Multidisciplinary team care for people with rheumatoid arthritis: a systematic review and meta-analysis

• Published in: Rheumatology International Vol. 36; no. 3; pp. 311 - 324
• Main Authors: Bearne, Lindsay M., Byrne, Anne-Marie, Segrave, Hannah, White, Claire M.
• Format: Journal Article Book Review
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2016; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - physiopathology; Arthritis, Rheumatoid - psychology; Arthritis, Rheumatoid - therapy; Chi-Square Distribution; Combined Modality Therapy; Delivery of Health Care, Integrated; Disability Evaluation; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Patient Care Team; Quality of Life; Remission Induction; Review Article - Health Services Research; Rheumatology; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult; Disability; Disease activity; Multidisciplinary team; Rheumatoid arthritis; Quality of life
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s00296-015-3380-4

The objective of this study was to systematically review the evidence from randomised controlled trials (RCTs) evaluating the effectiveness of multidisciplinary team (MDT) care for the management of disability, disease activity and quality of life (QoL) in adults with rheumatoid arthritis (RA). Data sources identified published (MEDLINE, PsychINFO, EMBASE, CINAHL, Web of Science, CENTRAL) and unpublished (OpenGrey) literature. Independent data extraction and quality assessment, using the Cochrane risk of bias tool, were conducted by two reviewers. The primary outcome was change in disability at 12 months; secondary outcomes included disability at other time points and disease activity and QoL at 12 months. Where possible, the pooled effect sizes were calculated for inpatient or outpatient MDT interventions. Four hundred and fifteen studies were retrieved. Twelve manuscripts, which reported 10 RCTs, representing 1147 participants were included. Only data from five high- or moderate-quality trials were pooled according to clinical setting. There was no difference in disability between inpatient MDT care and any comparison group [mean difference (95 % confidence intervals) 0.04, −0.13 to 0.20] or between outpatient MDT care and comparison groups (0.09, −0.07 to 0.25) at 12 months. There was no difference in disability at 2 years or <12 months or disease activity and QoL at 12 months between MDT care and any comparison group. There is limited evidence evaluating the effect of MDT care on disability, disease activity or QoL in people with RA. There is likely to be no effect of MDT care on disability at 12 months or other time points.