Abstract
BackgroundSelf-management has become increasingly popular in the management of chronic diseases. There are many different self-management models. Meta analyses of arthritis self-management have concluded that it is difficult to recommend any one program in preference to another due to inconsistencies in the study designs used to evaluate different programs.The Stanford Arthritis Self-Management Program (ASMP), most commonly delivered by trained lay leaders, is a generic program widely used for people with rheumatological disorders. We have developed a more specific program expressly for people with osteoarthritis of the knee (OAKP). It includes information designed to be delivered by health professionals and results in improvements in pain, function and quality of life.Aim: To determine whether, for people with osteoarthritis (OA) of the knee, the OAKP implemented in a primary health care setting can achieve and maintain clinically meaningful improvements in more participants than ASMP delivered in the same environment.Methods/DesignThe effectiveness of the programs will be compared in a single-blind randomized study.Participants: 146 participants with established OA knee will be recruited. Volunteers with coexistent inflammatory joint disease or serious co-morbidities will be excluded.Interventions: Participants will be randomised into either OAKP or ASMP groups and followed for 6 months.Measurements: Assessments will be immediately before and after the intervention and at 6 months. Primary outcome measures will be WOMAC and SF-36 questionnaires and a VAS for pain. Secondary outcomes will include balance, tested using a timed single leg balance test and a timed step test and self-efficacy. Data will be analysed using repeated measures ANOVA.DiscussionWith an aging population the health care costs for people with arthritis are ever increasing. Although cost analysis is beyond the scope of this study, it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders. Consequently it is critical to examine the relative effectiveness of the primary care management strategies available for OA.Trial RegistrationThis study is registered with the Australian New Zealand Clinical Trials Registry: 12607000031460
Highlights
Self-management has become increasingly popular in the management of chronic diseases
Cost analysis is beyond the scope of this study, it is reasonable to expect that costs will be greater when health professionals deliver self-management programs as opposed to lay leaders
This assumes that the response rates for the Arthritis Self-Management Program (ASMP) and Osteoarthritis of the Knee Program (OAKP) groups are equal, and that a difference of 20.0 points or less is unimportant and allows for 20% drop out
Summary
Meta-analyses of self-management have all concluded that it is difficult to compare models between different chronic conditions, and this is the case with different types of arthritis [3,7,27]. Many disease states exist under the banner of arthritis, and all of them have different symptoms and requirements. People with any type of arthritis can enrol in ASMP, as it is a generic program. The OAKP is a disease specific education self-management program that was designed for facilitation by health professionals to enable more detailed information specific to OA knee to be included. The study described in this paper will determine comparative efficacy of these programs and the results will assist in planning future arthritis self-management strategies.
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