Effects of patient education on compliance with basic treatment regimens and health in recent onset active rheumatoid arthritis
- aRheumatology Twente, Departments of Rheumatology, Almelo, Twenteborg Ziekenhuis,Enschede, Medisch Spectrum Twente, the Netherlands, bUniversity Twente, Department of Psychology, Faculty of Philosophy and Social Sciences, the Netherlands
- Dr H L M Brus, Medisch Spectrum Twente, Department of Rheumatology, Postbus 50.000, 7500 KA Enschede, the Netherlands.
- Accepted 13 February 1998
OBJECTIVES To determine the effects of patient education on compliance and on health in patients with active, recent onset rheumatoid arthritis (RA).
METHODS A randomised, controlled, assessor blinded, one year trial. The experimental group followed an education programme. All patients started on sulphasalazine therapy. Compliance with sulphasalazine was measured by pill counting. Compliance rates with regimens of physical exercise, endurance activities, and energy conservation were measured by questionnaires. Compliance with prescriptions of joint protection was scored using a test for joint protection performance. Health was measured by a Disease Activity Score (function of erythrocyte sedimentation rate, Ritchie score, and number of swollen joints), C reactive protein, Dutch-AIMS scores, and M-HAQ scores, range of motion of shoulder, elbow, and knee joints. Parameters were scored at baseline and after three, six, and 12 months.
RESULTS Sixty of 65 patients gave informed consent, five of them withdrew from follow up. Compliance with sulphasalazine exceeded 80% with no differences between groups. Compliance with physical exercise (at three months), energy conservation (at three and at 12 months), and joint protection (at three months) improved significantly more in the experimental group. The improvements of health were not different in the groups.
CONCLUSION Compliance with sulphasalazine among patients with active, recent onset RA is high, whether formal patient education is followed or not. Compliance with physical exercise, energy conservation, and joint protection was increased by patient education. Formal patient education did not improve health status.
↵* Additional information on the education programme will be provided by the authors on request.