Background Onset of arthritis leads to significant limitation in physical activity, severe and chronic pain and disability. Self-management programs are effective for some conditions however evidence for arthritis self-management is inconclusive (Coleman, et al., 2008; Newman, Steed, & Mulligan, 2004).
Objectives The purpose of this study was to identify the effects of a newly developed self-management support program (Smart Patient Program, SPP) for enhancing health status and patient activation among rural Korean people with osteoarthritis.
Methods This study was part of a larger open-label, randomized, and controlled research of a community-based multifaceted intervention. Community-dwelling people with osteoarthritis (n=270) were recruited from 3 community health posts (CHPs) in a rural area. Two were designated experimental areas and one control. Ninety persons with osteoarthritis were randomly recruited, thirty from each area and they were enrolled in the study. The 8 week-SPP based on Cox's Interaction Model of Client Health Behavior, which focuses on patient-centered, tailored intervention and partnership with a doctor, was developed to support disease self-management. Two trained community health practitioners with cognitive-emotional-behavioral approaches and coaching strategy for activating participants led the participants. Outcome measures were WOMAX, Stanford Health Assessment Questionnaire Disability Index, CES-D, Patient Activation Measure (PAM), and goniometer and tape to measure joint flexibility in shoulders and knees. Data were analyzed using descriptive analysis, chi-square test, t-test, and ANOVA.
Results Homogeneity test among the 3 groups showed no significant differences in either the independent variables or dependent variables including health status (joint stiffness and flexibility, physical function and depression) except for joint pain (p<.05) and patient activation (p<.0001). Statistically significant mean increases were found for health status but not for shoulder joint flexibility, and patient activation in the two experimental groups. There were statistically significant mean increases in health status, but not physical function or patient activation in the control group. The mean differences between the experimental and control groups in the change of before-after scores were statistically significant for joints pain (p<.0001), joints stiffness (p=.007) and physical function (p<.0001).
Conclusions This 8-week community-based multifaceted intervention program improved the health status of people with osteoarthritis. Follow-up studies will be continued in order to determine short (6 months) and medium (12 months)-term effects of the SPP on health outcomes.
Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J (2008). Short and medium-term effects of an education self-management program for individuals with osteoarthritis of the knee, designed and delivered by health professionals: a quality assurance study. BMC Musculoskeletal Disorders, 9, 117. Doi:10.1186/1471-2474-9-117.
Newman S, Steed L, Mulligan K (2004). Self-management interventions for chronic illness, Lancet, 364(9444), 1523-1537.
Acknowledgements This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012-8-5261).
Disclosure of Interest None declared