Evaluation of an ankylosing spondylitis education and self-management program: Beneficial effects on ankylosing spondylitis specific outcomes.

Abstract

Self-management programs have demonstrated significant health benefits in people with musculoskeletal diseases. To examine the benefits of a tailored ankylosing spondylitis self-management program (ASSMP) delivered by trained health professionals for people with ankylosing spondylitis (AS) relative to health status, quality of life and disease activity. ASSMP was developed within a continuous quality improvement framework following a needs assessment and focus group discussions. Formal feedback from the group after each 6week program cycle group by questionnaire helped refine the ASSMP. Patient health status, quality of life and disease activity were assessed at multiple time points up to 12months. Fifty-five percent were female; mean age 48.5±15.2years. Median time to AS diagnosis was 4years (interquartile range: 1-10). AS disease activity Bath Ankylosing Spondylitis Global Score scores improved at 3, 6 and 12months (P<.001). Bath Ankylosing Spondylitis Disease Activity Index improved at 6weeks and was sustained at 3, 6 and 12months (P<.001). The Ankylosing Spondylitis Quality of Life improved at 3, 6 and 12months (P<.001). Bath Ankylosing Spondylitis Functional Index improved by 12months (P<.001). Participants reported less nocturnal back pain at 6months and was sustained at 12months (P<.001). Patients Global Disease Activity improved by 6months (P=.012), Multi-Dimensional Assessment of Fatigue and a Global Fatigue Index at 6months (P=.003), Hospital Anxiety and Depression Scale - Anxiety at 12months (P=.001), Evaluation Ankylosing Spondylitis Quality of Life at 6months (P=.001) and Pain Self-Efficacy Questionnaire at 12months (P=.002). This ASSMP demonstrated significant and sustained benefit in symptoms, disease activity measures and quality of life in a condition that results in significant impairment, disability and poorer quality of life. The cost effectiveness and benefit of this program should be tested.