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Effectiveness of a measurement feedback system on outcome in rheumatoid arthritis: a controlled clinical trial
  1. J Fransen1,
  2. G Stucki2,
  3. J Twisk3,
  4. A-M Chamot4,
  5. J-C Gerster5,
  6. T Langenegger6,
  7. M Seitz7,
  8. B A Michel1,
  9. the members of the Swiss Clinical Quality Management in Rheumatoid Arthritis (SCQM)
  1. 1Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Switzerland
  2. 2Department of Physical Medicine and Rehabilitation, University Hospital Munich, Germany
  3. 3Institute of Research in Extramural Medicine, Faculty of Medicine, Free University Amsterdam, The Netherlands
  4. 4Private practice, Morges, Switzerland
  5. 5Department of Rheumatology, Physical Medicine and Rehabilitation, University Hospital Lausanne, Switzerland
  6. 6Adelheid Page Rehabilitation Hospital, Oberaegeri, Switzerland
  7. 7Clinic for Rheumatology and Clinical Immunology and Allergology, University Hospital Berne, Switzerland
  1. Correspondence to:
    Dr J Fransen, Department of Rheumatology, University Medical Centre Nijmegen, PO Box 9101, NL-6500 HB Nijmegen, The Netherlands;


Background: With the help of a measurement feedback system, the treatment strategy for individual patients with rheumatoid arthritis (RA) can be adjusted to achieve optimal control of disease activity.

Objective: To study whether a measurement feedback system is effective in reducing disease activity in patients with RA.

Methods: Forty eight rheumatologists and 264 patients participated in a controlled clinical trial. A three month control period was followed by a 12 month period, where feedback on disease activity, disability, and damage was provided to the rheumatologist. The primary outcome measure was the rheumatoid arthritis disease activity index (RADAI).

Results: The feedback system was used for 142/228 (62%) patients. Disease modifying antirheumatic drug changes occurred in 69/169 (41%) patients. In patients with high disease activity and feedback use (n=70), the RADAI decreased in the feedback period by –0.27 points per 30 days (p<0.05), as compared with the control period. Patients for whom the feedback system was used had a better outcome than non-users.

Conclusion: Much more training on the use of a feedback system and outcome measures, as well as the inclusion of explicit treatment guidelines will be necessary to increase the clinical use of measurement feedback and, possibly, to reduce disease activity for a larger number of patients with RA.

  • rheumatoid arthritis
  • disease activity
  • decision support
  • multilevel analysis
  • CDSS, computerised decision support systems
  • DAS28, disease activity score
  • DMARDs, disease modifying antirheumatic drugs
  • ESR, erythrocyte sedimentation rate
  • HAQ, Health Assessment Questionnaire
  • RA, rheumatoid arthritis
  • RADAI, rheumatoid arthritis disease activity index
  • RCT, randomised controlled trial
  • SCQM, Swiss Clinical Quality Management
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  • The members of the Swiss Clinical Quality Management in Rheumatoid Arthritis (SCQM) are: I Büchler, A-M Chamot, B Christen, G Dalvit, A Forster, P-A Guerne, P Hasler, T Langenegger, B A Michel, L Schmid, H Schwarz, M Seitz, A So, R Theiler, D van Linthoudt, P Villiger.

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