AB1355-HPR THE IMPACT OF A STRUCTURED TRAINING PROGRAMME FOR THE DETECTION OF SYNOVITIS WITH MUSCULOSKELETAL ULTRASOUND (MSUS) IN RHEUMATOLOGY NURSING
Authors: L. Cano Garcia, C. Dominguez, S. Garcia Diaz, R. Segura, J. M. Martín Martín, F. G. Jiménez-Núñez
Journal: Annals of the Rheumatic Diseases (2020)

Background: Objectives: To analyse the effect of a teaching intervention for the technical performance of a reduced index of ultrasound synovitis by nurses without previous experience in musculoskeletal ultrasound (MSUS). Methods: Design: Quasi-experimental study of the before-after type. Protocol: The nurses received a theoretical-practical, face-to-face and intensive training of 8 hours, by an expert rheumatologist in musculoskeletal ultrasound (MSUS), to perform the Perricone index, which assesses the presence of grey-scale synovitis (GS) and quantifies the presence of a power-doppler (PD) signal semiquantitatively (0-3), in 6 joints (Wrists, 2nd Metacarpophalangeal (MCP) joints and knees). The theoretical knowledge acquired was assessed by an exam test type at the end of the training, and the technical skills were assessed by an ultrasound examination in patients with rheumatoid arthritis, immediately after the teaching session and at 18 months later. Variables: Illumination of the consultation, protection of privacy and unequivocal identification of the patient, technique (explorer ergonomics, bilateral comparison, use of both hands, measurement, marking and saving data), GS (probe position, centred image, cortical-cartilage-tendon display, depth, focus, frequency, gain), PD (probe pressure, PRF, position-width-depth of the box, focus, frequency, gain), synovial recesses (dorsal and palmar examination of the wrist, 2nd Metacarpophalangeal (MCP) joints and supra and parapatellar medial and lateral examination of the knees) and semi-quantitative gradation of synovitis in GS and PD. Statistical analysis: descriptive analysis, and in relation to the statistical significance tests for paired variables (pre and post teaching intervention) the McNemar test was used for dichotomous qualitative variables and McNemar-Bowker test for those of more than two categories. Results: 5 nurses, 80% women, aged between 36 and 54 years participated. They adequately answered 100% of the 4-student test questions, and the remaining one matched 80% of them. The average time of baseline exploration was 45,2 ±3,8 minutes and the final time was 32,6 ± 3,5, improving the 5 students in an average of 12,6± 4,4 minutes. The technical aspects not performed correctly in the baseline ultrasound examination were the bilateral comparative, centred image, grey scale gain, measuring, correct anatomical image of the synovial recess of the wrist and position-width-depth of the Doppler box. An improvement was observed at 18 months in the unequivocal identification of the patient, adequate illumination of the consultation, bilateral comparison, correct anatomical acquisition of synovial recesses and the quantification of GS synovitis, but no statistically significant differences were observed, before and after the teaching intervention, in possible relation with the difficulty to use the ultrasound in their respective Rheumatology Units in clinical practice, but mainly because the aspects correctly performed in the baseline exploration were numerous. Conclusion: A formal training of rheumatology nurses in musculoskeletal ultrasound (MSUS) could be very useful, and cost-efficient, in the health care of patients with rheumatoid arthritis. Disclosure of Interests: None declared