Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial.
Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of concept trial.
复制标题
DOI：
10.1186/s12969-018-0292-3
复制
发表时间：
2018-11-22
期刊：
影响因子：
--
通讯作者：
Modi AC
中科院分区：
文献类型：
--
作者：
Favier LA;Ting TV;Modi AC
不依从是青少年特发性关节炎（JIA）的一个普遍和可改变的问题，目前缺乏基于提供者的干预。围绕疾病状况的教育是家庭继续参与护理的一种方式。肌肉骨骼超声是一种演示性的实时教育形式，可能会影响患者和护理人员自我管理疾病的方式。本研究的目的是：1）评估肌肉骨骼超声作为非依从性干预工具的可行性、可接受性和感知有用性; 2）检查超声治疗后JIA青少年甲氨蝶呤依从性的变化。八名患有多关节或广泛少关节JIA的青少年及其照顾者完成了这项为期12周的研究。采用受试者内设计比较基线和干预后依从性、生活质量和疾病活动指数。依从性测量包括甲氨蝶呤的电子测量以及自我报告的依从性问卷。超声干预包括由风湿病学家提供的一次性教育检查，检查三个或更多当前或历史活动关节。超声介入被认为是可行和可接受的。100%的合格参与者完成了超声干预。超声波受到患者和护理人员的欢迎，大多数人认为这是一个有用的工具。参与者的基线依从性为75.3%，一半的参与者被归类为非依从性。电子测量和自我报告的依从性措施没有显示出显着的变化，在干预后的时期。两名参与者改善，四名参与者保持，两名参与者降低依从性。在超声检查中，18/27（66.7%）的受检关节显示异常，其中63%与风湿病学家的体格检查不一致。虽然我们的干预措施在这个概念验证试验中没有显示出依从性、生活质量或疾病活动指数的任何变化，但干预措施确实显示出可接受性指标的前景，值得在更稳健的试验设计中进行未来研究。另一项研究受益是肌肉骨骼超声干预能够证明亚临床疾病，导致几名参与者发生具有临床影响力的治疗变化。
Non-adherence is a prevalent and modifiable issue in juvenile idiopathic arthritis (JIA) that currently lacks provider-based intervention. Education surrounding disease status is one way in which families remain engaged in their care. Musculoskeletal ultrasound is one such form of demonstrative, real-time education that may impact the way patients and caregivers self-manage their disease. The aims of this study are to 1) assess the feasibility, acceptability and perceived usefulness of musculoskeletal ultrasound as a non-adherence intervention tool and 2) to examine changes in methotrexate adherence in adolescents with JIA following the ultrasound. Eight adolescents with polyarticular or extended oligoarticular JIA and their caregivers completed this 12 week study. A within subject design was used to compare baseline and post-intervention adherence, quality of life and disease activity indices. Adherence measures included electronic measurement of methotrexate in addition to self-reported adherence questionnaires. The ultrasound intervention included a one-time, rheumatologist provided, educational examination of three or more currently or historically active joints. The ultrasound intervention was found to be both feasible and acceptable. One hundred percent of eligible participants completed the ultrasound intervention. The ultrasound was well received by patients and caregivers, with most believing this to be a helpful tool. Baseline adherence was 75.3% among participants, with half of the participants being classified as non-adherent. Electronically measured and self-reported adherence measures did not show significant changes during the post-intervention period. Two participants improved, four participants maintained, and two participants decreased adherence. On ultrasound, 18/27 (66.7%) of the examined joints displayed abnormalities, with 63% being discrepant and additive to the rheumatologist’s physical examination. While our intervention did not show any changes in adherence, quality of life or disease activity indices in this proof-of-concept trial, the intervention does show promise in acceptability measures and merits future study in a more robust trial design. An additional study benefit was that the musculoskeletal ultrasound intervention was able to demonstrate subclinical disease, leading to clinically impactful therapeutic changes in several participants.
登录
查看更多内容
DOI：
10.1002/art.22534
发表时间：
2007-03-15
期刊：
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH
影响因子：
--
作者：
Feldman, Debbie Ehrmann;De Civita, Mirella;Duffy, Ciaran M.
通讯作者：
Duffy, Ciaran M.
影响因子：
2.2
作者：
Kumar K;Raza K;Gill P;Greenfield S
通讯作者：
Greenfield S
影响因子：
8
作者：
Modi, Avani C.;Pai, Ahna L.;Drotar, Dennis
通讯作者：
Drotar, Dennis
影响因子：
4.7
作者：
Collado, Paz;Jousse-Joulin, Sandrine;D'agostino, Maria Antonietta
通讯作者：
D'agostino, Maria Antonietta
影响因子：
0.9
作者：
Modi, Avani C.;Crosby, Lori E.;Mitchell, Monica J.
通讯作者：
Mitchell, Monica J.