***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective To determine the clinical effectiveness and cost-effectiveness of nurse-led care ( NLC ) for people with rheumatoid arthritis ( RA ) . Methods In a multicentre pragmatic r and omised controlled trial , the assessment of clinical effects followed a non-inferiority design , while patient satisfaction and cost assessment s followed a superiority design . Participants were 181 adults with RA r and omly assigned to either  NLC or rheumatologist-led care ( RLC ) , both arms carrying out their normal practice . The primary outcome was the disease activity score ( DAS28 ) assessed at baseline , weeks 13 , 26 , 39 and 52 ; the non-inferiority margin being DAS28 change of 0.6 . Mean differences between the groups were estimated controlling for covariates following per- protocol ( PP ) and intention-to-treat ( ITT ) strategies . The economic evaluation ( NHS and healthcare perspectives ) estimated cost relative to change in DAS28 and quality -adjusted life-years ( QALY ) derived from EQ5D . Results Demographics and baseline characteristics of patients under NLC ( n=91 ) were comparable to those under RLC ( n=90 ) . Overall baseline-adjusted difference in DAS28 mean change ( 95 % CI ) for RLC minus NLC was −0.31 ( −0.63 to 0.02 ) for PP and -0.15 ( −0.45 to 0.14 ) for ITT analyses . Mean difference in healthcare cost ( RLC minus NLC ) was £ 710 ( −£352 , £ 1773 ) and −£128 ( −£1263 , £ 1006 ) for PP and ITT analyses , respectively . NLC was more cost-effective with respect to cost and DAS28 , but not in relation to QALY utility scores . In all secondary outcomes , significance was met for non-inferiority of NLC . NLC had higher ‘ general satisfaction ’ scores than RLC in week 26 . Conclusions The results provide robust evidence to support non-inferiority of NLC in the management of RA . Trial registration IS RCT Background Workers with rheumatoid arthritis ( RA ) often experience restrictions in functioning at work and participation in employment . Strategies to maintain work productivity exist , but these interventions do not involve the actual workplace . Therefore the aim of this study is to investigate the (cost)effectiveness of an intervention program at the workplace on work productivity for workers with RA . Methods / design This study is a r and omized controlled trial ( RCT ) in specialized rheumatology treatment centers in or near Amsterdam , the Netherl and s. R and omisation to either the control or the intervention group is performed at patient level . Both groups will receive care as usual by the rheumatologist , and patients in the intervention group will also take part in the intervention program . The intervention program consists of two components ; integrated care , including a participatory workplace intervention . Integrated care involves a clinical occupational physician , who will act as care manager , to coordinate the care . The care manager has an intermediate role between clinical and occupational care . The participatory workplace intervention will be guided by an occupational therapist , and involves problem solving by the patient and the patients ’ supervisor . The aim of the workplace intervention is to achieve consensus between patient and supervisor concerning feasible solutions for the obstacles for functioning at work . Data collection will take place at baseline and after 6 and 12 months by means of a question naire . The primary outcome measure is work productivity , measured by hours lost from work due to presenteeism . Secondary outcome measures include sick leave , quality of life , pain and fatigue . Cost-effectiveness of the intervention program will be evaluated from the societal perspective . Discussion Usual care of primary and outpatient health services is not aim ed at improving work productivity . Therefore it is desirable to develop interventions aim ed at improving functioning at work . If the intervention program will be (cost)effective , substantial improvements in work productivity might be obtained among workers with RA at lower costs . Results are expected in 2015.Trial registration Background Comprehensive rehabilitation , involving health professionals from various disciplines , is widely used as an adjunct to pharmacological and surgical treatment in people with rheumatic diseases . However , the evidence for the clinical - and cost-effectiveness of such interventions is limited , and the majority of those who receive rehabilitation are back to their initial health status six to 12 months after discharge . Methods / design To evaluate the goal attainment , health effects and cost-effectiveness of a new rehabilitation programme compared to current traditional rehabilitation programmes for people with rheumatic diseases , a stepped-wedge cluster r and omized trial will be performed . Patients admitted for rehabilitation at six centres in the south-eastern part of Norway will be invited to participate . In the trial , six participating centres will switch from a control ( current rehabilitation programme ) to an intervention phase ( the new rehabilitation programme ) in a r and omized order . Supported by recent research , the new programme will be a supplement to the existing programme at each centre , and will comprise four elements design ed to enhance and support lifestyle changes introduced in the rehabilitation period : structured goal -planning , motivational interviewing , a self-help booklet and four follow-up telephone calls during the first five months following discharge . The primary outcome will be health-related quality of life and goal attainment , as measured by the Patient Generated Index directly before and after the rehabilitation stay , as well as after six and 12 months . Secondary outcomes will include self-reported pain , fatigue , a global assessment of disease activity and motivation for change ( measured on 11-point numeric ratings scales ) , health-related quality of life as measured by the Short Form 36 Health Survey ( SF-36 ) and utility assessed by the SF6D utility index . The main analysis will be on an intention to treat basis and will assess the clinical - and cost-effectiveness of the structured goal planning and tailored follow-up rehabilitation programme for patients with rheumatic diseases . Discussion The findings will constitute an important contribution to more cost-effective- and evidence -based rehabilitation services for people with rheumatic diseases . Trial registration IS RCT N91433175 AIM To compare the long-term effectiveness of care delivered by a clinical nurse specialist ( CNS ) with inpatient team care and day patient team care in patients with rheumatoid arthritis and increasing functional limitations . Background . The role of CNSs in the management of patients with rheumatoid arthritis ( RA ) is evolving , and their effectiveness in comparison with care provided by a rheumatologist alone has been established . However , long-term controlled studies showing how the effectiveness of CNSs compares with that of other forms of co-ordinated care , such as multidisciplinary team care , are lacking . METHODS Two hundred and ten patients rheumatoid arthritis patients were r and omized to care delivered by a CNS in a rheumatology outpatient clinic ( 12 weeks ) , inpatient team care ( 2 weeks ) and day patient team care ( 3 weeks ) . Clinical assessment s recorded on study entry , weeks 12 , 26 , 52 , 78 and 104 comprised the health assessment question naire ( HAQ ) and MacMaster Toronto Arthritis ( MACTAR ) patient preference interview as primary outcome measures . Grip strength , walk test , R AND -36 , Rheumatoid Arthritis Quality of Life question naire and disease activity score ( DAS ) were applied as secondary outcome measures . RESULTS No significant differences in medical treatment , use of services of other health professionals , introduction of adaptive equipment or number of hospitalizations were observed between the three treatment groups during 2 year follow-up , except that visits to nurse specialists were more frequent and home help was less frequent in the CNS group . A comparison of clinical outcomes among the three groups and a comparison between the nurse specialist and inpatient and day patient care groups together did not show any significant differences . Within all three groups functional status , quality of life and disease activity improved significantly ( P < 0.05 ) . In general , the results obtained after 12 weeks remained stable until 104 weeks after the start of the study . CONCLUSION Care provided by a CNS in an outpatient rheumatology clinic has a similar long-term clinical outcome to inpatient and day patient team care in patients with rheumatoid arthritis . A CNS intervention appears to be an effective innovation in the care for patients with rheumatoid arthritis Objective Multidisciplinary team ( MDT ) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service ( NHS ) . However , evidence for their effectiveness is mixed . Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans . This is a proxy measure of effectiveness , because it lies on the pathway to improvements in health , and reflects team decision making which has taken account of clinical and non- clinical information . Additionally , this measure can be compared across MDTs for different conditions . Methods We undertook a prospect i ve mixed- methods study of 12 MDTs in London and North Thames . Data were collected by observation of  370 MDT meetings , interviews with 53 MDT members , and from 2654 patient medical records . We examined the influence of patient-related factors ( disease , age , sex , deprivation , whether their preferences and other clinical /health behaviours were mentioned ) and MDT features ( as measured using the ‘ Team Climate Inventory ’ and skill mix ) on the implementation of MDT treatment plans . Results The adjusted odds ( or likelihood ) of implementation was reduced by 25 % for each additional professional group represented at the MDT meeting . Implementation was more likely in MDTs with clear goals and processes and a good ‘ Team Climate ’ ( adjusted OR 1.96 ; 95 % CI 1.15 to 3.31 for a unit increase in Team Climate Inventory ( TCI ) score ) . Implementation varied by disease category , with the lowest adjusted odds of implementation in mental health teams . Implementation was also lower for patients living in more deprived areas ( adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60 , 95 % CI 0.39 to 0.91 ) . Conclusions Greater multidisciplinarity is not necessarily associated with more effective decision making . Explicit goals and procedures are also crucial . Decision implementation should be routinely monitored to ensure the equitable provision of care Purpose . To examine the effect of an interdisciplinary , out-patient rehabilitation programme for patients with chronic inflammatory arthritis on aerobic capacity and health-related quality of life ( HRQOL ) . Method . One hundred and seventy-four patients , 115 with peripheral arthritis ( PA ) ( 91 women , mean age 53 years , disease duration 16 years ) and 59 with spondylarthropathies ( SpA ) , ( 27 women , mean age 46 years , disease duration 14 years ) were consecutively enrolled in 18 days of interdisciplinary rehabilitation . We report data from evaluations at inclusion , at discharge , and at 4 and 12 months using a sub-maximal treadmill test of aerobic capacity and the Nottingham Health Profile ( NHP ) ( t-test ) . Results . At inclusion , less than 20 % of all patients tested had aerobic capacity classified as ‘ average ’ or better . At discharge , 41 % ( PA ) and 54 % ( SpA ) reached the ‘ average ’ level or better with improvements maintained for 12 months . The total NHP scores improved in both groups ( mean change −12 ( 99%CI –15 , –9 ) for PA ; mean change –13 ( 99%CI –19 , –8 ) for SpA ) and were maintained . Conclusion . Aerobic capacity and HRQOL improved significantly in this interdisciplinary out-patient rehabilitation study , and improvements were maintained for 12 months . The preserved level of aerobic capacity after 12 months indicated a change to a more physically active lifestyle among the participants Background Evidence supports the use of educational and physical training programs for people with rheumatoid arthritis ( RA ) . Objective The purpose of this study was to evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA . Design This was a r and omized controlled trial . Setting The study was conducted at a rehabilitation center in the Netherl and s. Participants Thirty-four people diagnosed with RA participated in the study . Participants were r and omly assigned to either an intervention group ( n=19 ) or a waiting list control group ( n=15 ) . Intervention The intervention in this study was an 8-week , multidisciplinary , group therapy program for people with RA , consisting of physical exercise design ed to increase aerobic capacity and muscle strength ( force-generating capacity ) together with an educational program to improve health status and self-efficacy for disease-self-management . Measurements The main outcome measures were maximum oxygen uptake ( V̇o2max ) , muscle strength of the elbow and knee flexors and extensors , health status , and perceived self-efficacy . All data were recorded before intervention in week 1 , after intervention in week 9 , and at follow-up in week 22 . Results The intervention group showed significant improvement ( 12.1 % ) in V̇o2max at week 9 compared with the control group ( −1.7 % ) . Although significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group , no between-group changes were found regarding these outcomes . Limitations An important limitation was the small number of participants included in our study , which may have result ed in a lack of power . Conclusions The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength , health status , or self-efficacy OBJECTIVE To study health-related quality of life ( HRQoL ) in  arthritis rehabilitation performed by mult 
    Output:
    
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