medwireNews: Patients with axial spondyloarthritis (axSpA) are likely to derive short-term benefits from a nurse-led education program focused on self-management and self-assessment of disease activity, COMEDSPA trial results suggest.
The education program was associated with improvements in physical activity levels, disease activity, and symptom status, but the primary endpoint of coping was not improved relative to a nurse-led comorbidity screening and management program that did not include advice on disease activity monitoring or disease educational materials.
“[O]ur findings are in perfect agreement with the new ASAS quality standards, which include a specific quality standard on education and self-management, and emphasizes that health-care professionals (e.g. nurses) can support a patient’s ability to self-manage their disease,” highlight the researchers in Rheumatology.
For the program, which consists of two parts – self-management and self-assessment – the patients first watched a video explaining the importance of monitoring disease activity and doing physical activity, which was reinforced in a discussion with the nurse. The nurse then performed a physical examination to determine disease severity and subsequently gave patients a video to watch with specific home-based exercises depending on their severity.
The second part of the program focused on self-assessing disease activity, with a video explaining the importance of regular measurement and the rationale for using composite indices. This message was reinforced by the nurse, who then trained the patients on how to calculate BASDAI, which the patients then reported in a booklet on a monthly basis.
In all, 250 patients were randomly assigned to receive the educational program and 252 to the control program.
The mean age of patients in this study was 47 years, around 60% were male, and they all had stable disease, having been diagnosed at least a year before baseline.
At the 12-month follow-up, the level of coping was similar among patients who received the educational program and those who received the control program, with respective mean scores of 2.8 versus 3.0 points, based on a 10-point scale where 0 indicates that a patient is coping very well.
Anna Molto (Cochin Hospital, Paris, France) and fellow researchers emphasize that patients in their study had “long-standing and stable disease,” which may mean that they have “a pre-existing better coping level (e.g. floor effect), compared with what has been reported in other studies.”
However, the disease activity of patients who received the education program significantly improved over the year, with a mean decrease in BASDAI score of 1.2 points compared with an increase of 1.4 points in the control group. Overall, 72.7% of patients in the education arm had a patient acceptable symptom status, as determined by having a BASDAI score below 4 points, versus 64.3% of those in the control arm.
The fact that “nurses took the time to explain the importance of collecting the BASDAI, but also to explain the purpose of each of the questions of the BASDAI,” may partly account for the better scores in the education group, speculate Molto et al.
Patients who received the education program also reported exercising significantly more at the 1-year visit than those who received the control program, at an average of 7.3 versus 5.0 sessions a month, even though exercise frequency was comparable between the two groups at baseline (mean 5.1 vs 5.2 sessions a month). Their workouts were also significantly longer on average, at 12.9 versus 7.2 minutes per session.
Additionally, patients in the education group scored significantly higher on the International Physical Activity Questionnaire than those in the control group, at a mean of 138.4 versus 95.7 points.
The study authors conclude: “Further studies aiming to evaluate the long-term benefit of such programs are needed to confirm (or not) our findings.”
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