A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee

Abstract

The aim was to assess the self-efficacy and health outcomes of an adopted Arthritis Self-Management Programme (ASMP) among osteoarthritic knee sufferers in Hong Kong at 1 year. An experimental study with 95 participants assigned randomly to the intervention (n=45) or control group (n=50). Seventy-seven (81.1%) participants joined at least one out of three follow-ups in the 12 month period. Participants in the intervention group received a 6-week ASMP with an added exercise component in two general clinics. Outcome measures included arthritis self-efficacy (ASE) and health outcomes including pain and fatigue rating, self-rated health, daily activities limitation and number of unplanned arthritis-related medical consultations. Mean change (12 months minus baseline) and the effect size of the outcome measures were calculated by Mann-Whitney U test and nQuery Advisor 4.0. At 12 months, there were significant reductions of current pain (p=0.0001), pain at night (p=0.001), pain during walking (p=0.01) and number of unplanned arthritis-related medical consultations (p=0.03) and a significant increase in ASE for pain (p=0.01) and other symptoms (p=0.02) and self-rated health (p=0.04) among the intervention group but not for the control group. However, there were similarities in outcome measures of pain while switching from a sitting to a standing position, fatigue rating and physical functional limitation (p=0.15; p=0.22 and p=0.91, respectively) for both groups. Our findings add to the evidence that the modified arthritis empowering programme improved perception of control of osteoarthritis and three health outcomes after 12 months of treatment.

The effects of a non-operative multimodal programme on osteoarthritis of the knee

“…Adherence to exercise especially in overweight patients is known to improve physical function 12 and perceptions of disease control. 31 Since most patients did not attend all 12 classes, it was hypothesised that the number of classes attended would correlate with a proportional improvement in function; however, this was not our experience. This is likely to be due to a number of reasons.…”

Arthritis Self-Efficacy Scale Scores in Knee Osteoarthritis: A Systematic Review and Meta-analysis Comparing Arthritis Self-Management Education With or Without Exercise

“…[5][6][7][8]17,18,29,34,35 Intervention 2 was some form of arthritis self-management education that also included exercise (15 studies; subjects, n = 1757; women, n = 1406 [80%]). 16,20,[25][26][27][28][30][31][32]40,47,51,[59][60][61] These interventions included both cohort studies using the ASES pain (10 studies; subjects, n = 1035) 5 37.5% (9 of 24) did not describe a control or placebo group, 41.7% (10 of 24) did not adequately describe study exclusion criteria, and 25% (6 of 24) did not adequately describe subject dropout management. Studies with arthritis self-management education with exercise (intervention 2) displayed significantly higher methodological quality scale scores (76.8  13.1 versus 61.6  19.6, P = .03) compared to studies with arthritis self-management education alone (intervention 1).…”

“…These studies reported a mean effect size of 0.438  0.07. Forest plots were created for randomized controlled studies that used the ASES pain (13 studies, n = 1925), 6,18,20,[26][27][28][29]34,40,51,[59][60][61] other symptoms (13 studies, n = 1976), 6,18,20,[25][26][27][28][29]34,51,[59][60][61] and function (5 studies, n = 428) 18,20,28,29,34 subscales. Small to moderate standardized mean difference effect sizes were noted for both intervention 1 and intervention 2 for ASES pain (0.37  0.47 versus 0.20  0.32, P = .60) (FIGURE 2), other symptoms (0.25  0.17 versus 0.29  0.29, P = .94) (FIGURE 3), and function (0.17  0.11 versus 0.18  0.21, P = .99) (FIG-URE 4) subscales.…”

“…Hartman et al 20 Hughes et al 26 Hughes et al 27 Hunt et al 28 Murphy et al 40 Sullivan et al 51 Wu et al 59 Yip et al 60 Yip et al 61 …”

“…Although most studies relied on a waiting list, 6 standard care, 18,20,34,51,[59][60][61] or only an instructional booklet 26,27 for control-group subjects, others employed lesser versions of the primary intervention, such as spouse-assisted education alone rather than specific coping skills training or spouse-assisted coping skills training, 29 nondirective counseling with standard exercise rather than pain coping skills training with standard exercise, 28 or generic health education with standard exercise rather than activity strategy training with standard exercise. 39 Additionally, this study only evaluated ASES subscale scores and did not evaluate other scales that measured self-efficacy characteristics or other psychobehavioral constructs, such as fear avoidance, depression, or health locus of control.…”