Effectiveness of a measurement feedback system on outcome in rheumatoid arthritis: a controlled clinical trial.
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.


CONCLUSIONS
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.
Fransen
J
J
Department of Rheumatology and Institute of Physical Medicine, University Hospital Zurich, Switzerland. j.fransen@reuma.azn.nl
Stucki
G
G
Twisk
J
J
Chamot
A-M
AM
Gerster
J-C
JC
Langenegger
T
T
Seitz
M
M
Michel
B A
BA
D000208:Acute Disease; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D000069285:Infliximab; D007721:Knowledge of Results, Psychological; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D010347:Patient Care Planning; D011239:Prednisolone / Q000627:therapeutic use; D012044:Regression Analysis; D012219:Rheumatology; D012460:Sulfasalazine / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D012460:Sulfasalazine; D011239:Prednisolone; D000069285:Infliximab; D008727:Methotrexate