Openreuma Consensus on the role of nursing in the care of patients with rheumatoid arthritis and diffuse interstitial lung disease.
Laura Cano García, María Jesús García de Yébenes, Natalia Mena Vázquez and 12 others
PMID 36867790WHAT IT FOUND
Nurses managing rheumatoid arthritis with interstitial lung disease have 12 consensus recommendations, covering screening, education, treatment safety, smoking cessation and frailty.
Only head-of-bed elevation was evidence-based, and that evidence was very low.
Key findings
0112 recommendations for rheumatology nurses were accepted, and only one was based on a systematic review; the rest were expert opinion.
02Three proposed recommendations were rejected in the second Delphi round, including respiratory rehabilitation access and speech rehabilitation for refractory cough, despite both being evidence-based at a very low level.
03The only accepted evidence-based recommendation, raising the head of the bed for reflux or orthopnoea, came from a gastro-oesophageal reflux review that did not include patients with ILD or rheumatoid arthritis and had elevated risk of bias and high heterogeneity.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most recommendations were expert opinion, not tested nursing interventions. The only evidence-based accepted recommendation came from a reflux review that did not include patients with ILD or rheumatoid arthritis, and it had elevated risk of bias and high heterogeneity. The cough and reflux searches were not limited to ILD, so they may not apply to RA-ILD. The paper does not state how many OpenReuma members completed the Delphi, so the agreement percentages are hard to interpret. Three rejected recommendations were evidence-based at very low level, so the final list may omit interventions that had some support. The document reports no patient outcomes, so it cannot show that these recommendations improve symptoms, hospitalisation or survival.
Declared interests
The work was funded by OpenReuma, the Spanish association of professionals in Rheumatology.
The easy way to misread this
Do not read the 12 recommendations as proven nursing care. Only one was evidence-based, and that one came from a gastro-oesophageal reflux review that did not include patients with ILD or rheumatoid arthritis.