Self management of arthritis in primary care: randomised controlled trial

Abstract

Objective To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis. Design Randomised controlled trial. Setting 74 general practices in the United Kingdom. Participants 812 patients aged 50 and over with osteoarthritis of hips or knees (or both) and pain or disability (or both). Intervention Participants were randomised to six sessions of self management of arthritis and an education booklet (intervention group) or the education booklet alone (control group). Main outcome measures Primary outcome was quality of life, as assessed by the short form health survey (SF-36). Several other physical and psychosocial secondary outcomes were assessed. Data were collected at baseline, four months, and 12 months. Results Response rates were 80% and 76% at four and 12 months. The two groups showed significant differences at 12 months on the anxiety subscore of the hospital anxiety and depression scale (mean difference − 0.62, 95% confidence interval − 1.08 to − 0.16), arthritis self efficacy scale for pain (0.98, 0.07 to 1.89), and self efficacy for other aspects of management (1.58, 0.25 to 2.90). Results were similar for intention to treat and per protocol analyses. No significant difference was seen in number of visits to the general practitioner at 12 months. Conclusions The self management of arthritis programme reduced anxiety and improved participants' perceived self efficacy to manage symptoms, but it had no significant effect on pain, physical functioning, or contact with primary care. Trial registration Current Controlled Trials ISRCTN79115352.

Limited results of group self-management education for rheumatoid arthritis patients and their partners: explanations from the patient perspective

“…A majority of these motivated participants increased in self-efficacy. Motivational problems were also detected in other studies [7].…”

“…Effects of the ASMP on self-efficacy, health behaviors, health status, and health care utilization have been documented in many studies [2][3][4][5]. However, at least two studies with primary care patients reported limited results [6,7]. In general, the effects of patient education programs for adults with RA are robust but short lived [8].…”

Predicting who will benefit from an Expert Patients Programme self-management course

“…3,7 However, analyses of the impact of baseline self-efficacy and health have not been reported previously. It is also suggested that other research teams who have undertaken recent trials of chronic disease selfmanagement courses 7,11 investigate whether the present results can be replicated.…”

“…3,4 Further trials of the course have recruited patients with a self-defined long-term condition, 5 adapted the generic programme to specific cultures, [6][7][8][9][10] and tested condition-specific adaptations. [11][12][13] A recently completed randomised controlled trial of the Expert Patients Programme showed it was effective in improving subjective measures of health, including a medium effect on self-efficacy (confidence in managing the effects of long-term conditions; effect size = 0.4), and small effects on energy (effect size = 0.2) and health-related quality of life (providing the equivalent of one extra week of perfect health per year). 5 These findings accorded with previous trials of the Stanford course.…”

PARQVE-Project Arthritis Recovering Quality of Life by Means of Education Short-term Outcome in a Randomized Clinical Trial

“…A meta-analysis with eleven studies and three other randomized controlled trials (not included in this meta-analysis) undertaken in Sweden, France and in the United Kingdom (UK), showed limited improvement in pain and function. The UK study showed no superiority of a self-management course when an educational booklet was given [10][11][12][13]. However, it is feasible in a primary care setting and it can improve self-perceived health as well as function and a structured consultation program for patients with knee OA resulted in short term improvement in weight loss and time spent on physical activity [11,12].…”