The effectiveness of self‐management educational interventions for osteoarthritis of the knee Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial Self-management for osteoarthritis of the knee: Does mode of delivery influence outcome? Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis? The effectiveness of a self-management program on quality of life for knee osteoarthritis (OA) patients. Family practice nurses supporting self-management in older patients with mild osteoarthritis: a randomized trial 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 Self management of arthritis in primary care: randomised controlled trial Treating disability in knee osteoarthritis with exercise therapy: a central role for self-efficacy and pain. The Self-Management of OsteoArthritis in Veterans (SeMOA) Study: design and methodology. Self-management in osteoarthritis of hip or knee: a randomized clinical trial in a primary healthcare setting. An 8-yr follow-up of arthritis self-management programme participants. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Effects of a Group-Based Exercise and Educational Program on Physical Performance and Disease Self-Management in Rheumatoid Arthritis: A Randomized Controlled Study Randomized Controlled Trial Investigating the Role of Exercise in the Workplace to Improve Work Ability, Performance, and Patient-Reported Symptoms Among Older Workers With Osteoarthritis Patient education in arthritis: randomized controlled trial of a mail-delivered program.
Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : Abstract Background Self-management has become increasingly popular in the management of chronic diseases . There are many different self-management models . Meta analyses of arthritis self-management have concluded that it is difficult to recommend any one program in preference to another due to inconsistencies in the study design s used to evaluate different programs . The Stanford Arthritis Self-Management Program ( ASMP ) , most commonly delivered by trained lay leaders , is a generic program widely used for people with rheumatological disorders . We have developed a more specific program expressly for people with osteoarthritis of the knee ( OAKP ) . It includes information design ed to be delivered by health professionals and results in improvements in pain , function and quality of life . Aim : To determine whether , for people with osteoarthritis ( OA ) of the knee , the OAKP implemented in a primary health care setting can achieve and maintain clinical ly meaningful improvements in more participants than ASMP delivered in the same environment . Methods / Design The effectiveness of the programs will be compared in a single-blind r and omized study . Participants : 146 participants with established OA knee will be recruited . Volunteers with coexistent inflammatory joint disease or serious co-morbidities will be excluded . Interventions : Participants will be r and omised into either  OAKP or ASMP groups and followed for 6 months . Measurements : Assessment s will be immediately before and after the intervention and at 6 months . Primary outcome measures will be WOMAC and SF-36 question naires and a VAS for pain . Secondary outcomes will include balance , tested using a timed single leg balance test and a timed step test and self-efficacy . Data will be analysed using repeated measures ANOVA . Discussion With an aging population the health care costs for people with arthritis are ever increasing . Although cost analysis is beyond the scope of this study , it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders . Consequently it is critical to examine the relative effectiveness of the primary care management strategies available for OA.Trial Registration This study is registered with the Australian New Zeal and Clinical Trials Registry : Background Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis ( OA ) . The most well-known is the disease-specific Stanford Arthritis Self-Management Program ( ASMP ) . While Australian and international clinical guidelines promote the concept of self-management for OA , there is currently little evidence to support the use of the ASMP . Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability . However , previous studies have had method ological shortcomings including the use of outcome measures which do not accurately reflect program goals . Additionally , limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored . Methods / design This study is a r and omised controlled trial to determine the efficacy ( in terms of Health-Related Quality of Life and self-management skills ) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practice s within 2 private hospital setting s in Victoria , Australia . Participants must be 18 years or over , fluent in English and able to attend ASMP sessions . Exclusion criteria include cognitive dysfunction , previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement . Eligible , consenting participants will be r and omised to an intervention group ( who receive the ASMP and an arthritis self-management book ) or a control group ( who receive the book only ) . Follow-up will be at 6 weeks , 3 months and 12 months using st and ardised self-report measures . The primary outcome is Health-Related Quality of Life at 12 months , measured using the Assessment of Quality of Life instrument . Secondary outcome measures include the Health Education Impact Question naire , Western Ontario and McMaster Universities Osteoarthritis Index ( pain subscale and total scores ) , Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool . Cost-utility analyses will be undertaken using administrative records and self-report data . A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP . Discussion Using an innovative design combining both quantitative and qualitative components , this project will provide high quality data to facilitate evidence -based recommendations regarding the ASMP PURPOSE To evaluate the effectiveness of the Taipei Osteoarthritis Program ( TOAP ) for community elderly persons who suffer from knee OA . METHODS A quasi-experimental study was conducted between January 2008 and December 2008 . Two hundred and five community-dwelling individuals aged 67±10 years with knee OA were recruited from four districts in Taipei City and r and omized . By a clustered r and omization according to the districts , 114 participants were in the intervention group ( IG ) with a 4-week TOAP program and 91 participants were in the control group ( CG ) with routine care . The main outcome measures included health-related quality of life ( HRQOL ) and disability level , which were assessed by the Short Form-36 Taiwan Version ( T-SF36 ) and the Western Ontario McMaster Universities Arthritis Index Taiwan Version ( T-WOMAC ) , respectively , and were repeatedly measured at the baseline , post invention ( 4 weeks after baseline ) , and follow-up ( 8 weeks after baseline ) . RESULTS Subjects in the IG increased their changes of GH scores from baseline to post-intervention and follow-up , which were significantly more than those of subjects in the CG ( p=0.011 and 0.005 , respectively ) . Significant difference of changes was also found at follow-up for the mental component scale between the groups ( p=0.013 ) . There was no change in disability level . CONCLUSIONS The arthritis self-management program improved the psychological outcomes among the participants , but it had no significant effect on a self-reported disability level Background Supporting self-management intends to improve life-style , which is beneficial for patients with mild osteoarthritis ( OA ) . We evaluated a nurse-based intervention on  older OA patients ' self-management with the aim to assess its effects on mobility and functioning . Methods R and omized controlled trial of patients ( ≥ 65 years ) with mild hip or knee OA from nine family practice s in the Netherl and s. Intervention consisted of supporting patients ' self-management of OA symptoms using a practice -based nurse . Outcome measures were patients ' mobility , using the Timed Up and Go test ( TUG ) , and patient reported functioning , using an arthritis specific scale ( Dutch AIMS 2 SF ) . Results Fifty-one patients were r and omized to the intervention group and 53 to the control group . Patient-reported functioning improved on four scales in the intervention group compared to one scale in the control group . However , this result was not significant . Mobility improved in both groups , without a significant difference between the two groups . There were no differences between the groups regarding consultations with family physicians or physiotherapists , or medication use . Conclusion A nurse-based intervention on older OA patients ' self-management did not improve self-reported functioning , mobility or patients ' use of health care re sources 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 r and omly 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 st and ing 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 Abstract Objective To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis . Design R and omised controlled trial . Setting 74 general practice s 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 r and omised 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 IS RCT N79115352 [ controlled-trials.com ] OBJECTIVE To examine the effects of aerobic and resistance exercise on self-efficacy beliefs in older adults with knee osteoarthritis ( OA ) and to determine whether self-efficacy and knee pain mediated the effects of the treatments on stair time performance and health perceptions . METHODS Measures of self-efficacy , knee pain , stair climbing performance , and health perceptions were collected prior to r and omization and again at an 18-month followup in older adults with knee OA who were assigned to 1 of 3 treatment conditions : aerobic exercise , resistance training , or health education control .  All analyses were conducted on the intention-to-treat principle . RESULTS Both exercise treatments increased self-efficacy for stair climbing in comparison to the health education control group . Both knee pain and self-efficacy mediated the effect of the treatments on stair climb time , whereas only knee pain mediated health perceptions . CONCLUSIONS The findings suggest that control beliefs and changes in physical symptoms such as knee pain are important outcomes in physical activity programs with patients who have OA of the knee . Moreover , these variables mediate the effects that such programs have on disability and health perceptions BACKGROUND Osteoarthritis ( OA ) is a leading cause of disability among adults . Although self-management behaviors such as exercise and weight management can improve pain and function , these behaviors are vastly underutilized . There is a need to implement effective self-management programs among the growing number of adults with OA . OBJECTIVES The Self-Management of OsteoArthritis ( SeMOA ) in Veterans Study examines a 12-month telephone-based OA self-management program in the primary care setting . This manuscript details the design , methodology , and advances of the SeMOA trial . METHODS Participants ( N=519 ) with hip or knee OA are r and omly assigned to one of three groups : OA self-management , health education ( attention control ) , or usual care . The OA self-management group receives written and audio material s regarding OA care ( including health behaviors , medical care , and interacting with health care providers ) . A health educator calls participants monthly to review these material s and provide support for developing individualized goals and action plans related to OA management . The health education group receives written and audio material s and monthly calls from a health educator discussing health issues unrelated to OA . Usual care involves no additional material s or phone calls . The primary outcome is change in the Arthritis Impact Measurement Scales-2 pain subscale from baseline to 12 months . Analysis of covariance models will compare changes in pain across study groups . The cost-effectiveness of the OA self-management program will also be assessed . CONCLUSION SeMOA is one of the first to examine telephone-based delivery of OA self-management and one of few trials to target the primary care setting . This program has the potential for broad dissemination because it reduces both the costs and barriers that accompany in-person programs . This study will provide important information about its feasibility and effectiveness in a real-world clinical setting OBJECTIVE To assess in a primary healthcare setting the efficacy of a self-management program in middle-aged patients with osteoarthritis ( OA ) . METHODS This was a 2-group r and omized controlled trial , with 273 patients aged 40 to 60 years with OA of the hip(s ) and /or knee(s ) . The experimental intervention was compared with care-as-usual . Treatments and followup measurements were performed in a general healthcare setting by general practitioners . Duration of followup was 21 months after start of the intervention . Instruction in self-management techniques was given by physiotherapists . The main outcome measures were pain severity in hips and knees , other significant complaints , and functional limitations . RESULTS To begin , 297 patients were r and omized : 149 as self-management and 148 controls ; before the intervention 24 withdrew for practical reasons ( 17 self-management  , 7 controls ) . At 3-month followup the intervention group was significantly improved on a visual analog scale ( VAS ) for knee pain ( score 0.67 ; SD 2.10 ) and the WOMAC ( score 2.46 ; SD 9.49 ) , while the control group showed stable VAS knee pain ( 0.01 ; SD 2.00 ) and deterioration on WOMAC ( -0.53 ; SD 9.47 ) . At 21-month followup the differences between the groups increased in favor of the intervention group ( VAS pain knee : p values from 0.023 at 3 mo to 0.004 at 21 mo ; WOMAC : p values from 0.030 to 0.022 ) . CONCLUSION The self-management program positively influenced knee pain and self-reported functional level in this sample of patients with OA . Differences between the study groups increased during followup in favor of the intervention group OBJECTIVES To examine the pattern of scores on self-efficacy , health status and use of self-management techniques  among a group of Arthritis Self-Management Programme ( ASMP ) participants over an 8-yr period , and to describe participants ' perspectives of the ASMP and current use of self-management . METHODS Data from 125 participants who attended the ASMP as part of a r and omized controlled trial and completed assessment s at baseline , 4-month and 8-yr follow-ups were entered into the analysis . A sub- sample of 10 participants ( five high- and five low self-efficacy ) was interviewed . RESULTS The sample was 87 % female ; mean age 65 ( s.d . 12 ) yrs ; mean disease duration 19 ( s.d . 11 ) yrs ; 48 % RA ; 48 % OA . The overall pattern of scores showed improvements between baseline and 4 months , which appeared to be maintained at 8-yr follow-up on self-efficacy , positive and negative affect , anxious and depressed moods , pain and fatigue , cognitive symptom management and communication with physician . The exception was HAQ , which was stable from baseline to 4 months ( as expected ) , but had increased at 8 yrs indicating a decline in physical functioning . Sub-group analyses by RA and OA showed similar patterns of results . Interviews revealed that some participants continued to have problems with disease acceptance and highlighted the importance of pre-course expectations . CONCLUSIONS Long-term maintenance of self-efficacy , psychological well-being and self-management techniques may be possible following attendance on the ASMP . The need for additional psychological support for those who are having difficulty adjusting to their condition and its consequences is highlighted OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance Background Evidence supports the use of educational and physical training programs for people with rheumatoid arthritis ( RA ) . Objective The purpose of this study was to evaluate the effects of a group-based exercise and educational program on the physical performance and disease self-management of people with RA . Design This was a r and omized controlled trial . Setting The study was conducted at a rehabilitation center in the Netherl and s. Participants Thirty-four people diagnosed with RA participated in the study . Participants were r and omly assigned to either an intervention group ( n=19 ) or a waiting list control group ( n=15 ) . Intervention The intervention in this study was an 8-week , multidisciplinary , group therapy program for people with RA , consisting of physical exercise design ed to increase aerobic capacity and muscle strength ( force-generating capacity ) together with an educational program to improve health status and self-efficacy for disease-self-management . Measurements The main outcome measures were maximum oxygen uptake ( V̇o2max ) , muscle strength of the elbow and knee flexors and extensors , health status , and perceived self-efficacy . All data were recorded before intervention in week 1 , after intervention in week 9 , and at follow-up in week 22 . Results The intervention group showed significant improvement ( 12.1 % ) in V̇o2max at week 9 compared with the control group ( −1.7 % ) . Although significant within-group changes were found over time for muscle strength of the upper and lower extremities and health status that favored the intervention group , no between-group changes were found regarding these outcomes . Limitations An important limitation was the small number of participants included in our study , which may have result ed in a lack of power . Conclusions The present group-based exercise and educational program for people with RA had a beneficial effect on aerobic capacity but not on muscle strength , health status , or self-efficacy Objective : The aim of this study was to evaluate the effectiveness of a 12-week workplace exercise program on work ability , performance , and patient-reported symptoms in older university employees with knee and /or hip osteoarthritis . Methods : Twenty-four participants with clinical hip and /or knee osteoarthritis were r and omized to exercise or no exercise . At baseline and follow-up , several work ( work ability , resilience ) , patient-reported ( pain , physical function , depressive symptoms , self-efficacy ) , and performance outcomes ( hip and knee strength , mobility performance ) were measured . Results : Significant improvements in work ability ( P < 0.049 ) and patient-reported outcomes ( pain , function , depressive symptoms ) existed in the exercise group . No improvements were demonstrated in the no exercise group . Conclusions : Exercise in the workplace improved work ability and patient-reported symptoms in older workers with osteoarthritis . The benefits of workplace exercise programs should be studied in a larger sample in which attention is given to improving exercise adherence OBJECTIVE Self-management courses in arthritis have been shown to improve outcomes and to decrease medical re source utilization . We studied the effectiveness of a mail-delivered arthritis self-management program with the potential for extending these effects more broadly . METHODS R and omized controlled trial of 375 program participants and 434 controls over a 6 month period . Baseline and 6 month data were analyzed for each group and between groups by paired 2 sample t test . The intervention consists of health assessment question naires at 3 month intervals , with computer processed recommendation letters and reports individualized to age , diagnosis , education level , disability , pain , medication , and other patient-specific variables . RESULTS At 6 months , outcomes of function ( 4.7 % ; 95 % confidence limits 2.7 , 6.7 ) , decreased pain ( 9 % ; 2.8 , 15.2 ) , global vitality ( 7 % ; 2.8 , 11.2 ) , and joint count ( 28 % ; 20 , 36 ) were improved in the program group compared with controls ( p < 0.01 ) . Exercise ( 35 % ; 26 , 44 ) and self-efficacy ( 14.7 % ; 9 , 20 ) were increased in the program group but not controls ( p < 0.001 ) . Doctor visits/year were decreased by 16 % ( 3 , 29 ) in the program group compared with controls ( p < 0.05 ) and days missed work or confined to home decreased by 52 % ( -3 , 107 ) in the program group compared with controls ( p = 0.06 ) . At one year , patients in the original program group continued to improve , and the control group , provided with the program in the second 6 months , showed improvement similar to the first 6 months of the original program group . CONCLUSION A mail-delivered arthritis self-management program can positively affect patient outcomes and can decrease medical re source utilization
Small to moderate effect sizes were observed regardless of whether the intervention included exercise .
OBJECTIVE To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis .
BACKGROUND Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function .