Patient education, disease activity and physical function: can we be more targeted? A cross sectional study among people with rheumatoid arthritis, psoriatic arthritis and hand osteoarthritis

Introduction: In order to target educational needs of patients more effectively, an Austrian-German educational needs assessment tool (OENAT) was developed, the educational needs of patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and hand osteoarthritis (HOA) were described and the relationships between educational needs, gender, disease activity and function were explored. Methods: The English ENAT was adapted into Austrian-German using Beaton's cross-cultural adaptation process. Internal construct validity was assessed by Rasch analysis. Educational needs across diagnostic groups and subgroups of patients were summarized descriptively and their relationship with disease activity and physical functioning explored. Results: The sample comprised 130 RA, 125 PsA and 48 HOA patients. Their mean ages +/- SD were 56 +/- 14, 51 +/- 11 and 64 +/- 7 years for RA, PsA and HOA; disease duration was 11 +/- 9, 11 +/- 11 and 14 +/- 9 years, respectively. More than 70% in each patient group expressed interest in receiving education about their disease. The educational needs differed significantly between women and men in all 3 groups. In RA and PsA, female patients expressed significantly higher educational needs than men in `movements' and `feelings' domains (p=0.04 and p=0.03 for RA and p<0.01 and p=0.01 for PsA). Female patients in the HOA group had significantly higher scores on all domains except for the `movements'. Older patients with PsA scored significantly higher than their youngercounterparts in the `pain' domain (p=0.05). RA patients with disease duration >5 years), expressed higher educational needs in `movements' (p<0.01). Educational background had effects in the PsA group only, patients with basic education had greater scores than those with higher education on `movements' and `arthritis process' (p=0.01). In the RA group, DAS28 correlated significantly with `movements' (r=0.24, p=0.01), `feelings' (r=0.22, p=0.02), and `treatments' (r=0.22, p=0.03). In the PsA group, all OENAT domains correlated with disease activity (DAPSA and CDAI). Conclusions: This study showed that educational needs vary with personal characteristics. Patient education may be more targeted and effective, if gender, age, educational background and disease duration are taken into account. Correlations with disease activity and function suggest that the OENAT could enable identification of `intervention points', which can be ideal opportunities for effective patient education.