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Nagy Z, Szigedi E, Takács S, Császár-Nagy N. The Effectiveness of Psychological Interventions for Rheumatoid Arthritis (RA): A Systematic Review and Meta-Analysis. Life (Basel) 2023; 13:life13030849. [PMID: 36984004 PMCID: PMC10057722 DOI: 10.3390/life13030849] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/13/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
Rheumatoid arthritis (RA) is a long-term disorder that significantly impairs somatic, emotional, and psychological functioning. The objective of this review is to identify, appraise, and synthesize the effects of psychological interventions (e.g., cognitive behavioral therapy (CBT), emotional disclosure (ED), group therapy (GT), mindfulness (M), patient education (PE), and relaxation (R)) on biopsychosocial outcomes in the treatment of rheumatoid arthritis (RA). A systematic search of all relevant existing randomized clinical trials (RCTs) was conducted using the following online bibliographic databases: JSTOR, PubMed, PsycNET, and The Cochrane Library. Reference lists were searched for additional reports. The Cochrane Risk of Bias tool (RoB 2.0) was used to assess the risk of bias in the included studies. After the selection process, 57 articles were included and 392 were excluded. Three separate meta-analyses were conducted involving psychological interventions as the main variables, showing: (1) significant positive medium effect sizes for average values (Hedges-g = 0.399, Z = 0.399, p = 0.009); (2) significant positive large effect sizes for maximum values (Hedges-g = 0.856, Z = 4.223, p < 0.001); and (3) non-significant results for minimum values (Hedges-g = -0.047, Z = -0.335, p = 0.738). These results demonstrate that, when grouped, psychological interventions are, on average, moderately effective in treating RA. Overall, this review shows consistent, supportive evidence that psychological interventions can significantly contribute to the standard medical care of RA patients. However, more high-quality, large-sample RCTs still need to confirm these findings.
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Affiliation(s)
- Zsófia Nagy
- Psychosomatic Outpatient Clinic, 1037 Budapest, Hungary
| | | | - Szabolcs Takács
- General Psychology and Methodology, Faculty of Humanities, Károli Gáspár University of the Reformed Church, Bécsi Str. 324, 1037 Budapest, Hungary
| | - Noémi Császár-Nagy
- Psychosomatic Outpatient Clinic, 1037 Budapest, Hungary
- Department of Public Organization and Information Technology, Faculty of Public Governance, and International Studies, University of Public Service, Ludovika Square 2, 1083 Budapest, Hungary
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Pot-Vaucel M, Aubert MP, Guillot P, Glémarec J, Berthelot JM, Le Goff B, Maugars Y. Randomised study versus control group of customised therapeutic education for patients in follow-up for rheumatoid arthritis. Joint Bone Spine 2015; 83:199-206. [PMID: 26677992 DOI: 10.1016/j.jbspin.2015.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 05/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We have evaluated customized objectives, predefined during a therapeutic education session for rheumatoid arthritis (RA). METHODS Fifty-four RA patients were randomised into patient therapeutic education (PTE) group versus waiting list (WL). The final comparative evaluation involved solving 3 predefined problems. RESULTS Fifty-four were evaluated after 6 months. The main criterion was defined for all three of the chosen themes at 76.9% in the PTE group and 42.4% in the WL group. Among the other positively evaluated criteria were: less corticotherapy, more occupational therapy, more demand for social aid, more physical activity, knowledge of the recognition of an RA attack and how to cope with it. On the other hand, knowledge of the treatments did not differ between the 2 groups nor did the RAPID scores, fatigue, stiffness, depression, compliance, number of consultations and hospitalisations. Patient satisfaction was excellent (between 85.3 and 93.9%). CONCLUSION This study is a good illustration of the position occupied and value of PTE in solving the problems specific to each RA case, the resulting high level of patient satisfaction and its independently complementary aspects relative to the purely medical treatment of RA. Customized PTE could better respond to specific patients problems in RA.
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Affiliation(s)
- Marianne Pot-Vaucel
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
| | - Marie-Pierre Aubert
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
| | - Pascale Guillot
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
| | - Joëlle Glémarec
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
| | - Jean-Marie Berthelot
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
| | - Benoit Le Goff
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France
| | - Yves Maugars
- Nantes University Hospital, 1, place Alexis-Ricordeau, 44093 Nantes cedex, France.
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Deng W, Hu J. The effects of a pilot intervention for community-dwelling adults with rheumatoid arthritis in wuhan, china. Front Public Health 2013; 1:43. [PMID: 24350212 PMCID: PMC3860135 DOI: 10.3389/fpubh.2013.00043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 09/24/2013] [Indexed: 11/21/2022] Open
Abstract
This study examined the effects of a pilot educational intervention program on knowledge, perceived self-efficacy, and health-related quality of life (HRQoL) of community-dwelling adults with rheumatoid arthritis (RA). A convenience sample of 16 participants with RA completed the program in Wuhan, China. Data were collected in face-to-face interviews using questionnaires at baseline, post-test, and 1 month follow-up. Knowledge scores were significantly increased over time. Significant differences were found in pain self-efficacy, symptoms self-efficacy, bodily pain, social functioning, and role emotional functions. Community health providers should provide educational programs to improve HRQoL for adults with RA.
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Affiliation(s)
- Wenfang Deng
- Hope School of Nursing, Wuhan University , Wuhan , China
| | - Jie Hu
- School of Nursing, The University of North Carolina at Greensboro , Greensboro, NC , USA
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Eleishi HH, Allison BD. Rheumatological medicine literacy among Middle Eastern populations. Int J Rheum Dis 2010; 12:336-42. [PMID: 20374372 DOI: 10.1111/j.1756-185x.2009.01432.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND It has been observed for years that many Middle Eastern patients with autoimmune rheumatic disorders, are more likely to be delayed in seeing a rheumatologist for their symptoms and that the rheumatology services are in general under-utilized by the population. AIM To explore if patients with autoimmune rheumatic disorders were truly delayed in seeing rheumatologists and to explore the possible reasons for that delay should any delay be documented. SUBJECTS AND METHODS Patients suffering from chronic autoimmune rheumatic disorders were interviewed and were asked to answer a questionnaire that assesses their initial set of actions when they had their first symptoms of disease, how much time they took to see a rheumatologist and their background knowledge about rheumatology as a specialty before and after they saw a rheumatologist. RESULTS Seventy-eight patients, 57 (73%) females and 21 (27%) males were included in this study. Their ages ranged from 11 to 72 years with a mean of 38.9 +/- 13 years. Patients' explanations for their initial symptoms were 'evil eye doing', disease, exertion, cold weather and trauma in 44%, 37%, 20%, 16% and 8% respectively. Ninety-six percent of patients had to make a total of 166 consultations first at other specialties before they were finally advised or directed to see a rheumatologist. Non-rheumatologist referrals to rheumatologists happened in only 33% of the time. The duration from the onset of the disease until patients finally came to see a rheumatologist ranged from 0.5 weeks to 432 weeks with a mean of 51 +/- 88 weeks. CONCLUSIONS General health literacy and knowledge of the rheumatology scope of service is extremely limited among Middle Eastern patients. Most patients with autoimmune rheumatic diseases make their initial consultations at clinics other than rheumatology clinics and non-rheumatologists have been shown to consistently not refer patients with rheumatic diseases to rheumatologists. Wrong diagnosis is attributed to rheumatology symptoms by non-rheumatologists 82% of the time. Level of education of patients, has no impact on their choice of the right specialty to be consulted for their disease symptoms.
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Mäkeläinen P, Vehviläinen-Julkunen K, Pietilä AM. Rheumatoid arthritis patients' education - contents and methods. J Clin Nurs 2008; 16:258-67. [PMID: 17931319 DOI: 10.1111/j.1365-2702.2007.01953.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES The purpose of this study is to describe the contents and methods used by rheumatology nurses when they educate their patients with rheumatoid arthritis. BACKGROUND Rheumatology nurses have an important role in educating patients with rheumatoid arthritis. However, there is a lack of knowledge on the content provided and the methods used by rheumatology nurses. DESIGN AND METHODS The sample was drawn in using stratified random sampling and the data were collected from 80 rheumatology nurses with a questionnaire in 2003-2004 (response rate was 65.2%). The data were analysed using descriptive and non-parametric statistical tests. RESULTS Medical treatment was the most commonly taught issue, as 76% of rheumatology nurses gave information on anti-rheumatic drugs prescribed to the rheumatoid arthritis patients and blood tests (64%) which must be taken as follow-up controls. Only 45% of the nurses discussed self care at home. Individual oral patient education (88%) and written materials by the local hospitals or drug industries (71%), were the most commonly used methods. Patients with rheumatoid arthritis were educated mostly in special health care units. A rheumatology nursing course did not have an effect on the chosen contents or methods when educating rheumatoid arthritis patients. CONCLUSIONS It is important that rheumatology nurses teach more self-care abilities to patients with rheumatoid arthritis and use also the other teaching methods than oral individual method such as group sessions, teleinformatics and internet. The contents of rheumatology nursing course should be developed further to stress the importance of appropriate teaching methods and to point out the importance of self care abilities for patients. RELEVANCE TO CLINICAL PRACTICE The results provided useful insight into education of patients with rheumatoid arthritis. Nurses should avoid the routine teaching programmes. They should take time to discuss with their patients and plan together the contents and methods, that education of patients with rheumatoid arthritis is based on patients' information needs and their individual learning capabilities.
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Bruno M, Cummins S, Gaudiano L, Stoos J, Blanpied P. Effectiveness of two Arthritis Foundation programs: Walk With Ease, and YOU Can Break the Pain Cycle. Clin Interv Aging 2008; 1:295-306. [PMID: 18046884 PMCID: PMC2695175 DOI: 10.2147/ciia.2006.1.3.295] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of two Arthritis Foundation programs: Walk With Ease (WWE) and YOU Can Break The Pain Cycle (PC). DESIGN Quasi-experimental, repeated measures design. Retested at six weeks and four months. SETTING Community based intervention. PARTICIPANTS Volunteer sample of 163 adults with arthritis recruited through mailings, newspapers, and flyers. INTERVENTIONS Subjects participated in a 90 minute seminar (PC, Group A), a six-week walking program (WWE, Group B), or both programs (Group C). MAIN OUTCOME MEASURES Survey assessment of arthritis knowledge, general health, self-management activities, confidence, physical abilities, depression, health distress, and how arthritis affects their life. A Squat Test, a Six Minute Walk test, and a Timed Functional Walk Test were also administered. RESULTS Subjects in Group B were more confident, less depressed, had less health distress, and less pain than subjects in Group A. Scores of Group C were between Group A and B scores. Differences in groups over time indicated that the WWE resulted in increased confidence, physical abilities, time spent in self-management activities and decreased pain and fatigue. All groups increased in walking endurance at six weeks, and increased in health distress at four months. CONCLUSION Subjects in different programs differed on impact of arthritis. These programs provide effective arthritis management opportunities.
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Affiliation(s)
- Michelle Bruno
- Physical Therapy Program, University of Rhode Island, Kingston, RI 02881, USA
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Metsios GS, Stavropoulos-Kalinoglou A, Veldhuijzen van Zanten JJCS, Treharne GJ, Panoulas VF, Douglas KMJ, Koutedakis Y, Kitas GD. Rheumatoid arthritis, cardiovascular disease and physical exercise: a systematic review. Rheumatology (Oxford) 2007; 47:239-48. [PMID: 18045810 DOI: 10.1093/rheumatology/kem260] [Citation(s) in RCA: 149] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This systematic review investigates the effectiveness of exercise interventions in improving disease-related characteristics in patients with rheumatoid arthritis (RA). It also provides suggestions for exercise programmes suitable for improving the cardiovascular profile of RA patients and proposes areas for future research in the field. Six databases (Medline, Cochrane Library, CINAHL, Google Scholar, EMBASE and PEDro) were searched to identify publications from 1974 to December 2006 regarding RA and exercise interventions. The quality of the studies included was determined by using the Jadad scale. Initial searches identified 1342 articles from which 40 met the inclusion criteria. No studies were found investigating exercise interventions in relation to cardiovascular disease in RA. There is strong evidence suggesting that exercise from low to high intensity of various modes is effective in improving disease-related characteristics and functional ability in RA patients. Future studies are required to investigate the effects of exercise in improving the cardiovascular status of this patient population.
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Affiliation(s)
- G S Metsios
- University of Wolverhampton, School of Sport, Performing Arts and Leisure, Walsall, West Midlands.
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Gaudin P, Leguen-Guegan S, Allenet B, Baillet A, Grange L, Juvin R. Is dynamic exercise beneficial in patients with rheumatoid arthritis? Joint Bone Spine 2007; 75:11-7. [PMID: 17913551 DOI: 10.1016/j.jbspin.2007.04.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 04/19/2007] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Dynamic exercise therapy as defined by the American College of Sports Medicine for healthy individuals is of unclear relevance to patients with rheumatoid arthritis (RA). No recommendations on this issue are available. Few studies have evaluated the optimal program, frequency, or target population; furthermore, there is no consensus about the best assessment tools for monitoring clinical, functional, and structural parameters during dynamic exercise therapy in patients with RA. METHODS We conducted an extensive review of the literature published between 1964 and 2005. We identified nine randomized controlled studies that provided a high level of proof regarding the effects of dynamic exercise therapy in RA patients older than 18 years of age. RESULTS Dynamic exercise programs improve aerobic capacity and muscle strength in patients with RA. Their effects on functional capacity are unclear, and many sources of bias influenced the study results. The clinical and laboratory safety profiles were good. The structural impact of dynamic exercise remains to be determined.
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Affiliation(s)
- Philippe Gaudin
- Department of Rheumatology, Hôpital Sud, Teaching Hospital, BP 338, 38434 Echirolles cedex, France.
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Victor CR, Triggs E, Ross F, Lord J, Axford JS. Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee. Clin Rheumatol 2005; 24:358-64. [PMID: 15937632 DOI: 10.1007/s10067-004-1001-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2003] [Accepted: 09/18/2004] [Indexed: 10/25/2022]
Abstract
Osteoarthritis (OA) is the commonest cause of locomotor disability and forms a major element of the workload of the primary care team. There is evidence that patient education may improve quality of life, physical functioning, mental health and coping as well as reducing health service use. The aim of this study was to evaluate the effectiveness of a primary care-based patient education programme (PEP) using a randomised controlled trial. A cluster randomised controlled trial, involving 22 practices, was used to determine the efficacy of a nurse-led education programme. The programme consisted of a home visit and four 1-h teaching sessions. Patients were assessed at baseline and then 1, 3, 6 and 12 months post intervention using 36-item Short Form (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), arthritis helplessness index and a patient knowledge questionnaire. Direct interviews were used at baseline and at the 12-month follow-up. There were no differences in depression, OA knowledge, pain or physical ability at either 1 month or 1 year between the two groups. Control practices (65 patients from 12 practices) recruited significantly fewer patients than intervention practices (105 patients from ten practices, p = 0.02). Control practices had more doctors (p = 0.02), more non-white patients (p = 0.007), fewer patients living alone (p = 0.005) and lower levels of disability (p = 0.008). We detected a lack of benefit of PEP for people with OA of the knee. This was thought to be due in part to the short intervention time employed and the heterogeneous nature of the disease and the population studied.
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Affiliation(s)
- Christina R Victor
- Department of Social Gerontology, St George's Hospital & Medical School, London, UK
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Ramos-Remus C, Salcedo-Rocha AL, Prieto-Parra RE, Galvan-Villegas F. How important is patient education? Best Pract Res Clin Rheumatol 2000; 14:689-703. [PMID: 11092796 DOI: 10.1053/berh.2000.0107] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prevalence and disability rate of rheumatic diseases are increasing. It seems that non-medical causes play an important role in the morbidity, disability and mortality of these patients. Efforts to reduce their impact are extremely important. Patient education is thought to be one way to limit disability in rheumatic diseases and to achieve an improvement in quality of life. In this chapter, we review the influence of non-medical causes of morbidity on disease outcome, some basic aspects of education and the evidence of the effectiveness of patient education in diseases such as ankylosing spondylitis, systemic lupus erythematosus, rheumatoid arthritis and fibromyalgia syndrome.
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Affiliation(s)
- C Ramos-Remus
- Department of Rheumatology, Unidad de Investigación en Enfermedades Crónico-Degenerativas, Guadalajara, Mexico
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Abstract
Many patients with arthritis are strongly influenced by religious beliefs and often participate in religious healing activities such as prayer and worship attendance. Scientific studies demonstrate, and most patients confirm, that faith and involvement in religious healing activities can be helpful in preventing and treating illness, recovering from surgery, reducing pain, and improving quality of life. To improve the care of patients, clinicians should develop a patient-centered, spiritually sensitive form of medical practice in which religious issues are addressed gently and appropriately with dignity, respect, and integrity.
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Affiliation(s)
- D A Matthews
- Division of General Internal Medicine, Georgetown University School of Medicine, Washington, DC, USA.
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Gignac MA. An evaluation of a psychotherapeutic group intervention for persons having difficulty coping with musculoskeletal disorders. SOCIAL WORK IN HEALTH CARE 2000; 32:57-75. [PMID: 11291892 DOI: 10.1300/j010v32n01_05] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This study evaluated an 8-9 week psychotherapeutic group program designed to help people cope with the difficulties and changes that arise when living with musculoskeletal (MSK) disorders. Also examined were individual differences in client expectations about the benefits of the groups. Participants were 64 community-dwelling adults who completed questionnaires at the beginning, end, and three months after their final group session. Outcomes were mastery, coping efficacy, helplessness, self-acceptance and depression. Significant changes from pre- to post-intervention were found in mastery, depression, and coping-efficacy with effect sizes of .50 or greater. Individuals who had concerns or reservations about participating in the groups gained from the intervention in the same ways as others who were more positive at the outset of the groups.
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Affiliation(s)
- M A Gignac
- The Arthritis Community Research & Evaluation Unit, The University Health Network, Toronto, Ontario, Canada.
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Suarez-Almazor ME, Kaul P. Health services research. Curr Opin Rheumatol 1999; 11:110-6. [PMID: 10319213 DOI: 10.1097/00002281-199903000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the past year, several publications have reported on aspects of health services research in regard to musculoskeletal disorders. Utilization studies in the elderly have shown that an effective procedure such as hip arthroplasty may be underused in this population. As well, surgical complications in these patients appear to vary according to the number of procedures performed in a hospital, with high-volume hospitals showing better outcomes. Studies of practice patterns show variations among rheumatologists in the treatment of various rheumatic diseases. Practice variations between physician groups, in particular, rheumatologists versus primary care providers, have also been reported. Several studies show that primary care physicians may have some difficulties in diagnosing common rheumatic disorders. There is some evidence as well that rheumatologists may provide better care for some conditions, such as rheumatoid arthritis. These findings have major implications for restrictions to patient access to specialist care by health organizations. A variety of clinical practice guidelines have been developed and tested, most aimed at general practitioners. Physician compliance with guidelines continues to be low for most implementation strategies. Multidisciplinary programs for the treatment of rheumatoid arthritis appear to have a somewhat beneficial effect. Programs based only on patient education appear to have short-term gains, and longer-term effects are diluted because of noncompliant behaviors.
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Affiliation(s)
- M E Suarez-Almazor
- Department of Public Health Sciences, Faculty of Medicine & Oral Health Sciences, University of Alberta, Edmonton, Canada
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Callahan LF, Pincus T. Education, self-care, and outcomes of rheumatic diseases: further challenges to the "biomedical model" paradigm. ARTHRITIS CARE AND RESEARCH : THE OFFICIAL JOURNAL OF THE ARTHRITIS HEALTH PROFESSIONS ASSOCIATION 1997; 10:283-8. [PMID: 9362594 DOI: 10.1002/art.1790100502] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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