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Evaluation of a multidisciplinary care model to improve quality of life in rheumatoid arthritis: a randomised controlled trial

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Abstract

Background and purpose

Health-Related Quality of Life (HR-QOL) is an important patient-reported domain in patients with rheumatoid arthritis (RA). The uptake of multidisciplinary team (MDT) care in RA is generally low, due to initial high demand for resources. We hypothesised that whilst pharmacological treatments are effective in controlling disease activity, a multipronged intervention in an MDT may have a positive impact on HR-QOL.

Methods

This was a single-centre randomized parallel group, single-blind controlled trial of MDT vs. usual care in an established RA clinic. Data were collected through face-to-face questionnaires, medical records review, and joint counts by a blinded assessor at 0, 3 and 6 months. Adult RA patients were randomly assigned in a single visit to a 6-member MDT (rheumatologist, nurse, social worker, physiotherapist, occupational therapist, and podiatrist) or usual care. MDT providers prescribed medications and counselled patients on managing flares, medication adherence, coping, joint protection, exercise, footwear. The primary outcome was minimal clinically important difference (MCID) in HR-QOL (increase in European QOL-5-Dimension-3-Level, EQ-5D-3L by 0.1) at six months.

Results

140 patients (86.3% female, 53.4% Chinese, median (IQR) age 56.6 (46.7, 62.4) years); 70 were randomized to each arm. Median (IQR) disease duration was 5.5 (2.4, 11.0) years and disease activity in 28 joints (DAS28) was 2.87 (2.08, 3.66). 123 patients completed the study. Twenty-six (40.6%) MDT vs. 23 (34.3%) usual care patients achieved an MCID in EQ-5D-3L, OR 1.3 (0.6, 2.7). In multivariable logistic regression, baseline EQ-5D-3L was the only predictor of achieving MCID. There was more disease modifying anti-rheumatic drug escalation in MDT (34.4% vs. 19.4%). Patients with high disease activity were more likely to achieve MCID in the MDT arm.

Conclusions

A single visit by stable patients with low disease activity to an MDT failed to achieve MCID in the EQ-5D-3L; however, did achieve small but significant improvements in the EQ-5D-3L, DAS28, pain, coping and self-efficacy. To be sustainable, MDT care should be targeted at patients with high disease activity or those with a new diagnosis of RA.

Trial registration

The study is registered on ClinicalTrials.gov, identifier: NCT03099668.

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Funding

The Centre for Health Services and Policy Research (CHSPR), National University of Singapore (NUS) Seed Grant. The grant body approved the study but had no role in the design or conduct of the study, analysis of data or interpretation of findings. The corresponding author confirms that she has full access to all the data in the study and had final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore

    Manjari Lahiri, Peter P. M. Cheung, Siew-Hwa Chong, Chiew-Hwa Tan & Amelia Santosa

  2. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Manjari Lahiri, Peter P. M. Cheung, Preeti Dhanasekaran, Amelia Santosa & Phillip Phan

  3. Department of Rehabilitation, National University Hospital, Singapore, Singapore

    Su-Ren Wong, Ai Yap & Daphne S. H. Tan

  4. Department of Medicine, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Phillip Phan

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  1. Manjari Lahiri
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Correspondence to Manjari Lahiri.

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The study was approved by our domain specific review board (DSRB Reference Number 2016/00848) and all patients gave informed consent.

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Lahiri, M., Cheung, P.P.M., Dhanasekaran, P. et al. Evaluation of a multidisciplinary care model to improve quality of life in rheumatoid arthritis: a randomised controlled trial. Qual Life Res 31, 1749–1759 (2022). https://doi.org/10.1007/s11136-021-03029-3

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