Article type
Year
Abstract
Introduction/Objective: In patients with RA, MTC programmes including medical and nursing care, exercise and occupational therapy and support by a social worker, are often prescribed. The aim of the systematic review was to assess the effectiveness of MTC for patients with RA.
Methods: Data were obtained by a MEDLINE database search (1966-January 1997) using the MeSH headings 'rheumatoid arthritis', 'rehabilitation', 'hospitalization', 'ambulatory care' and 'patient care team', and 'multidisciplinary team care' as free text. In addition, a manual search of reference lists was performed. The selection and review of all studies was done by both authors.
Results: Forty-two papers reporting on 35 trials of MTC in patients with RA were identified. Nine trials were randomised and were selected for further review. The characteristics of the participants, interventions and outcome measures varied widely. In most of the trials concealment of allocation and blinded outcome assessment were unclear or lacking. In 3/9 trials inpatient MTC was compared with regular outpatient care. All 3 inpatient MTC programmes (average duration 11-28 days) showed to be effective with respect to disease activity. In 4/9 trials outpatient MTC was compared with regular outpatient care. In 3 of these studies (average duration 1-2 years) an effect on disease activity, functional status and overall health was demonstrated, in one study no effect of outpatient MTC was seen. Of the 2 randomised trials in which inpatient MTC was compared with outpatient MTC (average duration 16-21 days) one showed that inpatient MTC was more effective than outpatient MTC according to disease activity and functional status, whereas in the other study similar results in both groups were obtained. In this latter study, outpatient MTC was provided in a day patient care setting. In both studies inpatient MTC was more expensive than outpatient MTC.
Discussion: The methodological quality of studies on the effectiveness of MTC in RA is low, but the results of a few randomised clinical trials suggest that is effective. Future trials on MTC in RA need to focus on methodological quality and the analysis of both effectiveness and costs.
Methods: Data were obtained by a MEDLINE database search (1966-January 1997) using the MeSH headings 'rheumatoid arthritis', 'rehabilitation', 'hospitalization', 'ambulatory care' and 'patient care team', and 'multidisciplinary team care' as free text. In addition, a manual search of reference lists was performed. The selection and review of all studies was done by both authors.
Results: Forty-two papers reporting on 35 trials of MTC in patients with RA were identified. Nine trials were randomised and were selected for further review. The characteristics of the participants, interventions and outcome measures varied widely. In most of the trials concealment of allocation and blinded outcome assessment were unclear or lacking. In 3/9 trials inpatient MTC was compared with regular outpatient care. All 3 inpatient MTC programmes (average duration 11-28 days) showed to be effective with respect to disease activity. In 4/9 trials outpatient MTC was compared with regular outpatient care. In 3 of these studies (average duration 1-2 years) an effect on disease activity, functional status and overall health was demonstrated, in one study no effect of outpatient MTC was seen. Of the 2 randomised trials in which inpatient MTC was compared with outpatient MTC (average duration 16-21 days) one showed that inpatient MTC was more effective than outpatient MTC according to disease activity and functional status, whereas in the other study similar results in both groups were obtained. In this latter study, outpatient MTC was provided in a day patient care setting. In both studies inpatient MTC was more expensive than outpatient MTC.
Discussion: The methodological quality of studies on the effectiveness of MTC in RA is low, but the results of a few randomised clinical trials suggest that is effective. Future trials on MTC in RA need to focus on methodological quality and the analysis of both effectiveness and costs.