title: A randomized controlled trial of a cognitive behavioural patient education intervention vs a traditional information leaflet to address the cardiovascular aspects of rheumatoid disease.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) is responsible for 50% of the excess mortality for patients with RA. This study aimed to evaluate a novel 8-week cognitive behavioural patient education intervention designed to effect behavioural change with regard to modifiable CVD risk factors in people with RA.
  
  
  METHODS
  This was a non-blinded randomized controlled trial with a delayed intervention arm. Participants were randomly assigned to receive the cognitive behavioural education intervention or a control information leaflet at a ratio of 1:1. The primary outcome measure was patient's knowledge of CVD in RA; secondary measures were psychological measures relating to effecting behaviour change, actual behaviour changes and clinical risk factors. Data were collected at baseline, 2 and 6 months.
  
  
  RESULTS
  A total of 110 participants consented (52 in the intervention group and 58 in the control group) to participate in the study. At 6 months, those in the intervention group had significantly higher knowledge scores (P < 0.001); improved behavioural intentions to increase exercise (P < 0.001), eat a low-fat diet (P = 0.01) and lose weight (P = 0.06); and lower mean diastolic blood pressure by 3.7 mmHg, whereas the control group's mean diastolic blood pressure increased by 0.8 mmHg. There was no difference between the groups on actual behaviours.
  
  
  CONCLUSIONS
  Patient education has a significant role to play in CVD risk factor modification for patients with RA, and the detailed development of this programme probably contributed to its successful results. It is disappointing that behaviours, as we measured them, did not change. The challenge, as always, is how to translate behavioural intentions into action. Larger studies, powered specifically to look at behavioural changes, are required. Trial registration. National Institute for Health Research, UKCRN 4566.
authors.affiliation: Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Russells Hall Hospital, Pensnett Road, Dudley DY1 2HQ, UK. hollypiper@hotmail.com
authors.forename: Holly
authors.initials: H
authors.lastname: John
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Hale
authors.forename: Gareth J
authors.initials: GJ
authors.lastname: Treharne
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.forename: Douglas
authors.initials: D
authors.lastname: Carroll
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000523:psychology; D002318:Cardiovascular Diseases / Q000150:complications*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D018752:Diet, Fat-Restricted; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010174:Pamphlets; D010353:Patient Education as Topic; D012307:Risk Factors; D016896:Treatment Outcome