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Evaluation of the impact of a nurse-led program of patient self-assessment and self-management in axial spondyloarthritis: results of a prospective, multicentre, randomized, controlled trial (COMEDSPA).

Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France.Université de Paris, INSERM U-1153, CRESS, France.Sorbonne Université, IPLESP, INSERM, France.Pitié Salpêtrière Hospital, APHP, Rheumatology Department, France.Rehabilitation and Physical Medicine Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.Rheumatology Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, and Université Paris Est Créteil, EA, 7379 - EpidermE, Créteil, France.Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.Rheumatology Department, CHRU de BESANCON, University Teaching Hospital, and Université Bourgogne Franche-Comté, EA4266 (EPILAB), Besançon, France.Rheumatology Department, CHU Grenoble, France.Rheumatology Department, CH Le Mans, France.Rheumatology Department, CHU Marseille, France.Rheumatology Department, CHU Rouen, France.Centre de Rhumatologie, Hôpital Purpan, et Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Inserm UMR1027, Toulouse, France.Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France.Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France.Rheumatology Department, Saint Antoine Hospital, APHP, Paris, France.Rheumatology Department, CHU Montpellier, Montpellier University, Montpellier, France.Rheumatology Department, CHU Roger Salengro Hospital, University of Lille, Lille, France.Université Paris Diderot, UFR médicale, France.APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France.Department of Rheumatology, Nancy Hospital, Nancy, France.Rheumatology Unit, UMR1227 (Lymphocytes B et Autoimmunité), Université de Brest, Inserm, CHU, Brest, LabEx IGO, Brest, France.Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France.Rheumatology Department, Pellegrin Hospital, Bordeaux, France.Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, France.Université de Paris, INSERM U-1153, CRESS, France.

Rheumatology (Oxford, England). 2021;(2):888-895
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Abstract

OBJECTIVE To evaluate the impact of a nurse-led program of self-management and self-assessment of disease activity in axial spondyloarthritis. METHODS Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants were consecutive axial spondyloarthritis patients (according to the rheumatologist) and nurses having participated in a 1-day training meeting. The program included self-management: educational video and specific video of graduated, home-based exercises for patients; and self-assessment: video presenting the rationale of tight monitoring of disease activity with composite scores (Ankylosing Spondylitis Disease activity Score, ASDAS/Bath Ankyslosing Spondylitis Disease Activity Index, BASDAI). The nurse trained patients to collect, calculate and report (monthly) ASDAS/BASDAI. Treatment allocation was by random allocation to this program or a comorbidities assessment (not presented here and considered here as the control group). RESULTS A total of 502 patients (250 and 252 in the active and control groups, respectively) were enrolled (age: 46.7 (12.2) years, male gender: 62.7%, disease duration: 13.7 (11.0) years). After the one-year follow-up period, the adherence to the self-assessment program was considered good (i.e. 79% reported scores >6 times). Despite a lack of statistical significance in the primary outcome (e.g. coping) there was a statistically significant difference in favor of this program for the following variables: change in BASDAI, number and duration of the home exercises in the active group, and physical activity (international physical activity score, IPAQ). CONCLUSION This study suggests a short-term benefit of a nurse-led program on self-management and self-assessment for disease activity in a young axial spondyloarthritis population in terms of disease activity, exercises and physical activity.

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MeSH terms : Exercise Therapy