Thirty-five clinical trials were included in the review: 15 controlled trials (9 of which were randomised) with a total of 1,044 participants, and 20 studies without a control group for comparison. Of these 20 studies, 18 were on in-patient and 2 were on out-patient multidisciplinary team care.
In-patient MTCP was compared with regular out-patient care in 6 controlled trials. In the 2 randomised trials, a significantly greater improvement of disease activity was seen in the in-patient group immediately after treatment. The difference between the groups diminished after one year. In the 2 controlled non-randomised trials, a greater improvement of disease activity and functional status was shown immediately after hospitalisation. One study reported greater improvement in disease activity directly after treatment, with declining benefit during the follow-up. Another noted a beneficial effect on disease activity, functional status and mental health, one year after treatment.
The effects of in-patient MTCP for RA were described in 18 uncontrolled studies. Eleven studies showed functional improvement, while 8 showed a moderate decrease in disease activity between admission and discharge. Seven studies showed that the level of functional status or disease activity at discharge was maintained for periods up to 2 years for most patients. However, one study found the treatment effect decreased within 6 months.
Six controlled trials compared out-patient MTCP with regular out-patient care. Of the 4 trials that were randomised, a significantly greater improvement in overall physical function and overall health was found in the multidisciplinary group at the end of the treatment programme in one study. In another study, none of the differences in improvement between the treatment and control groups reached significance. Another study provided no statistical comparison of the change scores between the treatment and control groups, but improvement in disease activity seemed greater in the former group. The final randomised study showed that significantly fewer patients in the treatment group deteriorated in activities of daily living and, in comparison with controls, more patients were socially well adjusted after 12 months. No significant differences in disease activity were seen. There were 2 controlled non-randomised studies. In one study, the treatment groups showed more improvement in depression score and the patient's global assessment, and in the other, treatment groups showed more improvement in disease activity, deformity and psychosocial adaption.
Two uncontrolled studies examined the effect of MTCP on RA. One study found an improvement in disease activity and functional status; the other noted a significant improvement in articular index and subscales of a generic health status measure in a 1-year out-patient team care programme.
Three controlled trials compared in-patient MTCP with similar out-patient programmes. One study showed that in-patient care was more effective, while 2 studies showed that similar results were obtained in both groups.