Ph.D. Student : Jette Primdahl
Enrolment : 1 March 2008
Project Title : 'The relevance of self-efficacy in patients with rheumatoid arthritis, measured
by a Danish translation of RASE (Rheumatoid Arthritis Self-Efficacy
Questionnaire), according to self-management education and three different
organizations of follow-up for outpatients'
Supervisors : MD, DMSci, Professor Kim Hørslev-Petersen and Dr. PH, Professor Lis Wagner
Institute : Institute for Regional Health Research
Research Unit : King Christian X's Hospital for rheumatic diseases, Gråsten
Abstract: The impact on self-efficacy beliefs from participation in one of three different types of
outpatient care for persons with rheumatoid arthritis - a randomized trial.
Background: British studies have indicated that persons with Rheumatoid arthritis (RA) monitored
in nursing consultations or in different versions of shared care are not worse off than patients in
traditional medical follow-up. Arthritis Self-efficacy (SE) refers to beliefs in one's ability to control
or manage various aspects of RA in daily life. SE is thought to affect health behavior and outcome.
Objectives: To explore the impact of different types of outpatient care on SE, disease activity and
disability in established rheumatoid arthritis (RA).
Methods: 287 adult RA patients (classification criteria ACR 88 fulfilled for >1½ year), with low
disease activity (DAS28-CRP <3.2) and a Health Assessment Questionnaire (HAQ) < 2.5 were
recruited from two Danish rheumatology specialist-led outpatient clinics and randomized for
follow-up care. 1: planned rheumatologists' consultation, 2: a shared care model without planned
consultations 3: planned nursing consultations. Data on disease activity (DAS28-CRP) and
disability (HAQ) as well as the participants' SE assessed by the Danish versions of the Rheumatoid
Arthritis Self-Efficacy questionnaire (RASE) and the Arthritis Self-Efficacy Scale (ASES), were
collected at base-line and during one year follow up. The relation between SE, outpatient setting,
socio-demographic and disease related variables were explored in mixed models.
Results: The type of care did not influence the disease activity or physical disability. Compared to
the medical group the participants in the nursing group increased their SE during the first year of
follow-up despite of which questionnaire we used. Increasing disease activity, disease duration,
level of fatigue and disability predicted a decrease in the ASES, but had no influence on the RASE.
Conclusions: Participators in the nursing group increased their SE after three planned nursing
consultations compared to the medical group. The participant's disease activity and disability did
not change compared to medical follow-up. The shared care group did not differ significantly from
the medical group at any time. The RASE proved to be a useful response variable in longitudinal
studies because of its independency of disease related variables.
Keywords: Clinical research