Table 3

Design and outcomes of studies of self-management in patients with osteoarthritis only

Author (year)Design and sample (n); mean age; % women; arthritis durationRecruitment source; % drop-outIntervention; duration; comparison groupFacilitator training provided (Y/N)TheoryFollow-upSignificant outcomes: improved
Victor et al (2005)22Cluster RCT of 22 practices for n=193 patients with knee OA; 63.5 y; 69% women; duration, 55% had OA for more than 3 yearsPC; drop-out:(A) Home visit to review goals, educational booklet and 4×1 h group teaching sessions (6–8 participants) led by nurse educator at GP officeRN (NS)NS1, 3, 6 and 12 mCC analysis:
12 m, 35%(B) Educational leaflet about arthritis only1 and 12 m, no differences
Heuts et al (2005)23RCT (n=297); hip and/or knee OA aged 40–60 years; 51.5 y; 60% women; duration, not statedPC; drop-out:(A) SMP: 6×2 h (goal-setting, exercise (resistance), relaxation, problem-solving, communication, emotions, assistive devices, action plans and feedback) plus participant handbook. No booster. 12 hPT (Y)CBT3 and 21 mITT analysis:
3 m, 9%(B) Usual care3 m, SMP: pain, function
21 m, NS21 m, SMP: pain, function
Buszewicz et al (2006)24 Patel et al (2009)30RCT (n=812); >50 y with hip and/or knee OA; 68 y; 63% women; duration, not statedPC; drop-out:(A) ASMP: 6×2 h plus information booklet. No booster. 12 hPM (Y)SCT4 and 12 mITT analysis:
4 m, 20%(B) Information booklet4 m, ASMP: self-efficacy, anxiety, depression
12 m, 24%12 m, ASMP: self-efficacy, anxiety
Hurley et al (2007)26 31Cluster RCT (n=418); >50 y; chronic knee pain >6 m; 66 y; 70% women; median duration, 6 yPC; drop-out:(A) Exercise and SMP (ESCAPE): group: 12 sessions 2×/week for 6 weeks (goal-setting, action plans, pain, pacing, healthy eating, relaxation, graded class and home exercise programmes). No booster. 12 h.PT (not stated)SCT7.5 mITT analysis:
7.5 m, 20%(B) ESCAPE: individual (as above)7.5 m, both ESCAPE groups: pain, function, anxiety group more cost-effective than individual
(C) Usual care
Yip et al (2007)28RCT (n=182); knee OA; 65 y; 75% women; duration, 8 yearsOrtho; drop-out:(A) Modified ASMP: 6×2 h/week plus exercise (including increased exercise: 30 min tai chi/week, stretching, home walking+pedometer). Arthritis handbook. No booster. 12 hRN (Y)SCT1 week and 4 mITT analysis:
1 week, 18%(A) Usual care only1 week, ASMP: pain, function, selfefficacy, health behaviours
4 m, 34%4 m, ASMP: pain, function, selfefficacy, health behaviours (hot/cold packs, joint protection, exercise)
Rosemann et al (2007)27Cluster RCT (n=75) practices; 1021 patients knee or hip OA; 66 y; 66% women; duration, not statedPC; drop-out:(A) GP-delivered SMI: individual; motivating patients, evidence based self-management information; audio exercise CD; information leaflet. Duration, not statedGPs (Y); RN (Y)NS9 mITT analysis:
6 m, 22%(B) GP-SMI plus RN monthly structured telephone case management over 6 m9 m, GP-SMI: fewer x-ray referrals and increased acetaminophen prescriptions
(C) Usual careGP-SMI+case management: pain, mobility, social support; fewer x-ray, orthopaedic referrals, increased paracetamol prescriptions
Yip et al (2008)29RCT (n=95); knee OA; 63 y; 85% female; duration, 7 yearsPC; drop-out:(A) Modified ASMP: 6×2 h/week plus exercise (including increased exercise: 30 min tai chi/week, stretching, home walking+pedometer). Arthritis handbook. No booster. 12 hRN (Y)SCT1 week, 4 and 12 mITT analysis:
1 week, 19%(B) Usual care only12 m, ASMP: pain (overall, at night, when walking), global health, selfefficacy, unplanned doctor visits for arthritis
4 m, 22%
12 m, 44%
Wetzels et al (2008)25RCT (n=104); mild hip or knee OA; 74 y; 76% women; duration, not statedPC; drop-out:(A) Individual SMP: OA booklet; self-identification of problems; 30 min home visit×1; agree to change 1 of 4 behaviours (exercise, weight loss, walk aid use, medication); 3 m telephone follow-up. Approx 1 hRN (N )NS6 mCC analysis:
6 m, 14%(B) OA booklet6 m, no difference
  • Diagnosis: FM, fibromyalgia; OA, osteoarthritis.

  • Recruitment: Ortho, orthopaedic clinic; PC, primary care.

  • Intervention: ASMP, the Arthritis Self-Management Programme; SMP, self-management programme.

  • Programme facilitator: PM, trained peer/lay moderator; PT, ; RN, registered nurse.

  • Theory: CBT, cognitive-behavioural theory; NS, not stated; SCT, Social Cognitive Theory.

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

  • GP, general practitioner; m, months; NS, not stated; RCT, randomised controlled trial; SMI, self-management intervention; y, years; PT, physical therapy.