Effectiveness of a novel digital patient education programme to support self-management of early rheumatoid arthritis: a randomized controlled trial

Author:

Knudsen Line R12ORCID,Ndosi Mwidimi34ORCID,Hauge Ellen-Margrethe12ORCID,Lomborg Kirsten56ORCID,Dreyer Lene78ORCID,Aaboe Sidsel9,Kjær Marie B1,Sørensen Lis7,Volsmann Lena10,Christensen Heidi M11ORCID,de Thurah Annette12ORCID

Affiliation:

1. Department of Rheumatology, Aarhus University Hospital , Aarhus, Denmark

2. Department of Clinical Medicine, Aarhus University , Aarhus, Denmark

3. School of Health and Social Wellbeing, University of the West of England , Bristol, UK

4. Rheumatology Unit, University Hospitals Bristol and Weston NHS Trust , Bristol, UK

5. Steno Diabetes Center Copenhagen , Copenhagen, Denmark

6. Department of Clinical Medicine, University of Copenhagen , Copenhagen, Denmark

7. Center of Rheumatic Research Aalborg (CERRA), Department of Rheumatology, Aalborg University Hospital , Aalborg, Denmark

8. Department of Clinical Medicine, Aalborg University , Aalborg, Denmark

9. Department of Rheumatology, Randers Regional Hospital , Randers, Denmark

10. Department of Rheumatology, Horsens Regional Hospital , Horsens, Denmark

11. Department of Rheumatology, Hjørring Regional Hospital , Hjørring, Denmark

Abstract

Abstract Objectives To evaluate the effectiveness of a novel digital patient education (PE) programme in improving self-management in patients newly diagnosed with rheumatoid arthritis (RA). Methods This was a parallel, open-label, two-armed, randomized controlled trial with superiority design. Patients from five rheumatology clinics were randomized into digital PE (intervention) or face-to-face PE (control). The primary outcome was self-efficacy, measured by average difference in the Rheumatoid Arthritis Self-Efficacy (RASE) score from baseline to month 12. Secondary outcomes were RA knowledge, health literacy, adherence and quality of life. Healthcare utilization data and digital PE programme usage were recorded. Self-efficacy, knowledge and health literacy data were analysed using mixed-effects repeated measures modelling; adherence using logistic regression, and quality of life and healthcare utilization using descriptive statistics with the Wilcoxon rank-sum test. Results Of the 180 patients randomized (digital PE, n = 89; face-to-face PE, n = 91), 175 had data available for analysis. Median age was 59.0 years and 61% were women. The average difference in self-efficacy between groups from baseline to month 12 was significant by a −4.34 difference in RASE score, favouring the intervention group (95% CI: −8.17 to −0.51; P = 0.026). RA knowledge, health literacy and quality of life showed minor improvements over time but no difference between groups, except out-patient clinic contacts, which were fewer in the intervention group. Conclusion The findings suggest that digital PE is effective in improving self-efficacy and therefore self-management in patients with early RA. This intervention has potential to lower healthcare costs by decreasing out-patient clinic contacts. Trial registration number clinicaltrials.gov, NCT04669340.

Funder

TrygFonden

Publisher

Oxford University Press (OUP)

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