Session Title: Education/Community Programs
Session Type: Abstract Submissions (ARHP)
Background/Purpose: We performed a Cochrane systematic review to determine the effectiveness of self-management education programs (SMPs) for people with osteoarthritis (OA).
Methods: Published randomised controlled trials of SMPs delivered to people with OA were included up to 17 January 2013. We excluded studies of SMPs that did not have a reproducible structured format or that treated participants solely as passive recipients of care. Studies comparing different types of SMPs without a control group were excluded. We extracted data about SMP content using the domains of the Health Education Impact Questionnaire (heiQ) and considered contextual factors and participant characteristics relevant to health equity issues using PROGRESS-Plus and the Health Literacy Questionnaire. Main comparisons were SMPs versus attention control or usual care. Main outcomes were self-management skills, positive and active engagement in life, pain, global OA scores, function, quality of life and withdrawal rates.
Results: Twenty-nine trials (6753 participants) were included: SMP vs attention control (5 trials, N=937), usual care (17 trials, N=3738), information alone (4 trials, N=1251) or another intervention (7 trials, N=919). Most SMPs included elements of skill and technique acquisition (94%), health directed activity (85%) and self-monitoring and insight (79%). Most trials did not provide enough information to assess health equity issues; 8 included mainly Caucasian, educated females and only 4 provided any information on participants’ health literacy. All studies were at high risk of performance and detection bias for self-reported outcomes.
Compared with attention control, there was low to moderate quality evidence that SMPs may not result in significant benefits at 12 months. Although there was a small difference in pain favouring SMPs (low quality evidence, 3 trials, N=575): SMD -0.26 (95% CI -0.44 to -0.09), this is unlikely to be of clinical importance, and there were no between-group differences for any of the other measured main outcomes, e.g. self-management skills (low quality evidence, 1 trial, N=344): MD 0.4 points (95% CI -0.39 to 1.19), withdrawal rates (moderate quality evidence, 5 trials, N=937): RR 1.11 (95% CI 0.78 to 1.57).
Compared with usual care, there was moderate quality evidence (11 trials, N=1706), of small but clinically unimportant benefits favouring SMPs up to 21 months. Differences favoured SMPs for self-management skills (absolute improvement 12.8% (2.4% to 23.2%), pain (SMD -0.19 (95% CI -0.28 to -0.1)), function (SMD -0.18 (95% CI -0.27 to -0.09)) and global osteoarthritis symptoms (SMD -0.28 (95% CI -0.39 to -0.17)) but there were no between-group differences in quality of life (SMD 0.02 (95% CI -0.09 to 0.13)) or positive and active engagement in life (SMD 0.01 (95% CI -0.2 to 0.21). There was low quality evidence (16 trials, N=3738) of similar withdrawal rates (RR 0.99 (95% CI 0.74 to 1.33)).
Conclusion: Although we found small statistically significant effects in a few outcomes favouring SMPs over attention control or usual care, these were of doubtful clinical importance. Our results challenge the current endorsement of SMPs in osteoarthritis treatment guidelines.
F. P. B. Kroon,
L. R. A. van der Burg,
R. H. Osborne,
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/cochrane-systematic-review-of-self-management-education-programs-for-people-with-osteoarthritis/