Effects of needs-based patient education on self-efficacy and health outcomes in people with rheumatoid arthritis: a multicentre, single blind, randomised controlled trial

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 RCT. Patients were randomised to either the intervention group (IG) where patients completed the ENAT, responses of which were used by the Clinical Nurse Specialist (CNS) to guide patient education; or control group (CG) in which they received patient education without the use of the ENAT. Patients were seen at weeks 0, 16 and 32. The primary outcome was self-efficacy (ASES-Pain and ASES-Other symptoms). Secondary outcomes were health status (AIMS2-SF) and patient knowledge (PKQ-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), 56(13.3) and disease duration 5.2(4.9), 6.7(8.9) for IG and CG respectively. There were significant between-group differences, in favour of the 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