intervention, 62 patients provided clinical data. Muscle strength improved significantly, whereas aerobic capacity, functional ability, psychological functioning, and disease activity did not change. All 9 informed local patient organizations facilitated patient recruitment, and 35 of 51 rheumatologists involved referred one or more patients. All 10 approached health insurance companies funded the program for 12 months. The quality audits showed sufficient quality in 9 of 12 practices. All of the providers of the program were willing to provide the program in the future, whereas future reimbursement by health insurance companies remained unclear.
The implementation of an intensive exercise program for RA patients on a limited scale can be considered successful regarding its reach, adoption, and implementation. The limited effectiveness and the limited data regarding maintenance warrant additional research.
评估类风湿关节炎患者强化团体运动方案的实施情况。
在荷兰的 4 个地区，对类风湿关节炎患者培训锻炼方案进行了有限规模的实施。采用 RE-AIM 模型进行评估，包括：实施的广度，即目标人群的参与比例；疗效，对肌肉力量、有氧能力、功能能力和心理功能的影响；采用情况，利益相关者对方案的采用；实施情况，干预质量（质量审核）；以及维持情况，利益相关者未来继续实施该方案的意愿。
培训了 14 家诊所的 25 名物理治疗师来提供该方案。共有 150 名类风湿关节炎患者（据估计，占目标人群的 2%）被招募。在完成 12 个月干预且可在干预后直接进行随访的 81 名患者中，有 62 名患者提供了临床数据。肌肉力量显著改善，而有氧能力、功能能力、心理功能和疾病活动度没有变化。当地的 9 个患者组织都为患者招募提供了便利，51 名风湿病学家中有 35 名转诊了 1 名或多名患者。所有 10 家接洽的健康保险公司都为该方案提供了为期 12 个月的资金。质量审核显示，12 家诊所中有 9 家的质量足够好。所有该方案的提供者都愿意在未来继续提供该方案，但未来的医疗保险报销情况仍不清楚。
在有限规模上实施针对类风湿关节炎患者的强化运动方案，在广度、采用和实施方面可被认为是成功的。疗效有限，维持方面的数据有限，需要进一步研究。
