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AB0345 A step forward to close the loop: Applying “joint-fitness” and patient reported outcome measures to tailor a patient-specific education program
  1. Y. El Miedany1,
  2. M. El Gaafary2,
  3. S. Youssef1,
  4. N. El Aroussy1,
  5. I. Ahmed3,
  6. D. Palmer4
  1. 1Rheumatology and Rehab
  2. 2Community, Environmental and Occupational Medicine, Ain Shams University
  3. 3Internal Medicine, Cairo University, Cairo, Egypt
  4. 4Rheumatology, North Middlesex University Hospitals, London, United Kingdom


Background Self-management programs are broadly focused on using information, problem-solving and coping skills for symptom management. Their aim is not only to achieve more than the provision of information to increase knowledge, but also to change health behavior and health status, teaching patients to identify and solve problems, set goals and plan actions. However, patient education remains a matter of research rather than use in clinical practice.The joint fitness program is a patient-based program that has been developed for arthritis patients. It includes 4 main components: Educational: joint learn, Behavioral: joint change, information: Joint act and Joint-cise (joint exercise)

Objectives To assess: 1. the integration of patient reported outcome measures (PROMs) and patients education, using the joint-fitness program as a health education tool for arthritic patients, in standard clinical practice. 2. the effectiveness of this combined approach to influence disease activity, behavior and perceived helplessness, health status of persons with arthritis (as determined by improvements in pain, quality of life and physical function) as well as adherence to therapy.

Methods This was a double-blind randomized controlled study which included 268 arthritic patients monitored over 18 months. Every patient completed a PROMs questionnaire [1]. By the 6th month of treatment, the patients were randomly allocated to an active group (134 patients) who were able to view former self-reported PROMs scores and discuss the implementation of the joint fitness program as a tool for psycho-educational interventions. The control group (134 patients) continued their treatment and management based on viewing their recorded PROMs and clinical assessment. The patients were assessed at 3 monthly intervals for another 12 months. Primary outcome: was the change in the patients’ adherence to their medications as well as the patients’ disease activity score (DAS-28). Secondary outcome was the change of the PROMs domains (pain score, patient global assessment, functional disability, quality of life and self-helplessness).

Results The integration of patient education and PROMs led to a significant greater reduction of disease activity parameters and DAS-28 score (p<0.01). 120/134 (89.6%) patients in group I were adherent to their drug therapy in comparison to 87/134 (64.9%) in group II (p<0.01). The improvement of disease activity parameters was associated with improvement in functional disability (p<0.01). Significant improvement of the quality of life scores (p<0.01) led to improvement of the patients’ ratings for ability to sleep, share in the social activities, feeling down or anxious, self-helplessness as well as pain (p<0.01). At 18 months follow-up, both the self-management and cognitive behavioral therapy intervention demonstrated improvement for disease activity (effect size 1.4 and 1.2 respectively)

Conclusions The integration of patient education and PROMs succeeded in improving self-perceived health, disease activity as well as the patients’ adherence to therapy. The patient education for those suffering from inflammatory arthritis is feasible in the standard clinical practice.

  1. El Miedany et al. Clin Exp Rheum 2010; 28: 734.

Disclosure of Interest None Declared

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