Osteoarthritis Self-management Research Articles

Change in self-efficacy after participation in a supported self-management program for osteoarthritis – an observational study of 11 906 patients

Purpose: Describe the change in self-efficacy after a supported osteoarthritis self-management program.Materials and methods: An observational register-based study comprising 11 906 patients. Participants with hip or knee osteoarthritis self-reported at baseline, 3 and 12 months. Self-efficacy for pain and other symptoms were assessed with the Arthritis Self-efficacy Scale. Change was analyzed using a mixed-effect model for repeated measurements.Results: In total, 9440 (pain subscale) and 9361 (symptom subscale) patients reported self-efficacy scores at baseline and at least one follow-up. The lowest self-efficacy at baseline was reported by patients with low education, walking difficulties, comorbidity and low physical activity level. Overall, the self-efficacy scores improved at the 3-month follow-up and returned to baseline at the 12-month follow-up. Younger age (pain and symptom subscales) and exercise (pain subscale) were associated with a greater increase in self-efficacy. Obesity (pain subscale) and hip problems (pain and symptom subscales) were associated with lower self-efficacy at baseline and a greater decrease at follow-up.Conclusion: Self-efficacy was related to the level of education, physical activity, mobility, and comorbidity. In addition, hip problems or obesity were associated with greater difficulties in enhancing or maintaining self-efficacy. An increased focus on patients with hip problems or obesity might help to improve outcomes after supported self-management programs for osteoarthritis.IMPLICATIONS FOR REHABILITATIONSelf-efficacy increased more in younger patients and in those who opted for exercise as part of the intervention, which indicates that offering supported self-management early in the course of the disease might be important.Lower self-efficacy at baseline and reduced beliefs about their ability to manage pain indicate that patients with hip OA or obesity may need to be given a special focus by healthcare.Self-efficacy in managing pain and other symptoms seemed to increase after a supported self-management osteoarthritis program, but was not maintained at the 12-month follow-up, indicating that more on-going support might be needed to maintain self-efficacy.

Health Literacy and Osteoarthritis Self-Management

Background: Osteoarthritis is a disabling joint disease with no known cure that negatively effects life quality among high numbers of aging adults. Aim: To examine the concept of health literacy as a potentially overlooked, but highly salient, disease correlate among this older chronically disabled group. Method: A literature search using the key terms osteoarthritis and health literacy was conducted using the major data bases. Results: Although almost no work has focused on health literacy and osteoarthritis, the concept of health literacy is clearly linked to health status and health outcomes. Varying from marginal to high, health literacy is not always assessed or recognized as being clinically relevant, however, despite a large volume of related literature. Conclusion: Acknowledging the possible role of limited health literacy in the context of osteoarthritis disease progression, and applying carefully tailored directives for overcoming any related health literacy limitations may offer a novel approach for improving the outcomes for older people with this condition.

Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review.

Systematic reviews of self-management programs for osteoarthritis suggest minimal evidence of benefit and indicate substantial heterogeneity in interventions. The purpose of this scoping review was to describe the nature of self-management interventions provided to patients with osteoarthritis focusing on the inclusion and type of education and social support components. We searched PsycINFO, EMBASE, MEDLINE, and Cochrane Library databases from 1990 to 2016 to identify studies addressing community-based management strategies for osteoarthritis that included aspects of disease-specific education and ongoing social support. Results are presented as a narrative synthesis to facilitate integration of diverse evidence. Data were extracted from 23 studies that met our inclusion and exclusion criteria, describing complex, multicomponent interventions for osteoarthritis. All studies included education components, and 18 of these were osteoarthritis-specific. Social support was most often offered through peers and health care professionals, but also through exercise trainers/instructors and researchers, and lasted between 5 and 52 weeks. We charted positive social interaction offered by peers in group settings and emotional/informational support offered by health care professionals. Overall, descriptions of self-management provided limited documentation of the rationale or content of the programs. This suggests that more precise definitions of the theoretical underpinnings, components, and mechanisms would be useful for greater insight into best practices for osteoarthritis self-management programs.

Does the patient activation measure provide a meaningful measure of OA self-management?

Does the patient activation measure provide a meaningful measure of OA self-management?

Evaluation of the self management of osteoarthritis and low back pain through activity and skills physiotherapist e-learning training programme compared to face to face training

Evaluation of the self management of osteoarthritis and low back pain through activity and skills physiotherapist e-learning training programme compared to face to face training

Evaluation of the behavioural process and secondary outcomes of the self-management of osteoarthritis and low back pain through activity and skills cluster randomised controlled feasibility trial

Evaluation of the behavioural process and secondary outcomes of the self-management of osteoarthritis and low back pain through activity and skills cluster randomised controlled feasibility trial

Exercise dose-response in individuals participating in a supported osteoarthritis self-management program; an observational register study

Exercise dose-response in individuals participating in a supported osteoarthritis self-management program; an observational register study

MHealth technologies for osteoarthritis self-management and treatment: A systematic review.

Osteoarthritis is a common chronic disease that can be better treated with the help of self-management interventions. Mobile health (mHealth) technologies are becoming a popular means to deliver such interventions. We reviewed the current state of research and development of mHealth technologies for osteoarthritis self-management to determine gaps future research could address. We conducted a systematic review of English articles and a survey of apps available in the marketplace as of 2016. Among 117 unique articles identified, 25 articles that met our inclusion criteria were reviewed in-depth. The app search identified 23 relevant apps for osteoarthritis self-management. Through the synthesis of three research themes (osteoarthritis assessment tools, osteoarthritis measurement tools, and osteoarthritis motion monitoring tools) that emerged from the current knowledge base, we provide a design framework to guide the development of more comprehensive osteoarthritis mHealth apps that facilitate self-management, decision support, and shared decision-making.

Feasibility of Training Physical Therapists to Deliver the Theory-Based Self-Management of Osteoarthritis and Low Back Pain Through Activity and Skills (SOLAS) Intervention Within a Trial.

Provider training programs are frequently underevaluated, leading to ambiguity surrounding effective intervention components. The purpose of this study was to assess the effectiveness of a training program in guiding physical therapists to deliver the Self-management of Osteoarthritis and Low back pain through Activity and Skills (SOLAS) group education and exercise intervention (ISRCTN49875385), using a communication style underpinned by self-determination theory (SDT). This was an assessment of the intervention arm training program using quantitative methods. Thirteen physical therapists were trained using mixed methods to deliver the SOLAS intervention. Training was evaluated using the Kirkpatrick model: (1) Reaction-physical therapists' satisfaction with training, (2) Learning-therapists' confidence in and knowledge of the SDT-based communication strategies and intervention content and their skills in applying the strategies during training, and (3) Behavior-8 therapists were audio-recorded delivering all 6 SOLAS intervention classes (n = 48), and 2 raters independently coded 50% of recordings (n = 24) using the Health Care Climate Questionnaire (HCCQ), the Controlling Coach Behavior Scale (CCBS), and an intervention-specific measure. Reaction: Physical therapists reacted well to training (median [IRQ]; min-max = 4.7; [0.5]; 3.7-5.0). Learning: Physical therapists' confidence in the SDT-based communication strategies and knowledge of some intervention content components significantly improved. Behavior: Therapists delivered the intervention in a needs-supportive manner (median HCCQ = 5.3 [1.4]; 3.9-6.0; median CCBS = 6.6 ([0.5]; 6.1-6.8; median intervention specific measure = 4.0 [1.2]; 3.2-4.9). However, "goal setting" was delivered below acceptable levels by all therapists (median 2.9 [0.9]; 2.0-4.0). The intervention group only was assessed as part of the process evaluation of the feasibility trial. Training effectively guided physical therapists to be needs-supportive during delivery of the SOLAS intervention. Refinements were outlined to improve future similar training programs, including greater emphasis on goal setting.

Using mixed methods to assess fidelity of delivery and its influencing factors in a complex self-management intervention for people with osteoarthritis and low back pain

Objectives and designDespite an increasing awareness of the importance of fidelity of delivery within complex behaviour change interventions, it is often poorly assessed. This mixed methods study aimed to establish...

A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program

Objective: To assess the effectiveness of a 12-week self-management and exercise intervention (the PLE2NO program) in elderly individuals with knee osteoarthritis. Design: Randomized controlled trial. Setting: Four different community settings. Subjects: Eighty individuals aged 60 years or older with clinical and radiographic knee osteoarthritis enrolled in the study. Intervention: A combined self-management and exercise intervention (treatment group) and an educational intervention (control group). Main measures: The primary outcomes were pain and other knee osteoarthritis symptoms (swelling, crackling, limitation on movement, and stiffness), self-management behaviors (communication with physician and cognitive symptom management), and functional lower limb strength. Secondary outcomes were knee osteoarthritis–specific health-related quality of life, self-perceived health, aerobic capacity, lower and upper limb flexibility, and handgrip strength. Results: In all, 67 participants, mean age 69.1 ± 5.8 years, completed the study: 32 in the Educational Group and 35 in the Self-Management and Exercise Group. A significant group effect favorable to the Self-Management and Exercise Group was observed in the following variables: communication with the physicians (P = .048), aerobic capacity (P = .035), and functional lower limb strength (P = .015). Although no significant group effect was detected, clinical improvements in pain (31%) and knee osteoarthritis symptoms (29%) were observed in the experimental group. No improvements regarding cognitive symptom management, self-perceived health, lower limb flexibility, and handgrip strength were found. Conclusion: This study supports the importance of a combined self-management and exercise intervention to improve functional lower limb strength and aerobic capacity in a Portuguese sample. Additionally, pain and other symptoms have improved clinically.

Measurement Properties of Instruments Assessing Attitudes and Capabilities Regarding Osteoarthritis Self-management: A Systematic Review

Measurement Properties of Instruments Assessing Attitudes and Capabilities Regarding Osteoarthritis Self-management: A Systematic Review

Instruments assessing attitudes toward or capability regarding self-management of osteoarthritis: a systematic review of measurement properties.

To make a recommendation on the "best" instrument to assess attitudes toward and/or capabilities regarding self-management of osteoarthritis (OA) based on available measurement property evidence. Electronic searches were performed in MEDLINE, EMBASE, CINAHL and PsychINFO (inception to 27 December 2016). Two reviewers independently rated measurement properties using the Consensus-based Standards for the selection of Health Measurement Instruments (COSMIN) 4-point scale. Best evidence synthesis was determined by considering COSMIN ratings for measurement property results and the level of evidence available for each measurement property of each instrument. Eight studies out of 5653 publications met the inclusion criteria, with eight instruments identified for evaluation: Multidimensional Health Locus of Control (MHLC), Perceived Behavioural Control (PBC), Patient Activation Measure (PAM), Educational Needs Assessment (ENAT), Stages of Change Questionnaire in Osteoarthritis (SCQOA), Effective Consumer Scale (EC-17) and Perceived Efficacy in Patient-Physician Interactions five item (PEPPI-5) and ten item scales. Measurement properties assessed for these instruments included internal consistency (k=8), structural validity (k=8), test-retest reliability (k=2), measurement error (k=1), hypothesis testing (k=3) and cross-cultural validity (k=3). No information was available for content validity, responsiveness or minimal important change (MIC)/minimal important difference (MID). The Dutch PEPPI-5 demonstrated the best measurement property evidence; strong evidence for internal consistency and structural validity but limited evidence for reliability and construct validity. Although PEPPI-5 was identified as having the best measurement properties, overall there is a poor level of evidence currently available concerning measurement properties of instruments to assess attitudes toward and/or capabilities regarding osteoarthritis self-management. Further well-designed studies investigating measurement properties of existing instruments are required.

Telephone-Delivered Exercise Advice and Behavior Change Support by Physical Therapists for People with Knee Osteoarthritis: Protocol for the Telecare Randomized Controlled Trial

Exercise and physical activity are a core component of knee osteoarthritis (OA) care, yet access to physical therapists is limited for many people. Telephone service delivery models may increase access. Determine the effectiveness of incorporating exercise advice and behavior change support by physical therapists into an existing Australian nurse-led musculoskeletal telephone service for adults with knee OA. Randomized controlled trial with nested qualitative studies. Community, Australia-wide. One hundred seventy-five people ≥45 years of age with knee symptoms consistent with a clinical diagnosis of knee OA. Eight musculoskeletal physical therapists will provide exercise advice and support. Random allocation to receive existing care or exercise advice in addition to existing care. Existing care is a minimum of one phone call from a nurse for advice on OA self-management. Exercise advice involves 5-10 calls over 6 months from a physical therapist trained in behavior change support to prescribe, monitor, and progress a strengthening exercise program and physical activity plan. Outcomes will be measured at baseline and at 6 and 12 months. Primary outcomes are knee pain and physical function. Secondary outcomes include other measures of knee pain, self-efficacy, physical activity and its mediators, kinesiophobia, health service usage, work productivity, participant-perceived change, and satisfaction. Additional measures include adherence, adverse events, therapeutic alliance, satisfaction with telephone-delivered therapy, and expectation of outcome. Semi-structured interviews with participants with knee OA and therapists will be conducted. Physical therapists cannot be blinded. This study will determine if incorporating exercise advice and behavior change support by physical therapists into a nurse-led musculoskeletal telephone service improves outcomes for people with knee OA. Findings will inform development and implementation of telerehabilitation services.

Unloading Shoes for Self-management of Knee Osteoarthritis.

Unloading Shoes for Self-management of Knee Osteoarthritis.

Unloading Shoes for Self-management of Knee Osteoarthritis.

Clinical guidelines recommend advice on appropriate footwear as part of the management of knee osteoarthritis. Shoes that reduce harmful knee loads are commercially available, but their effects are...

Unloading Shoes for Self-management of Knee Osteoarthritis.

Unloading Shoes for Self-management of Knee Osteoarthritis.

Health enhancing physical activity in patients with hip or knee osteoarthritis - an observational intervention study

BackgroundOsteoarthritis is one of the leading causes of inactivity worldwide. The recommended level of health enhancing physical activity (HEPA) is at least 150 min of moderate intensity physical activity per week. The purpose of this study was to explore how the proportion of patients, who reached the recommended level of HEPA, changed following a supported osteoarthritis self-management programme in primary care, and to explore how reaching the level of HEPA was influenced by body mass index (BMI), gender, age and comorbidity.MethodsAn observational study was conducted using data from a National Quality Registry in which 6810 patients in primary care with clinically verified hip or knee osteoarthritis with complete data at baseline, 3 and 12 months follow-up before December 31st 2013 were included. HEPA was defined as self-reported physical activity of at least moderate intensity either a) at least 30 min per day on four days or more per week, or b) at least 150 min per week. HEPA was assessed at baseline, and again at 3 and 12 months follow-up. Cochran’s Q test was used to determine change in physical activity over time. The association between reaching the level of HEPA and time, age, BMI, gender, and Charnley classification was investigated using the generalized estimation equation (GEE) model.ResultsThe proportion of patients who reached the level of HEPA increased by 345 patients, from 77 to 82%, from baseline to 3 months follow-up. At 12 months, the proportion of patients who reached the level of HEPA decreased to 76%. Not reaching the level of HEPA was associated with overweight, obesity, male gender and Charnley category C, i.e. osteoarthritis in multiple joint sites (hip and knee), or presence of any other disease that affects walking ability.ConclusionsFollowing the supported osteoarthritis self-management programme there was a significant increase in the proportion of patients who reached the recommended level of HEPA after 3 months. Improvements were lost after 12 months. To increase physical activity and reach long-lasting changes in levels of physical activity, more follow-up sessions might be needed.

Unloading Shoes for Self-management of Knee Osteoarthritis: A Randomized Trial.

Appropriate footwear is recommended for self-management of knee osteoarthritis. Shoes that reduce harmful knee loads are available, but symptomatic effects are uncertain. To evaluate the efficacy of unloading shoes in alleviating knee osteoarthritis symptoms. Participant- and assessor-blinded comparative effectiveness randomized, controlled trial. (Australian New Zealand Clinical Trials Registry: ACTRN12613000851763). Community. 164 persons with medial knee osteoarthritis. Walking shoes with triple-density, variable-stiffness midsoles and mild lateral-wedge insoles designed to unload the medial knee and worn daily (intervention) versus conventional walking shoes (comparator). Primary outcomes were pain with walking (assessed on a numerical rating scale [NRS]) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) at 6 months. Secondary outcomes were knee pain and stiffness (WOMAC), average pain (NRS), intermittent and constant knee pain (Intermittent and Constant Osteoarthritis Pain questionnaire), quality of life (Assessment of Quality of Life instrument), physical activity (Physical Activity Scale for the Elderly), and global change in pain and function (Likert scales). A total of 160 participants (98%) completed primary outcome measures at 6 months. Changes in pain (mean difference, 0.0 units [95% CI, -0.9 to 0.8 unit]) and function (mean difference, 0.3 unit [CI, -3.2 to 3.7 units]) did not differ between groups at 6 months, with both groups showing clinically relevant improvements in function and the intervention group showing clinically relevant improvements in pain. There were no differences in secondary outcomes. Pain was globally improved in 54% of participants, and function was globally improved in 44% to 48%. Unloading shoes were not associated with increased probability of improvement (odds ratios, 0.99 [CI, 0.53 to 1.86] for pain and 0.85 [CI, 0.45 to 1.61] for function). Effects on joint structure were not evaluated. Shoes with modified midsoles to unload the medial knee conferred no additional benefit over conventional walking shoes. Both improved pain and function by clinically relevant amounts. Australian National Health and Medical Research Council.

An evaluation of a new education and cycling programme that aims to promote the self-management of hip osteoarthritis through education, advice and exercise

An evaluation of a new education and cycling programme that aims to promote the self-management of hip osteoarthritis through education, advice and exercise