As with other chronic diseases, no cure is available for most
types of arthritis including rheumatoid arthritis. Furthermore, the course of
the disease is often unpredictable, and the symptoms can vary from day to day or
even from hour to hour.
Because of the nature of pain and disability, the partial and
inconsistent effects of treatment, and the unpredictability that people with
arthritis face on a daily basis, education programmes for patients have become a
complement to traditional medical treatment. These programmes have given people
with arthritis the strategies and tools necessary to make daily decisions to
cope with the disease.
From the available literature, the effectiveness of
educational interventions for people with rheumatoid arthritis and the clinical
relevance of the benefits are still unclear. It is also unclear what specific
types of educational interventions are most effective in improving health status
for patients with chronic diseases. Educational strategies can vary from the
provision of information only to the use of cognitive behavioural strategies.
A recent Cochrane review assessed the effectiveness of
education programmes in patients with rheumatoid arthritis, based on a
systematic review of the evidence from randomised controlled trials.
Small, but statistically significant, beneficial effects of
patient education were found for scores on disability, joint counts, patients’
global assessment, psychological status, and depression. These effects were
quite robust as most sensitivity analyses also showed significant effects.
Patient education does however, have two major drawbacks.
Firstly, its statistically significant benefits are modest. In comparison to no
intervention, patient education produced a 4% decrease in pain, 10% improvement
in disability, 9% improvement on the Ritchie articular index, 12% improvement on
the impact scale and a 5% improvement on the affect scale of the arthritis
impact measurement scales, and 12% improvement on depression scores.
The clinical relevance of these improvements is still
unclear, but it would be worthwhile to do a cost effectiveness analysis for
patient education to see how this intervention compares with drug interventions.
Secondly, the benefits of patient education are short lived; at final follow up
(up to 12 months after the intervention) no significant benefits were found.
Possibilities of improving the long term effects of patient education programmes
– for example, with booster sessions – need to be explored, although the few
studies that did include booster sessions found little effect.
Neither information only nor counselling programmes showed
any significant effects, but behavioural treatment showed statistically
significant beneficial effects for scores on disability, patient global
assessment, and depression. Although only studies including a control group that
had not undergone any intervention were included in the Cochrane review, a few
head to head comparisons could be made. These showed some superiority of
behavioural treatment over information only, but no significant differences were
found between effects of counselling and the other two types of interventions.
In conclusion, available evidence about patient education
programmes for adults with rheumatoid arthritis shows that these programmes have
clear but relatively small benefits that are short lived. Their clinical
significance is unclear, as are the relations between changes in behaviour and
changes in health outcomes.
