A therapeutic education and functional readaptation program for Spanish patients with musculoskeletal chronic diseases

Abstract

Chronic musculoskeletal diseases are one of the main reasons for health consultations. They cause pain and disability and reduce the quality of life, producing restrictions on activity and considerable economic and social costs [1, 2]. Musculoskeletal diseases are usually chronic, meaning that informing patients and their families of all factors that may lead to improvements, together with their participation in the control and evolution of the disease, is essential [3, 4]. Therapeutic patient education, provided by trained health professionals, may fulfil these objectives. The therapy should be based on a set of educational activities organized to provide the patient with information on their disease and the competence (knowledge, skills and attitudes) to manage living with a chronic disease. The educational contents should be adjusted to the patients’ needs [3–5] and be designed to reorient them towards healthy lifestyles. Active learning is a dynamic system based on the idea that adults can learn autonomously, using their own experience to solve problems, and that knowledge must be reinforced by practice to reach the competence necessary to apply that knowledge practically [6]. Patients, starting with the consequences of their disease process and their own needs, interests and expectations, learn in two ways: firstly, receiving knowledge from the therapist on the relationship between the aspects of their disease and the available therapeutic resources and, secondly, experiencing these relationships themselves, which permits the acquisition of practical knowledge applicable to the solution of diseasespecific problems. This enables patients to assume at least part of the responsibility for treating their own disease autonomously [7]. Within the framework of social cognitive theory and planned change strategies, in the Rheumatology Department of the Hospital Clinic of Barcelona (Spain), a tertiary care center, we began to implement a program of Therapeutic Education and Functional Readaptation (TEFR) using active learning [8, 9]. Although this type of program has been implemented in other countries [3], the project described in this article is, to our knowledge, the first specific therapeutic education program for patients with musculoskeletal diseases in Spain. The aims of this study were to assess whether a TEFR program could reduce disability and pain and increase competence in disease self-management in patients with musculoskeletal diseases and to determine the use of health resources and the costs derived.