Table 4

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

Author (year)Design and sample (n); mean age; % women; arthritis durationRecruitment source; % drop-outIntervention; duration; comparison groupFacilitatorTheoryFollow-upSignificant outcomes: improved
Riemsma et al (2003)32RCT (n=218); RA; 56 y; 62% women; duration, 12 yearsRheum; drop-out:(A) SMP 5×2 h/week (pain management, relaxation, coping with depression, communication, exercise advice) plus 3×2 h booster: 3, 6 and 9 m+partner. 16 h2×RN (Y)SCT6 and 12 mITT analysis:
12 m, 17%(B) As above without partner6 m: both SMP groups: exercise.
(C) Self-help guide only12 m: SMP without partner: self-efficacy, fatigue
Van Lankveld et al (2004)33RCT (n=59); RA; 50 y; 65% women; duration, 7.2 yearsRheum; drop-out:(A) Education and rational emotive therapy programme (ED-RET) 8×1.5 h/week for 4 weeks (ED×4: information; ‘encourage practice of active coping skills’; 4=RET)+partner. No booster. 12 h7 MDT members (not stated) and CP (Y)CBT and RET2 w and 6 mITT analysis:
6 m, 3%(B) As above without partner No control group6 m: both ED-RET groups: pain, function, mobility, dexterity
Kirwan et al (2005)34RCT (Zelen design) (n=79); RA; 54 y; 61% women; duration, 15 yearsRheum; drop-out:(A) Education (ED) and CBT 4×2.5 h/week+1×2.5 h booster at 8 weeks (ED: joint protection, heat and cold; CBT: managing mood, pain, relaxation, sleep, communication, coping). 12.5 h5 MDT members (not stated)+CP and RN (Y)CBT2 and 6 mITT and CC analysis: CC only at 2 m: ED-CBT: self-efficacy
6 m, 14%(B) Usual care6 m: no differences
Giraudet-le Quintrec et al (2007)35RCT (n=208); RA; 55 y; 89% women; duration, 13 yearsRheum; drop-out:(A) Education and self-management programme (ED-SMP: ED=3 sessions (RA, treatment, diet); SMP=five sessions (1=pain and stress management; 4=exercise, relaxation, joint protection, foot care, social advice); 8×6 h/week plus 4 h booster at 6 m. 52 h10 MDT members (not stated)SCT? CBT?6 and 12 mITT analysis:
12 m, 9%(B) Information booklets12 m: ED-SMP coping
Hammond et al (2008)36RCT (n=167); RA (50%), EIA (35%), PsA (15%); 55 y; 65% women; duration, 7 yearsRheum; drop-out:(A) LMAP: two modules: 4×2.5 h/week; 1×2 h booster (joint protection, fatigue management, exercise, foot care, managing pain and mood; communication, maintaining change); self-paced over 4–6 months. 22 h2 OTs and 1 PT (Y) 6 MDT members (N)SCT CBT None6 and 12 mITT analysis
12 m, 17%(B) Attention control group: information programme 5×2 h/week. 10 h6 m: LMAP: pain, fatigue, function, global health, self-efficacy, mood, helplessness, perceived control, behaviours (exercise, joint protection), healthcare use 12 m: LMAP: pain, self-efficacy, perceived control, behaviours (joint protection, fatigue management)
  • Diagnosis: EIA, early inflammatory arthritis; PsA, psoriatic arthritis; RA, rheumatoid arthritis.

  • Recruitment: Rheum, Rheumatology out-patient departments.

  • Intervention: SMP, self management programme.

  • Programme facilitator: CP, clinical psychologist; MDT, multidisciplinary team (nurse, physiotherapist (PT), occupational therapist (OT) (± rheumatologist, pharmacist); RN, registered nurse.

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

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

  • m, months; LMAP, Lifestyle Management for Arthritis Programme; RCT, randomised controlled trial; y, years.