Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis
Objectives This study sought to assess the effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA).Methods We conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, ClinicalTrials.gov databases and the references from relevant liter...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/14/1/e003037.full |
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| author | Dan Liu Li Liu Lin Yang Ting Wen Peng Xiang Guifang Pi |
| author_facet | Dan Liu Li Liu Lin Yang Ting Wen Peng Xiang Guifang Pi |
| author_sort | Dan Liu |
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| description | Objectives This study sought to assess the effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA).Methods We conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, ClinicalTrials.gov databases and the references from relevant literature published prior to May 2023. Two independent reviewers assessed the studies using population/intervention/comparison/outcome/study criteria, and quantitative tools were used to gauge the methodological quality of the included studies. Independent quality assessments were carried out using the Cochrane Collaboration’s risk-of-bias tool. Effect sizes were determined using mean difference (MD) or standardised mean difference (SMD) with corresponding 95% CIs.Results Ultimately, 14 articles were included, encompassing a total of 3369 RA patients. NLC exhibited significant advantages in the primary outcome, disease activity (MD =−0.09, 95% CI (−0.17 to –0.01)), and the secondary outcome, self-efficacy (MD=0.40, 95% CI (0.03, 0.77)). In subgroup analysis, NLC was more effective in reducing disease activity compared with usual care (MD=−0.15, 95% CI (−0.26 to –0.04)), and there was no significant difference in disease activity reduction between NLC and rheumatologist-led care (MD=−0.02, 95% CI (−0.14, 0.10)). In terms of self-efficacy, no significant difference was observed between NLC and usual care (SMD=0.56, 95% CI (−0.09, 1.21)) or between NLC and rheumatologist-led care (SMD=0.20, 95% CI (−0.19, 0.59). When comparing other secondary outcomes (pain, satisfaction, quality of life, fatigue, stiffness, physical function and psychological status), the effectiveness of NLC for RA patients was similar to that of the control group, with no statistically significant differences.Conclusions NLC proves highly effective in managing RA patients, surpassing usual care and equating to rheumatologist-led care in primary and some secondary outcomes. It may be feasible to allow nurses to participate in the disease management of some RA patients instead of doctors.PROSPERO registration number CRD42022362071. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Quality |
| spelling | doaj-art-d6bad81ddd71421fb790c61d629392502025-02-03T19:30:09ZengBMJ Publishing GroupBMJ Open Quality2399-66412025-01-0114110.1136/bmjoq-2024-003037Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysisDan Liu0Li Liu1Lin Yang2Ting Wen3Peng Xiang4Guifang Pi5Rheumatology and immunology department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, ChinaTelemedicine Center, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, ChinaDepartment of Pharmacy, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, People`s Republic of ChinaRheumatology and immunology department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, ChinaDepartment of Otorhinolaryngology, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, ChinaRheumatology and immunology department, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, ChinaObjectives This study sought to assess the effectiveness of nurse-led care (NLC) in patients with rheumatoid arthritis (RA).Methods We conducted a comprehensive search of the Cochrane Library, Web of Science, PubMed, Embase, CINAHL, ClinicalTrials.gov databases and the references from relevant literature published prior to May 2023. Two independent reviewers assessed the studies using population/intervention/comparison/outcome/study criteria, and quantitative tools were used to gauge the methodological quality of the included studies. Independent quality assessments were carried out using the Cochrane Collaboration’s risk-of-bias tool. Effect sizes were determined using mean difference (MD) or standardised mean difference (SMD) with corresponding 95% CIs.Results Ultimately, 14 articles were included, encompassing a total of 3369 RA patients. NLC exhibited significant advantages in the primary outcome, disease activity (MD =−0.09, 95% CI (−0.17 to –0.01)), and the secondary outcome, self-efficacy (MD=0.40, 95% CI (0.03, 0.77)). In subgroup analysis, NLC was more effective in reducing disease activity compared with usual care (MD=−0.15, 95% CI (−0.26 to –0.04)), and there was no significant difference in disease activity reduction between NLC and rheumatologist-led care (MD=−0.02, 95% CI (−0.14, 0.10)). In terms of self-efficacy, no significant difference was observed between NLC and usual care (SMD=0.56, 95% CI (−0.09, 1.21)) or between NLC and rheumatologist-led care (SMD=0.20, 95% CI (−0.19, 0.59). When comparing other secondary outcomes (pain, satisfaction, quality of life, fatigue, stiffness, physical function and psychological status), the effectiveness of NLC for RA patients was similar to that of the control group, with no statistically significant differences.Conclusions NLC proves highly effective in managing RA patients, surpassing usual care and equating to rheumatologist-led care in primary and some secondary outcomes. It may be feasible to allow nurses to participate in the disease management of some RA patients instead of doctors.PROSPERO registration number CRD42022362071.https://bmjopenquality.bmj.com/content/14/1/e003037.full |
| spellingShingle | Dan Liu Li Liu Lin Yang Ting Wen Peng Xiang Guifang Pi Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis BMJ Open Quality |
| title | Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis |
| title_full | Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis |
| title_fullStr | Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis |
| title_full_unstemmed | Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis |
| title_short | Effectiveness of nurse-led care in patients with rheumatoid arthritis: a systematic review and meta-analysis |
| title_sort | effectiveness of nurse led care in patients with rheumatoid arthritis a systematic review and meta analysis |
| url | https://bmjopenquality.bmj.com/content/14/1/e003037.full |
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