Critical review of arthritis self-management strategy use.

Abstract

Introduction Notions of self care and self management of common, but serious, health conditions were once viewed with skepticism by clinicians. However, over time, enlightened health care professionals have come to embrace the idea of informed, participative collaboration with patients as a key strategy for enhancing the effectiveness of clinical diagnostic and therapeutic interventions (1). Although these ideas are being absorbed into mainstream contemporary medicine and health care, our understanding of the range of self-initiated actions consumers use and the factors related to use of these actions is inadequate. Sobel (2) suggests that self care is the “hidden” health care system and that self care, rather than primary, secondary, or tertiary care, comprises the majority of health care. Others suggest that self-management activities are determinants of well being, potentially intervening between health status and health outcomes (3–5). If these assertions are true, we must have a clear understanding of the factors related to and outcomes associated with strategy use so people with chronic conditions can be guided in effective self-management practices. The terms self management and self care, often used interchangeably among lay and professional persons, are broadly defined as the activities people engage in to promote health and/or manage chronic conditions (6–9). These activities are usually self initiated and often undertaken with little to no supervision from health care professionals. For this article we use both phrases (self care and self management) to refer to the wide range of activities people use to promote personal health and to detect, prevent, and treat common health problems. The use of self-initiated actions to manage arthritis conditions is well recognized in the scientific literature and among health care providers. Applying the above definition of self management to arthritis, a variety of strategies could be used to manage the symptoms and consequences of the disease, such as taking medication, exercising, wearing splints or braces, taking herbs or supplements, or seeking care from alternative care providers. Two review articles by Ernst (10,11) show that use of complementary and alternative strategies is common but variable among people with rheumatic disease, with most people using at least 1 type of complementary therapy (e.g., special diets, jewelry, vitamins, herbs, prayer, relaxation, or massage). Little is known, however, about the broad range of strategies that could be used to manage arthritis, the degree to which people with arthritis use various strategies, and factors related to use of specific strategies. The purpose of this article is to address these gaps in the scientific literature.