Evidence suggests that nurse-led care is an effective means of reducing fatigue in patients with rheumatoid arthritis (RA), according to findings from a systematic review and meta-analysis published in Journal of Clinical Nursing. Authors of the review advocated for the implementation of nurse-led interventions for the management of patients with RA-associated fatigue.
Nurse-led care refers to a treatment model in which the nurse is a patient’s primary point of contact. Prior studies have shown that nurse-led fatigue management provides a more personalized approach and better addresses psychosocial factors.
To assess the efficacy of nurse-led care in patients with RA-associated fatigue, the study authors conducted a systematic search of the Cochrane Library, Web of Science, PubMed, EBSCOhost/CINAHL Complete, Springer Link, ProQuest, Science Direct, and Ovid databases for randomized clinical trials published between 2003 and 2021. Two separate reviewers evaluated the eligible studies. Methodologic quality and risk for bias were determined using the Quality Assessment Tool for Quantitative Studies and the Cochrane risk of bias tool, respectively. Studies that included fatigue data on a numeric scale were included in the current meta-analysis. Data were pooled and a random-effects model was used to estimate the overall effect of nurse-led care on fatigue reduction in RA.
Of 1445 screened studies, 6 were included in analysis. The pooled cohort included 994 adults with RA. Two studies were conducted in Norway; 2 in England; and 1 each in the United States and Denmark. Across the 6 studies, nurse-led care interventions included in-person visits, consultations, briefings, and clinic appointments. In 3 studies, interventions were implemented by more than 1 nurse. Education sessions were provided to patients in all studies. Psychosocial support was also provided to participants in 3 studies. The duration of each nurse-led care session ranged from 30 minutes to 2 hours. Comparator groups included rheumatologist-led care (n=3 studies), no nurse-led care (n=2), and the clinic support of junior physicians (n=1). Four studies showed that nurse-led care compared with the other study groups significantly reduced fatigue. However, in 2 studies, nurse-led care had no statistically significant impact on fatigue scores.
In the current meta-analysis, the overall effect of nurse-led care on fatigue was significant (Hedge’s g=-0.18; 95% CI, -0.3 to -0.06; P =.004).
According to these data, nurse-led care appears to have a positive impact on fatigue reduction in patients with RA.
However, sparse data limited the strength of this analysis. Although between-study heterogeneity was low, risk for bias was present in all 6 studies. Due to the nature of the intervention, blinding was not performed in 4 of 6 studies. In addition, sample size was small in 3 studies.
“Nurse-led care is an important strategy that should be considered as a complementary [program] for patients with RA [with] fatigue,” the authors wrote. “[While] there [are] no clear data on the duration and frequency of nurse-led care practices in the fatigue management of patients with RA…nurse-led care is recommended in the fatigue management of patients with RA.”
Overall, further studies are necessary to better understand the impact of nurse-led care in rheumatology settings.
Sezgin MG, Bektas H. The effect of nurse-led care on fatigue in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomised controlled studies. J Clin Nurs. Published online August 15, 2021. doi:10.1111/jocn.16003