title: Effects of needs-based patient education on self-efficacy and health outcomes in people with rheumatoid arthritis: a multicentre, single blind, randomised controlled trial.
abstract: OBJECTIVE
  The Educational Needs Assessment Tool (ENAT) is a self-completed questionnaire, which allows patients with arthritis to prioritise their educational needs. The aim of this study was to evaluate the effects of needs-based patient education on self-efficacy, health outcomes and patient knowledge in people with rheumatoid arthritis (RA).
  
  
  METHODS
  Patients with RA were enrolled into this multicentre, single-blind, parallel-group, pragmatic randomised controlled trial. Patients were randomised to either the intervention group (IG) where patients completed ENAT, responses of which were used by the clinical nurse specialist to guide patient education; or control group (CG) in which they received patient education without the use of ENAT. Patients were seen at weeks 0, 16 and 32. The primary outcome was self-efficacy (Arthritis Self Efficacy Scale (ASES)-Pain and ASES-Other symptoms). Secondary outcomes were health status (short form of Arthritis Impact Measurement Scale 2, AIMS2-SF) and patient knowledge questionnaire-RA. We investigated between-group differences using analysis of covariance, adjusting for baseline variables.
  
  
  RESULTS
  A total of 132 patients were recruited (IG=70 and CG=62). Their mean (SD) age was 54 (12.3) years, 56 (13.3)  years and disease duration 5.2 (4.9) years, 6.7 (8.9) years for IG and CG, respectively. There were significant between-group differences, in favour of IG at week 32 in the primary outcomes, ASES-Pain, mean difference (95% CI) -4.36 (1.17 to 7.55), t=-2.72, p=0.008 and ASES-Other symptoms, mean difference (95% CI) -5.84 (2.07 to 9.62), t=-3.07, p=0.003. In secondary outcomes, the between-group differences favoured IG in AIMS2-SF Symptoms and AIMS2-SF Affect. There were no between-group differences in other secondary outcomes.
  
  
  CONCLUSIONS
  The results suggest that needs-based education helps improve patients' self-efficacy and some aspects of health status.
  
  
  BACKGROUND
  ISRCTN51523281.
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: Ndosi
authors.affiliation: Department of Rheumatology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK Research & Development Department, Barnsley Hospital NHS Foundation Trust, Barnsley, UK.
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK.
authors.forename: T
authors.initials: T
authors.lastname: Young
authors.affiliation: Department of Rheumatology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK.
authors.forename: B
authors.initials: B
authors.lastname: Hardware
authors.affiliation: Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.affiliation: School of Healthcare, University of Leeds, Leeds, UK.
authors.forename: C
authors.initials: C
authors.lastname: Hale
authors.affiliation: Department of Rheumatology, Rotherham Hospital NHS Foundation Trust, Rotherham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Maxwell
authors.affiliation: Department of Rheumatology, King George Hospital, Barking Havering and Redbridge University Hospitals NHS Trust, Ilford, UK.
authors.forename: E
authors.initials: E
authors.lastname: Roussou
authors.affiliation: Department of Rheumatology, Barnsley Hospital NHS Foundation Trust, Barnsley, UK.
authors.forename: A
authors.initials: A
authors.lastname: Adebajo
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000523:psychology / Q000534:rehabilitation*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D017063:Outcome Assessment, Health Care / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care / Q000592:standards*; D020377:Self Efficacy; D016037:Single-Blind Method
keywords: Health services research; Multidisciplinary team-care; Patient perspective; Rehabilitation; Rheumatoid Arthritis