A randomised comparison of a multidisciplinary team care program with usual care in patients with systemic sclerosis

Abstract

OBJECTIVE: To compare the effectiveness of a multidisciplinary team care program with usual outpatient care in patients with systemic sclerosis (SSc). METHODS: A randomized controlled trial comparing a 12-week multidisciplinary team care program (1 day per week; individual treatments, group-exercises and group-education) with outpatient clinic care. Outcome measures included the HAMIS (Hand Mobility in SSc), grip-strength, maximal mouth-opening (MMO), 6-minute-walk-distance (6MWD), maximum aerobic-capacity (VO2(max) ), CIS-20 (Checklist Individual Strength), SSc-HAQ (Health Assessment Questionnaire) and SF-36 (0, 12 and 24 weeks). Statistical comparisons of change scores were done by analysis of covariance. RESULTS: Twenty-eight patients were assigned to the intervention group (mean age 54.6 years, 15/28 diffuse SSc) and 25 to the control group (mean age 52.2 years, 15/25 diffuse SSc). Twenty-five (89%) patients in the intervention group completed the treatment program. At 12 weeks there was a significantly greater improvement in grip-strength (2.2 versus -1.8 kg; p=0.001), MMO (1.4 versus -0.9 mm; p=0.000), 6MWD (42.8 versus 3.9 meter; p=0.015) and HAQ (-0.18 versus 0.13; p=0.003) in the intervention group, whereas differences for the other outcome measures didn't reach significance. At 24 weeks the effect on MMO persisted. CONCLUSION: In patients with SSc a 12-week multidisciplinary day patient treatment program was more effective than regular outpatient care with respect to 6MWD, grip-strength, MMO and HAQ, but not for VO2(max) , HAMIS, CIS-20, SF-36 and VAS pain. This study provides a first step in quantifying the effect of a multidisciplinary team care program and warrants the conduct of further intervention studies.