Self-management education programmes may be of limited benefit to people with osteoarthritis
Citation: Christie J (2014) Do self-care programmes help people with osteoarthritis? Nursing Times; 110: 44, 15.
Author: Janice Christie is senior lecturer/programme manager, School of Health Science, City University, London, and member, Cochrane Nursing Care Field.
- This article summarises the findings of a Cochrane systematic review
- Scroll down to read the article or download a print-friendly PDF including any tables and figures
Self-management education programmes (SMPs) may encourage people with osteoarthritis to actively engage with the management of their condition in various ways. These include encouraging self-monitoring, problem solving and self-interventions to improve functioning as well as psychological and/or social wellbeing. What is the effectiveness of self-management education programmes for people with osteoarthritis?
This Cochrane systematic review (Kroon et al, 2014) included 29 randomised controlled trials with a total of 6,753 participants diagnosed with osteoarthritis. The reviewers deemed the included trials to be of low-to-moderate methodological quality.
The SMP interventions could be either one-to-one or group-structured educational programmes delivered by any method. The 29 trials included the following interventions:
- Face-to-face (25 trials);
- Telephone (two trials);
- Internet (one trial); and
- A combination of these (six trials).
SMP interventions that featured only exercise or were information giving only were excluded. Most of the included programmes offered sessions lasting for six weeks (range: four weeks-12 months) and most were offered on a weekly basis. Those included had different content but overall the majority contained elements of:
- Skill and technique acquisition;
- Health-directed activity; and
- Self-monitoring and insight.
Comparison groups had to receive a programme other than a different type of SMP. This included attention control (control group offered a non-self-management programme of similar duration and professional contact), usual care, information alone, and other interventions such as exercise, physiotherapy and acupuncture.
A variety of primary outcome measures were considered, including:
- Active engagement in life;
- Global osteoarthritis scores;
- Self-reported function;
- Quality of life; and
- Study withdrawals.
Secondary outcomes such as physical performance tests, emotional distress, skill and technique acquisition, and participant satisfaction were also included.
SMPs versus attention control trials (five studies)
Low-quality evidence from four trials (575 people) shows SMPs may lead to a small but clinically unimportant reduction in pain. There were no between-group differences in function or self-management (three studies), quality of life (one trial), or programme withdrawals (five trials).
SMPs versus usual care trial (17 studies)
Compared with usual care, moderate-quality evidence from 11 studies indicates that SMPs probably offer small benefits for up to 21 months, in terms of self-management skills, pain, osteoarthritis symptoms and function. However, these benefits are of doubtful clinical importance.
No between-group differences were found for quality of life (eight trials) or for positive/active engagement in life (three trials). Similar withdrawal rates from intervention and control groups were found in 16 trials.
SMPs versus information alone (four trials)
No between-group differences in positive/active engagement in life, pain, self-management, global osteoarthritis scores, function, quality of life or study withdrawals were found.
SMPs versus other interventions (seven trials)
No between-group differences were found in global osteoarthritis scores, self-management, positive/active engagement in life, pain, function, quality of life or withdrawal outcomes.
The reviewers concluded there is low-to-moderate quality evidence that SMPs offer no or small benefits in people with osteoarthritis. Compared with attention control, SMPs do not improve outcomes for up to 12 months; compared with usual care, they may slightly improve self-management skills, pain, function and symptoms for up to 21 months but these benefits are unlikely to be clinically important. The reviewers concluded that further research into the effect of SMPs as delivered in the trials in their review would be unlikely to change the current review results.
Kroon FP et al (2014) Self-management education programmes for osteoarthritis. Cochrane Database of Systematic Reviews; 1: CD008963.