综合多学科骨关节炎门诊项目与常规门诊的效果对比：一项随机对照试验

Effectiveness of an Integrated Multidisciplinary Osteoarthritis Outpatient Program versus Outpatient Clinic as Usual: A Randomized Controlled Trial.

作者信息

Moe Rikke Helene, Grotle Margreth, Kjeken Ingvild, Olsen Inge Christoffer, Mowinckel Petter, Haavardsholm Espen A, Hagen Kåre Birger, Kvien Tore K, Uhlig Till

机构信息

From the National Advisory Unit on Rehabilitation in Rheumatology; Department of Rheumatology, Diakonhjemmet Hospital; Institute of Health and Society, Faculty of Medicine, the University of Oslo; Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital, Oslo, Norway.R.H. Moe, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; M. Grotle, PT, PhD, Professor, Department of Physiotherapy, Oslo and Akershus University College of Applied Sciences/Formi, Oslo University Hospital; I. Kjeken, OT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Statistician, Department of Rheumatology, Diakonhjemmet Hospital; P. Mowinckel, MSc, Statistician, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K.B. Hagen, PT, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, and Institute of Health and Society, Faculty of Medicine, the University of Oslo; T.K. Kvien, MD, PhD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; T. Uhlig, MD, PhD, Professor, National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital.

出版信息

J Rheumatol. 2016 Feb;43(2):411-8. doi: 10.3899/jrheum.150157. Epub 2015 Dec 15.

DOI:10.3899/jrheum.150157

PMID:26669917

Abstract

OBJECTIVE

Osteoarthritis (OA) is one of the leading causes of pain and disability. Given the constraint in the provision of care, there is a need to develop and assess effectiveness of new treatment models. The objective was to compare satisfaction with and effectiveness of a new integrated multidisciplinary outpatient program with usual care in an outpatient clinic for patients with OA.

METHODS

Patients with clinical OA referred to a rheumatology outpatient clinic were randomized to a 3.5-h multidisciplinary group-based educational program followed by individual consultations, or to usual care. The primary outcome was satisfaction with the health service evaluated on a numerical rating scale (0 = extremely unsatisfied, 10 = extremely satisfied) after 4 months. Secondary outcomes included health-related quality of life measures.

RESULTS

Of 391 patients, 86.4% (n = 338) were women, and mean age was 61.2 (SD 8.0) years. At 4 months, patients who received integrated multidisciplinary care were significantly more satisfied with the health service compared with controls, with a mean difference of -1.05 (95% CI -1.68 to -0.43, p < 0.001). Among secondary outcomes, only self-efficacy with other symptoms scale (10-100) improved significantly in the multidisciplinary group compared with controls at 4 months (3.59, 95% CI 0.69-6.5, p = 0.02). At 12 months, the Australian/Canadian Hand Osteoarthritis Index pain (0-10) and fatigue scores (0-10) were slightly worse in the multidisciplinary group with differences of 0.38 (95% CI 0.06-0.71, p = 0.02) and 0.55 (95% CI 0.02-1.07, p = 0.04), respectively.

CONCLUSION

Patients receiving an integrated multidisciplinary care model were more satisfied with healthcare than those receiving usual care, whereas there were no clinically relevant improvements in health outcomes.

摘要

目的

骨关节炎（OA）是疼痛和残疾的主要原因之一。鉴于医疗服务提供方面的限制，有必要开发并评估新治疗模式的有效性。目的是比较在门诊诊所中，针对OA患者的新型综合多学科门诊项目与常规护理的满意度和有效性。

方法

转诊至风湿病门诊诊所的临床OA患者被随机分为两组，一组接受为期3.5小时的多学科小组教育项目，随后进行个体咨询，另一组接受常规护理。主要结局是4个月后通过数字评分量表（0=极度不满意，10=极度满意）评估的对医疗服务的满意度。次要结局包括与健康相关的生活质量指标。

结果

在391例患者中，86.4%（n=338）为女性，平均年龄为61.2（标准差8.0）岁。4个月时，与对照组相比，接受综合多学科护理的患者对医疗服务的满意度显著更高，平均差异为-1.05（95%置信区间-1.68至-0.43，p<0.001）。在次要结局中，与对照组相比，多学科组在4个月时仅其他症状自我效能量表（10-100）有显著改善（3.59，95%置信区间0.69-6.5，p=0.02）。12个月时，多学科组的澳大利亚/加拿大手部骨关节炎指数疼痛（0-10）和疲劳评分（0-10）略差，差异分别为0.38（95%置信区间0.06-0.71，p=0.02）和0.55（95%置信区间0.02-1.07，p=0.04）。