Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France.
Université de Paris, INSERM U-1153, CRESS, France.
Rheumatology (Oxford). 2021 Feb 1;60(2):888-895. doi: 10.1093/rheumatology/keaa480.
To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis.
Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group).
A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ).
This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.
评估护士主导的疾病活动自我管理和自我评估方案在中轴型脊柱关节炎中的影响。
前瞻性、随机、对照、开放、12 个月试验（NCT02374749）。参与者为连续的中轴型脊柱关节炎患者（根据风湿病学家的诊断）和参加过 1 天培训会议的护士。该方案包括自我管理：教育视频和针对患者的特定分级、家庭为基础的锻炼视频；自我评估：视频介绍使用复合评分（强直性脊柱炎疾病活动评分、ASDAS/Bath 强直性脊柱炎疾病活动指数、BASDAI）密切监测疾病活动的原理。护士培训患者收集、计算和报告（每月）ASDAS/BASDAI。治疗分配采用随机分配到该方案或合并症评估（此处未介绍，此处视为对照组）。
共纳入 502 例患者（主动组和对照组分别为 250 例和 252 例，年龄：46.7（12.2）岁，男性：62.7%，疾病持续时间：13.7（11.0）年）。经过 1 年的随访期，自我评估方案的依从性被认为是良好的（即 79%的患者报告了>6 次评分）。尽管主要结局（如应对能力）无统计学意义，但该方案在以下变量方面具有统计学意义的优势：BASDAI 的变化、主动组家庭锻炼的次数和持续时间以及身体活动（国际身体活动评分、IPAQ）。
本研究表明，在年轻的中轴型脊柱关节炎人群中，短期的护士主导的疾病活动自我管理和自我评估方案在疾病活动、锻炼和身体活动方面具有一定的益处。
