Table 2

Design and outcomes of studies of self-management in patients with arthritis (osteoarthritis, rheumatoid arthritis, fibromyalgia and other arthritic conditions)

Author (year)Design and sample (n); diagnoses (%); mean age; % women; arthritis durationRecruitment source; % drop-outIntervention; duration; booster; comparison groupFacilitator; training provided (Y/N)TheoryFollow-upSignificant outcomes: improved
Lorig et al (2004)14RCT (n=1090); OA (40%), RA (60%); 62 y; 77% women; duration, not statedCV; drop-out:(A) SMART (individually tailored print materials based on the ASMP) plus the Arthritis helpbook; booster: follow-up materials every 4 m for 12.18 mSelf-completedSCT12, 24 and 36 mCC and ITT analysis:
12 m, 10%(B) Usual care12 m: SMART: function, role function, self-efficacy
24 m, 9%24 m: global severity, doctor visits
36 m, 15%36 m: no difference
Lorig et al (2004)14Randomised parallel group trial (n=341); OA (70%), RA (30%); 65 y; 75% women; duration, not statedCV; drop-out:(A) SMART (as above)PM (Y)SCT12, 24 and 36 mITT analysis:
12 m, 5%(B) 6×2 h/week ASMP (6×2 h/week: action planning, problem solving, decision making; exercise, cognitive symptom, pain, fatigue, sleep management; nutrition, communication plus Arthritis handbook; no booster; no control group12 m: SMART: function, social role function, selfefficacy
24 m, 7%24 m: no differences
34 m, 21%36 m: ASMP: social role function, doctor visits
Lorig et al (2005)15Randomised parallel group trial (n=355); OA (75%), RA (15%), other (15%); 65 y; 85% women; duration, not statedCV drop-out:(A) ASMP 6×2 h/week (see above)PM (Y)SCT4 and 12 mITT analysis:
4 m, 9%(B) CDSMP 6×2 h/week (content similar to ASMP; no booster either group; no control group12 m: within group: ASMP pain, fatigue, self-efficacy, health distress, activity limitation, exercise CDSMP: global health, activity limitation, exercise
12 m, 15%12 m: between group: ASMP fatigue, global health
Nour et al (2006, 2007)17 18; Laforest et al (2008)19RCT (n=125) housebound, 113 randomised; OA (65%), RA (35%); 78 y; 90% women; duration, not statedCHC; drop-out:(A) Self-management programme: (ITCA: exercise; relaxation; everyday coping behaviours; leisure activities; social networking); individually tailored 6×1 h/week home visits by healthcare practitioner; booster: 42% monthly telephone calls for 6 mHP (Y)CBT1 w and 8 mCC analysis: 1 week: ITCA: function, helplessness, behaviours (exercise, relaxation)
8 m, 22%(B) One year wait list control8 m: exercise
Goeppinger et al (2007)20Randomised parallel group trial (n=416) (predominantly African–Americans); ‘arthritis’; 64 y; 82% women; duration, not statedCV; drop-out:(A) ASMP 6×2h/weekPM (Y)SCT4 and 12 mCC analysis:
4 m, 23%(B) CDSMP 6×2 h/week; no booster either group; no control group4 m: both groups: self-efficacy, global health ASMP group: exercise use CDSMP: pain
12 m, 60% (but only 40% contacted)12 m: ASMP only: self-efficacy
Lorig et al (2008)16RCT (n=855); OA (64%), RA (28%), FM (52%), other (14%); 52 y; 60% women; duration, not statedCV, OV; drop-out:(A) Internet-based ASMP log-on 1.2 h .3×/week for 6 weeks: self-tests; read information; post-action plans, participate in discussion board; tailored exercise programme; Arthritis Helpbook; no boosterPM (Y)SCT6 and 12 mITT analysis:
6 m, 25%(B) Usual care12 m: ASMP: pain, activity limitation, global health, self-efficacy, health distress
12 m, 24%OA only (n=292): as above+function, fatigue
RA only (n=144): pain, activity limitation, global health only
FM only (n=86): no differences
Goeppinger et al (2009)21RCT (n=921), three ethnic/racial categories; OA (51%), RA (33%), FM (30%), other (17%); 54 y; 86% women; duration, not statedCV (90%), Rheum (10%); drop-out:(A) Mailed ASMP-based TK: self-test to evaluate arthritis impact and tailoring selected information; information sheets for example, exercise, dealing with emotions, fatigue/pain management, HP communication; how to action plan, problem solve, decide what to try, individualise exercise; Arthritis Helpbook and relaxation/exercise CDs; no boosterSelf-completedSCT4 and 9 mITT analysis:
4 m, 16%(B) 4 m wait list control group4 m: TK: pain, fatigue, function, global health, selfefficacy, depression, health distress, exercise, doctor communication
9 m, 30%9 m: (no control group comparison). Benefits sustained
  • Diagnosis: OA, osteoarthritis; RA, rheumatoid arthritis.

  • Recruitment: CHC, Community Health Centres; CV, community volunteers; OV, online volunteers; Rheum, Rheumatology outpatient departments.

  • Intervention: ASMP, the Arthritis Self-Management Programme; CDSMP, Chronic Disease Self-Management Programme; ITCA, ‘I'm Taking Charge of my Arthritis’; SMART, Mail delivered Arthritis Self-Management Programme.

  • Programme facilitator: HP, health professionals; PM, trained peer/lay moderator.

  • Theory: CBT, cognitive-behavioural theory; SCT, Social Cognitive Theory.

  • Analysis: CC, case completers only; ITT, all cases included, imputation of missing values.

  • m, months; RCT, randomised controlled trial; TK, Tool Kit; y, years.