The increasing prevalence of rheumatic and musculoskeletal diseases (RMDs) and other chronic diseases constitute a major challenge to sustainable health care. Self management is frequently seen as a cost-effective substitute for health care. Self management is expected to be effective, and to save costs.
Empirical studies provide a sobering perspective. Reviews and meta-analyses often show small to moderate effects of self management on health and quality of life, some reduction of health care use, while few studies show a reduction of health care costs.
Chronic illness is associated with a range of self management tasks :
– Monitoring health status and making associated care decisions
– Interacting with health care providers
– Engaging in activities to promote physical and psychological health
– Managing the impact of the illness on physical, psychological and social functioning.
It will be argued to some self management activities could substitute health care, leading to cost savings (e.g. monitoring health status). Other self management activities are of major importance, but are less likely to lead to substitution of care and cost savings (e.g. managing the impact of the illness on psychological and social functioning).
People with RMDs differ in their self management needs and preferences. Tailoring of self management to these needs and preferences is of utmost importance . Comorbidity is a major issue to consider in this respect. For example, comorbid cardiovascular disease is a major barrier to exercise, while exercise has been shown to be effective in many RMDs. Exercise needs to be adapted to comorbid disease [3,4]. More generally, needs and preferences need to be taken into account in developing effective approaches towards self management.
Self management is crucial for health and wellbeing of people with RMDs. Self management activities need to be tailored to personal needs and preferences of people with RMDs. This approach is expected to improve the effectiveness of self management, while the impact on saving costs remains to be seen.
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de Rooij M, van der Leeden M., Avezaat E, Hakkinen A, Klaver R, Maas T et al. Development of comorbidity-adapted exercise protocols for patients with knee osteoarthritis. Clinical Interventions in Aging (in press) 2014.
de Rooij M, Steultjens M., Avezaat E, Hakkinen A, Klaver R, van der Leeden M. et al. Restrictions and contraindications for exercise therapy in patients with hip and knee osteoarthritis and comorbidity. Physical Therapy Reviews 2013;18:101-11.
Disclosure of Interest None declared