Efficacy of multidisciplinary team care programs in rheumatoid arthritis.

OBJECTIVE To assess the efficacy of multidisciplinary team care programs in rheumatoid arthritis (RA). METHODS Data were obtained by a Medline and a manual search of the literature through January 1997. Both the design and analysis aspects of controlled trials were evaluated. RESULTS Forty-two papers reporting on 35 clinical trials of multidisciplinary team care were initially identified. Fifteen trials had a controlled design, nine of which were randomized. Patient characteristics, interventions, end point measures, and presentation of the data varied widely among the controlled studies. In 12 trials, inpatient (n = 6) or outpatient (n = 6) multidisciplinary programs were compared with regular outpatient care. Inpatient programs (average duration, 10 to 28 days) had a direct favorable effect on disease activity, lasting up to 1 year. The effect of outpatient programs (average duration, 1 to 2 years) was less marked, with greater improvement of functional status at the end of the treatment program shown in one study. In three trials, inpatient multidisciplinary programs were compared with similar outpatient programs. One study showed that inpatient care was more effective, whereas in two studies similar results were obtained in both groups. CONCLUSION Favorable effects on disease activity were seen in most trials comparing short inpatient team care with regular outpatient care. Proof of efficacy of prolonged outpatient team care is scanty. Results of trials comparing inpatient with outpatient team care remain inconclusive.