176. Multidisciplinary Care in the Management of Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

Background: Multidisciplinary team (MDT) care aims to improve disease activity, physical and psychosocial function and is considered the optimal management strategy for people with RA. Despite the widespread implementation of the MDT approach, there is a paucity of evidence for its effectiveness. This systematic review and metaanalysis evaluates the effectiveness of MDT care in the management of disability and disease activity in adults with RA. Methods: Data sources comprised 5 electronic databases, cross referencing from retrieved studies and expert review. Inclusion criteria were randomized controlled trials (RCTs) that included: (i) MDT care comprising two or more medical/allied health professionals working in a co-ordinated way, delivered in any setting; (ii) comparison groups of usual care, waiting list or interventions not involving an MDT; (iii) adults aged >18 years with RA; (iv) published or unpublished studies; (v) studies in any language between 1960-present; (vi) data available on disability and/or disease activity. Independent data extraction and quality assessment, using the Cochrane risk of bias tool, was conducted by 2 reviewers. The primary outcome was change in disability at 1 year after initiation of intervention and secondary outcomes included change in disability at<1 year or>2 years and change in disease activity at 1 year after intervention. Meta-analyses of mean differences using random effects models were used to pool disability and disease activity outcomes from all moderate and high quality RCTs, inpatient MDT or outpatient MDT interventions. Results: A total of 2407 studies were retrieved. Of these, 13 manuscripts, which reported 11 RCTs (3 high, 3 moderate, 5 low quality studies), representing 1,189 participants (599 MDT care, 590 comparison) met the inclusion criteria. Pooled effect sizes were established from all moderate and high quality trials and due to significant clinical heterogeneity, studies evaluating inpatient MDT care (4 studies) and outpatient MDT care (3 studies) were considered separately. There was no difference in disability between inpatient MDT care and any comparison group at 1 year [0.04 (-0.13, 0.20)], >2 years [-0.03 (-0.02, 0.14)] or between outpatient MDT care and any comparison groups at 1 year [0.02 (-0.08, 0.13), >2 years (0.15 (-0.04, 0.34) or <1 year (0.02, -54.64, 54.68)]. There was also no difference in disease activity between inpatient MDT care [-0.40,(-0.90, 0.10)] or outpatient MDT care [0.17 (-0.35, 0.69)] and any comparison groups at 1 year. Conclusion: A small number of moderate and high quality studies suggest there is no effect of MDT care on disability or disease activity in people with RA at 1 year or disability at less than 1 year or after 2 years.