Self management of arthritis in primary care: randomised controlled trial Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. The effectiveness of self‐management educational interventions for osteoarthritis of the knee Chronic disease management programme in people with severe knee osteoarthritis: efficacy and moderators of response A 1-year follow-up of an experimental study of a self-management arthritis programme with an added exercise component of clients with osteoarthritis of the knee Telephone-Based Self-management of Osteoarthritis Cost-effectiveness of exercise and diet in overweight and obese adults with knee osteoarthritis. Self-management for osteoarthritis of the knee: Does mode of delivery influence outcome? A physiotherapist-delivered, combined exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a pilot study. Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis? Effects of T'ai Chi training on function and quality of life indicators in older adults with osteoarthritis. A home-based pedometer-driven walking program to increase physical activity in older adults with osteoarthritis of the knee: a preliminary study. Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Family practice nurses supporting self-management in older patients with mild osteoarthritis: a randomized trial The Self-Management of OsteoArthritis in Veterans (SeMOA) Study: design and methodology. Pain coping strategies that predict patients' and spouses' ratings of patients' self-efficacy Can a Nurse-Directed Intervention Reduce the Exposure of Patients With Knee Osteoarthritis to Nonsteroidal Antiinflammatory Drugs? Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. Physical exercise and comorbidity. Results from the Fitness and Arthritis in Seniors Trial (FAST) Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Dynamic Balance Training Improves Physical Function in Individuals With Knee Osteoarthritis: A Pilot Randomized Controlled Trial. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study Resistance training for medial compartment knee osteoarthritis and malalignment.
Abstract Objective To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis . Design R and omised controlled trial . Setting 74 general practice s in the United Kingdom . Participants 812 patients aged 50 and over with osteoarthritis of hips or knees ( or both ) and pain or disability ( or both ) . Intervention Participants were r and omised to six sessions of self management of arthritis and an education booklet ( intervention group ) or the education booklet alone ( control group ) . Main outcome measures Primary outcome was quality of life , as assessed by the short form health survey ( SF-36 ) . Several other physical and psychosocial secondary outcomes were assessed . Data were collected at baseline , four months , and 12 months . Results Response rates were 80 % and 76 % at four and 12 months . The two groups showed significant differences at 12 months on the anxiety subscore of the hospital anxiety and depression scale ( mean difference −0.62 , 95 % confidence interval −1.08 to −0.16 ) , arthritis self efficacy scale for pain ( 0.98 , 0.07 to 1.89 ) , and self efficacy for other aspects of management ( 1.58 , 0.25 to 2.90 ) . Results were similar for intention to treat and per protocol analyses . No significant difference was seen in number of visits to the general practitioner at 12 months . Conclusions The self management of arthritis programme reduced anxiety and improved participants ' perceived self efficacy to manage symptoms , but it had no significant effect on pain , physical functioning , or contact with primary care . Trial registration Current Controlled Trials IS RCT N79115352 [ controlled-trials.com ] AIM This paper is a report of a study to assess the effect of an adapted arthritis self-management programme with an added focus on exercise practice among osteoarthritic knee sufferers . BACKGROUND Osteoarthritis of the knee is a major source of loss of function in older people . Previous studies have found self-management programmes to be effective in increasing arthritis self-efficacy and in mastery of self-management practice . METHOD A r and omized control trial was carried out from December 2002 to May 2003 and 120 participants ( 65.9 % , including 67 in intervention group and 53 in control group ) completed the 16-week postintervention assessment s. Outcome measures included arthritis self-efficacy , use of self-management techniques , pain intensity and daily activity . FINDINGS At 16 weeks , there was a ' statistically ' significant improvement in the arthritis self-efficacy level ( P < or= 0.001 ) , in most of the self-management skills , i.e. use of cold and hot compresses , in two of three joint protective practice s ( P < or= 0.001 ; P = 0.01 ) , an increase in the duration of light exercise practice ( P < or= 0.001 ) , reduction of current arthritis pain ( P < or= 0.001 ) and in the ability to perform daily activities ( P < or= 0.001 ) among the intervention group but not for the control group ( P-range from 0.04 to 0.95 ) . One joint protective practice showed a statistically significant increase in both groups ( P < or= 0.001 ) . CONCLUSION Our findings add to evidence showing short-term beneficial effects of self-efficacy theory in education programmes . Self-efficacy theory has great potential for empowering sufferers of chronic conditions to live with their illness Background Osteoarthritis ( OA ) is a common cause of pain and disability , and is the most common form of arthritis in the Western world . The most common joint to be affected is the knee . Pain and functional disability are common symptoms , which can lead to reduced quality of life and increase the risk of further morbidity . Current treatment aims to educate patients about the management of OA , reduce pain , improve function , decrease disability and reduce the progression of the disease . Education with clients has been described as a set of planned educational activities design ed to improve patients ' health behaviours and /or health status . The purpose of self‐education is to maintain or improve health , or , in some cases , to slow deterioration by increasing participant 's perception of self efficacy defined as an ability to control or manage various aspects of OA . To date , there is no systematic review of the literature undertaken to identify the effectiveness of self‐management educational activities for osteoarthritis of the knee . Objective The objective of this systematic review is to evaluate the effectiveness of  self‐management educational interventions on function and quality of life for adult subjects with OA of the knee . Search strategy A comprehensive search strategy was undertaken on data bases available from University of South Australia from their inception to January 2007 . Selection criteria R and omised controlled trials or clinical controlled trials were sought which evaluated any self management interventions for osteoarthritis knee . Critical appraisal of study quality was undertaken using Joanna Briggs Institute critical appraisal instruments . Data extraction was via the Joanna Briggs Institute st and ard data extraction form for evidence of effectiveness , and Review Manager Software was used to calculate comparative statistics . Results Thirteen trials were included in the review . Trials were clinical ly and method ologically heterogeneous . Pooled results indicate evidence of a beneficial effect from  self management strategies with reducing pain ( SMD ‐0.25 , 95%CI ‐0.36 to ‐0.13 , 11 trials 1379 participants ) . There was no effect on physical function ( SMD 0.13 , 95%CI ‐0.33 to ‐0.08 , eight trials , 1156 subjects ) . No beneficial effects were found from self management interventions with improving quality of life . We also found the exercise component of self management ( four trials ) demonstrated a benefit with reducing pain , improving function and quality of life . Exercise also offered a benefit over no exercise  . Overall method ological quality was moderate . Discussion Pooled results indicate evidence of a beneficial effect from self management strategies with reducing pain and improving function . Significant heterogeneity was found between trials . This was controlled for in the analysis but may be explained by heterogeneity in both the intervention and control group . The exercise component of self management programmes appears to contribute a significant benefit . Conclusion There is encouraging evidence of a small benefit from exercise in self management programs . Clear guidelines can not be provided for practice regarding the exercise content due to heterogeneity but overall benefit suggests this component should be emphasized and implemented in primary care self management programmes Aims : To establish ( 1 ) the efficacy of a six-week chronic disease management programme for knee osteoarthritis and ( 2 ) whether previous physiotherapy or being wait listed for surgery moderated the outcome of the programme . Design : A pretest , posttest design with multivariate statistical modelling . Participants : One hundred and twenty-one people with severe osteoarthritis who were waiting , or being considered , for surgery . Methods and measures : Western Ontario Osteoarthritis Index ( WOMAC ) scores , arthritis self-efficacy , distress and a patient-rated global indicator of response were collected at baseline , 6 and 12 weeks . History of previous physiotherapy , waiting list status , symptom duration , New Zeal and disease severity score , radiographic changes and self-perceived need for surgery were recorded at baseline . Results : There were moderate improvements in most outcomes ; WOMAC function decreased by 0.29 , WOMAC pain by 0.27 , pain self-efficacy by 4.4 , function self-efficacy by 5.6 and visual analogue scale ( VAS ) distress by 0.2 ( effect sizes ranging from 0.3 to 0.5 at 12 weeks ) . Waiting list status was a significant modifier for function , pain , distress and self-related outcomes . Participants on the waiting list for surgery experienced lesser improvements . Previous physiotherapy was associated with greater improvements in WOMAC scores at six weeks , but not at 12 weeks . Conclusion : The chronic disease management programme could be considered for people with severe knee osteoarthritis  , but should be given prior to referral and placement on the waiting list for surgery . Previous physiotherapy should not preclude people from participating in a chronic disease management programme The aim was to assess the self-efficacy and health outcomes of an adopted Arthritis Self-Management Programme ( ASMP ) among osteoarthritic knee sufferers in Hong Kong at 1 year . An experimental study with 95 participants assigned r and omly to the intervention ( n=45 ) or control group ( n=50 ) . Seventy-seven ( 81.1 % ) participants joined at least one out of three follow-ups in the 12 month period . Participants in the intervention group received a 6-week ASMP with an added exercise component in two general clinics . Outcome measures included arthritis self-efficacy ( ASE ) and health outcomes including pain and fatigue rating , self-rated health , daily activities limitation and number of unplanned arthritis-related medical consultations . Mean change ( 12 months minus baseline ) and the effect size of the outcome measures were calculated by Mann – Whitney U test and nQuery Advisor 4.0 . At 12 months , there were significant reductions of current pain ( p=0.0001 ) , pain at night ( p=0.001 ) , pain during walking ( p=0.01 ) and number of unplanned arthritis-related medical consultations ( p=0.03 ) and a significant increase in ASE for pain ( p=0.01 ) and other symptoms ( p=0.02 ) and self-rated health ( p=0.04 ) among the intervention group but not for the control group . However , there were similarities in outcome measures of pain while switching from a sitting to a st and ing position , fatigue rating and physical functional limitation ( p=0.15 ; p=0.22 and p=0.91 , respectively ) for both groups . Our findings add to the evidence that the modified arthritis empowering programme improved perception of control of osteoarthritis and three health outcomes after 12 months of treatment BACKGROUND Osteoarthritis is a leading cause of pain and disability , and self-management behaviors for osteoarthritis are underutilized . OBJECTIVE To examine the effectiveness of a telephone-based self-management intervention for hip or knee osteoarthritis in a primary care setting . DESIGN R and omized clinical trial with equal assignment to osteoarthritis self-management , health education ( attention control ) , and usual care control groups . ( Clinical Trials.gov registration number : NCT00288912 ) SETTING Primary care clinics in a Veterans Affairs Medical Center . PATIENTS 515 patients with symptomatic hip or knee osteoarthritis . INTERVENTION The osteoarthritis self-management intervention involved educational material s and 12 monthly telephone calls to support individualized goals and action plans . The health education intervention involved nonosteoarthritis educational material s and 12 monthly telephone calls related to general health screening topics . MEASUREMENTS The primary outcome was score on the Arthritis Impact Measurement Scales-2 pain subscale ( range , 0 to 10 ) . Pain was also assessed with a 10-cm visual analog scale . Measurements were collected at baseline and 12 months . RESULTS 461 participants ( 90 % ) completed the 12-month assessment . The mean Arthritis Impact Measurement Scales-2 pain score in the osteoarthritis self-management group was 0.4 point lower ( 95 % CI , -0.8 to 0.1 point ; P = 0.105 ) than in the usual care group and 0.6 point lower ( CI , -1.0 to -0.2 point ; P = 0.007 ) than in the health education group at 12 months . The mean visual analog scale pain score in the osteoarthritis self-management group was 1.1 points lower ( CI , -1.6 to -0.6 point ; P < 0.001 ) than in the usual care group and 1.0 point lower ( CI , -1.5 to -0.5 point ; P < 0.001 ) than in the health education group . Health care use did not differ across the groups . LIMITATION The study was conducted at 1 Veterans Affairs Medical Center , and the sample consisted primarily of men . CONCLUSION A telephone-based osteoarthritis self-management program produced moderate improvements in pain , particularly compared with a health education control group . PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs Health Services Research and Development Service PURPOSE The purpose of this study was to compare the cost-effectiveness of dietary and exercise interventions in overweight or obese elderly patients with knee osteoarthritis ( OA ) enrolled in the Arthritis , Diet , and Physical Activity Promotion Trial ( ADAPT ) . METHODS ADAPT was a single-blinded , controlled trial of 316 adults with knee OA , r and omized to one of four groups : Healthy Lifestyle Control group , Diet group , Exercise group , or Exercise and Diet group .  A cost analysis was performed from a payer perspective , incorporating those costs and benefits that would be realized by a managed care organization interested in maintaining the health and satisfaction of its enrollees while reducing unnecessary utilization of health care services . RESULTS The Diet intervention was most cost-effective for reducing weight , at $ 35 for each percentage point reduction in baseline body weight . The Exercise intervention was most cost-effective for improving mobility , costing $ 10 for each percentage point improvement in a 6-min walking distance and $ 9 for each percentage point improvement in the timed stair climbing task . The Exercise and Diet intervention was most cost-effective for improving self-reported function and symptoms of arthritis , costing $ 24 for each percentage point improvement in subjective function , $ 20 for each percentage point improvement in self-reported pain , and $ 56 for each percentage point improvement in self-reported stiffness . CONCLUSIONS The Exercise and Diet intervention consistently yielded the greatest improvements in weight , physical performance , and symptoms of knee OA . However , it was also the most expensive and was the most cost-effective approach only for the subjective outcomes of knee OA ( self-reported function , pain , and stiffness ) . Perceived function and symptoms of knee OA are likely to be stronger drivers of downstream health service utilization than weight , or objective performance measures and may be the most cost-effective in the long term Abstract Background Self-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 design s 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 design ed 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 clinical ly meaningful improvements in more participants than ASMP delivered in the same environment . Methods / Design The effectiveness of the programs will be compared in a single-blind r and omized 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 r and omised into either  OAKP or ASMP groups and followed for 6 months . Measurements : Assessment s will be immediately before and after the intervention and at 6 months . Primary outcome measures will be WOMAC and SF-36 question naires 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 . Discussion With 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 Registration This study is registered with the Australian New Zeal and Clinical Trials Registry : BACKGROUND Osteoarthritis ( OA ) of the knee is associated with a number of physical and psychological impairments . Unfortunately , very few treatment strategies are capable of addressing both types of impairments concurrently . We performed a pilot , r and omized controlled , proof of principle trial investigating the feasibility and effects of an intervention combining physical exercise and pain coping skills training ( PCST ) . METHODS Twenty patients with a clinical and radiographical diagnosis of tibiofemoral OA were r and omized to receive either 10 weeks of physiotherapist supervised exercises ( lower limb strengthening and walking ) combined with non-directive counseling ( NDC ) or the same exercise program delivered concurrently with PCST . Primary outcomes included self-reported pain and pain coping , while secondary outcomes included self efficacy and self-reported physical function . RESULTS Ten participants were r and omized to each group and both groups exhibited significant improvements in isometric knee strength , self-reported knee pain and physical function , self efficacy for control of pain management and other arthritis symptoms . Only those in the exercise + PCST group reported statistically significant improvements in pain control coping and rational thinking . No between-group differences existed in any outcome ( 0.07 < p < 0.98 ) . Based on our findings , 63 participants per group would be needed for future large-scale studies using similar outcome measures and design . CONCLUSIONS Our study showed that an intervention that combines exercise and PCST within the same treatment session and delivered by specially-trained physiotherapists is feasible and can improve both physical and psychological outcomes in individuals with knee OA . LEVEL OF EVIDENCE Level II Clinical Trials Registry number : ACTRN12609000623291 Background Patient education and self-management programs are offered in many countries to people with chronic conditions such as osteoarthritis ( OA ) . The most well-known is the disease-specific Stanford Arthritis Self-Management Program ( ASMP ) . While Australian and international clinical guidelines promote the concept of self-management for OA , there is currently little evidence to support the use of the ASMP . Several meta-analyses have reported that arthritis self-management programs had minimal or no effect on reducing pain and disability . However , previous studies have had method ological shortcomings including the use of outcome measures which do not accurately reflect program goals . Additionally , limited cost-effectiveness analyses have been undertaken and the cost-utility of the program has not been explored . Methods / design This study is a r and omised controlled trial to determine the efficacy ( in terms of Health-Related Quality of Life and self-management skills ) and cost-utility of a 6-week group-based Stanford ASMP for people with hip or knee OA.Six hundred participants referred to an orthopaedic surgeon or rheumatologist for hip or knee OA will be recruited from outpatient clinics at 2 public hospitals and community-based private practice s within 2 private hospital setting s in Victoria , Australia . Participants must be 18 years or over , fluent in English and able to attend ASMP sessions . Exclusion criteria include cognitive dysfunction , previous participation in self-management programs and placement on a waiting list for joint replacement surgery or scheduled joint replacement . Eligible , consenting participants will be r and omised to an intervention group ( who receive the ASMP and an arthritis self-management book ) or a control group ( who receive the book only ) . Follow-up will be at 6 weeks , 3 months and 12 months using st and ardised self-report measures . The primary outcome is Health-Related Quality of Life at 12 months , measured using the Assessment of Quality of Life instrument . Secondary outcome measures include the Health Education Impact Question naire , Western Ontario and McMaster Universities Osteoarthritis Index ( pain subscale and total scores ) , Kessler Psychological Distress Scale and the Hip and Knee Multi-Attribute Priority Tool . Cost-utility analyses will be undertaken using administrative records and self-report data . A subgroup of 100 participants will undergo qualitative interviews to explore the broader potential impacts of the ASMP . Discussion Using an innovative design combining both quantitative and qualitative components , this project will provide high quality data to facilitate evidence -based recommendations regarding the ASMP OBJECTIVE To determine the effects of T'ai Chi training on arthritis self-efficacy , quality of life indicators , and lower extremity functional mobility in older adults with osteoarthritis . DESIGN A prospect i ve , r and omized , controlled clinical trial . Intervention length was 12 weeks , with outcomes measured before and after intervention using blinded testers . Group ( T'ai Chi vs Control ) x time ( 2 x 2 ) mixed factorial ANOVA . SETTING Allied Health Sciences Center at Springfield College , Springfield , MA PARTICIPANTS : A total of 33 community-dwelling participants ( mean age 68 ) diagnosed with lower extremity osteoarthritis and having no prior T'ai Chi training longer than 2 weeks . INTERVENTION T'ai Chi training included two 1-hour T'ai Chi classes per week for 12 weeks . MEASUREMENTS Arthritis self-efficacy ( Arthritis Self-Efficacy Scale ) , quality of life indicators ( Arthritis Impact Measurement Scale ) , functional outcomes ( one-leg st and ing balance , 50-foot walking speed , time to rise from a chair ) . RESULTS T'ai Chi participants experienced significant ( P < .05 ) improvements in self-efficacy for arthritis symptoms , total arthritis self-efficacy , level of tension , and satisfaction with general health status . CONCLUSIONS A moderate T'ai Chi intervention can enhance arthritis self-efficacy , quality of life , and functional mobility among older adults with osteoarthritis . T'ai Chi training is a safe and effective complementary therapy in the medical management of lower extremity osteoarthritis OBJECTIVES To determine whether a home-based pedometer-driven walking program with arthritis self-management education ( Walk + ) would increase physical activity , muscle strength , and functional performance in older adults with osteoarthritis ( OA ) of the knee as opposed to arthritis self-management education alone ( EDU ) . DESIGN A r and omized two-by-three ( group-by-time ) design with participants assigned to  Walk + ( n = 17 , mean age + /- st and ard deviation = 69.6 + /- 6.7 ) or EDU ( n = 17 , age = 70.8 + /- 4.7 ) . SETTING Community located in the Baltimore-Washington area . PARTICIPANTS Thirty-four community-dwelling adults , aged 60 and older with symptomatic knee OA and self-reported functional impairment . INTERVENTIONS Both groups received 12 hours of the Arthritis Self-Management program over 12 weeks and were followed for an additional 12 weeks . In addition , the Walk + group received individualized instruction in the use of a pedometer , with the goal of increasing their step count by 30 % of their baseline step count . MEASUREMENTS The outcome measures were physical activity ( daily step counts and total activity vector magnitude as measured by a pedometer and Tritrac-R3D accelerometer ) , quadriceps femoris strength ( isometric peak torque ) , and functional performance tasks ( 100-foot walk-turn-walk , timed stair climb , timed chair rise , and pain status ) . RESULTS Daily steps walked showed a significant group-by-time interaction ( P = .04 ) after controlling for age . From baseline to completion of training , a 23 % increase in daily steps occurred in the Walk + group and a 15 % decrease in the EDU group . Although steps increased in the Walk + group , total activity vector magnitude was maintained , suggesting a more efficient gait . The Walk + group became quicker than the EDU group in the normal-pace walk-turn-walk ( P = .04 ) . An isometric strength gain of 21 % postintervention was seen in the Walk + group , compared with a loss of 3.5 % in the EDU group . CONCLUSION In older adults with symptomatic knee OA , Walk + appears to increase walking , with improvements in muscle strength and walking performance . The use of a home-based pedometer-driven program to increase physical activity , strength , and function in this population warrants further research OBJECTIVE To evaluate a concise program of self-care education delivered by an arthritis nurse specialist as an adjunct to primary care for inner-city patients with knee osteoarthritis ( OA ) . METHODS An attention-controlled clinical trial ; 211 inner-city patients with knee OA were assigned arbitrarily to education ( E ) or attention-control ( AC ) conditions . Group E received an individualized 30 - 60-minute educational intervention that emphasized nonpharmacologic management of joint pain , preservation of function by problem-solving , and practice of principles of joint protection . Brief telephone contacts 1 week and 4 weeks later monitored and reinforced new self-care activities . Group AC viewed a 20-minute st and ardized public education presentation on arthritis and received followup telephone calls ( only to encourage continued participation in the study ) . Outcomes included the Health Assessment Question naire ( HAQ ) Disability and Discomfort Scales , 10-cm visual analog scales measuring knee pain at rest and while walking , and the Quality of Well-Being ( QWB ) scale . Assessment s were made at baseline and at 4-month intervals for 1 year . RESULTS A total of 165 subjects ( 78 % ) completed all assessment s. After control for baseline status , group E had significantly lower scores for disability and resting knee pain throughout the year of postintervention followup ( P < 0.05 for both ) . Effects were somewhat discordant . By 12 months , functional benefits had begun to wane , while the effect on resting knee pain had grown . The overall effects of education on walking knee pain , overall joint pain ( by HAQ ) , and general health status ( by QWB ) were not significant . CONCLUSION Self-care education for inner-city patients with knee OA , delivered as an adjunct to primary care , was found to result in notable preservation of function and control of resting knee pain . The magnitude of the observed effects compares well with those of more labor-intensive and time-consuming intervention models . However , more sustained preservation of function and consistent effects on pain may require prolonged , more proactive followup , either by the patient educator or by a trained clinical assistant dedicated to the task of supporting self-care by patients with knee OA Background Supporting self-management intends to improve life-style , which is beneficial for patients with mild osteoarthritis ( OA ) . We evaluated a nurse-based intervention on  older OA patients ' self-management with the aim to assess its effects on mobility and functioning . Methods R and omized controlled trial of patients ( ≥ 65 years ) with mild hip or knee OA from nine family practice s in the Netherl and s. Intervention consisted of supporting patients ' self-management of OA symptoms using a practice -based nurse . Outcome measures were patients ' mobility , using the Timed Up and Go test ( TUG ) , and patient reported functioning , using an arthritis specific scale ( Dutch AIMS 2 SF ) . Results Fifty-one patients were r and omized to the intervention group and 53 to the control group . Patient-reported functioning improved on four scales in the intervention group compared to one scale in the control group . However , this result was not significant . Mobility improved in both groups , without a significant difference between the two groups . There were no differences between the groups regarding consultations with family physicians or physiotherapists , or medication use . Conclusion A nurse-based intervention on older OA patients ' self-management did not improve self-reported functioning , mobility or patients ' use of health care re sources BACKGROUND Osteoarthritis ( OA ) is a leading cause of disability among adults . Although self-management behaviors such as exercise and weight management can improve pain and function , these behaviors are vastly underutilized . There is a need to implement effective self-management programs among the growing number of adults with OA . OBJECTIVES The Self-Management of OsteoArthritis ( SeMOA ) in Veterans Study examines a 12-month telephone-based OA self-management program in the primary care setting . This manuscript details the design , methodology , and advances of the SeMOA trial . METHODS Participants ( N=519 ) with hip or knee OA are r and omly assigned to one of three groups : OA self-management , health education ( attention control ) , or usual care . The OA self-management group receives written and audio material s regarding OA care ( including health behaviors , medical care , and interacting with health care providers ) . A health educator calls participants monthly to review these material s and provide support for developing individualized goals and action plans related to OA management . The health education group receives written and audio material s and monthly calls from a health educator discussing health issues unrelated to OA . Usual care involves no additional material s or phone calls . The primary outcome is change in the Arthritis Impact Measurement Scales-2 pain subscale from baseline to 12 months . Analysis of covariance models will compare changes in pain across study groups . The cost-effectiveness of the OA self-management program will also be assessed . CONCLUSION SeMOA is one of the first to examine telephone-based delivery of OA self-management and one of few trials to target the primary care setting . This program has the potential for broad dissemination because it reduces both the costs and barriers that accompany in-person programs . This study will provide important information about its feasibility and effectiveness in a real-world clinical setting & NA ; This study examined the relationship of pain coping strategies to osteoarthritis patients ’ ratings of self‐efficacy and to spouses ’ ratings of the patients ’ self‐efficacy . Subjects , 130 individuals having osteoarthritis of the knees and persistent knee pain , completed a pain coping strategies measure ( the Coping Strategies Question naire ) , a measure of self‐efficacy ( the Arthritis Self‐Efficacy Scale ) , and a measure of pain ( the McGill Pain Question naire ) . Two sets of regression analyses were conducted , one examining the degree to which pain coping strategies predicted patients ’ self‐efficacy ratings , and the other examining the degree to which coping strategies predicted spouses ’ ratings of the patients ’ self‐efficacy . Several pain coping strategies were found to predict a significant proportion of variance in patients ’ ratings of self‐efficacy : ( i ) ignoring pain sensations was related to higher self‐efficacy for pain ; ( ii ) coping self statements were related to higher self‐efficacy for controlling other arthritis symptoms ( e.g. , fatigue or mood symptoms ; and ( iii ) catastrophizing was related to lower self‐efficacy for pain , and self‐efficacy for other arthritis symptoms . Pain coping strategies were also found to predict a significant proportion of variance in spouses ’ ratings of the patients ’ self‐efficacy . Specifically : ( i ) diverting attention was related to lower spousal ratings of self‐efficacy for pain ; ( ii ) praying or hoping was related to lower spousal ratings of self‐efficacy for function ; and ( iii ) catastrophizing was related to lower spousal ratings of self‐efficacy for control of fatigue or mood symptoms . The findings regarding coping strategies were particularly interesting in that they were obtained even after controlling for pain intensity and demographic variables . The pain coping strategies identified are potentially important targets for cognitive‐behavioral assessment and treatment efforts . Interventions design ed to increase the use of adaptive pain coping strategies and decrease the use of maladaptive pain coping strategies could enhance self‐efficacy , reduce pain , and improve the physical and psychological functioning of individuals having osteoarthritis Objective : The objective of this study was to evaluate a nurse-directed self-management intervention for managed care patients with knee osteoarthritis ( OA ) , emphasizing nonpharmacologic ( NonPharm ) management of pain and functional impairments and minimization of exposure to the risks and costs of nonsteroidal antiinflammatory drugs ( NSAIDs ) . Methods : Subjects were 186 patients from a large health maintenance organization ( HMO ) who satisfied American College of Rheumatology clinical criteria for knee OA . Two of 4 HMO sites ( and their patient cohorts ) were r and omly assigned to the education group ; the other 2 served as a delayed-intervention control group . At each location of care for the education group , an arthritis nurse educator , in consultation with the patient 's primary care physician ( PCP ) , followed a detailed algorithm for implementing and monitoring the response to NonPharm treatment modalities ( eg , quadriceps strengthening exercises , counseling in principles of joint protection , use of thermal modalities ) . The nurses apprised the PCP of the patient 's progress and made algorithm-based recommendations , as appropriate , for reduction of dose , and eventual discontinuation , of NSAIDs in favor of acetaminophen . Outcomes ( measured at baseline , 3 , 6 , and 12 months ) included pain and function scales from the Western Ontario and McMaster Universities ( WOMAC ) OA Index . Results : The treatment groups were similar at baseline with respect to sociodemographic and clinical characteristics . Medical record audits revealed that NonPharm treatments ( most often exercise ) were implemented by 75 % of patients in the education group but by only 18 % of patients receiving routine care ( P < 0.00001 ) . Over the subsequent 12 months , 20 patients ( 26 % ) in the education group , but only 3 ( 5 % ) in the control group ( P = 0.002 ) , underwent changes in drug treatment of OA pain consistent with the NSAID-sparing goals of the intervention , ie , acetaminophen as initial drug of choice ; reduction in dose , or discontinuation , of NSAID ; switch from an NSAID to an analgesic . Only one patient in the education group required reinstitution of NSAIDs because of an increase in knee pain . Mean WOMAC scores indicated no deterioration of pain control or function over 12 months in the group treated according to the algorithm . Conclusion : Incorporation into the primary care setting of self-care education for patients with knee OA , with collaboration between a proactive arthritis nurse and the patient 's PCP , can reduce reliance on NSAIDs without a result ant increase in OA pain and disability OBJECTIVE To examine changes in mobility-related self efficacy following exercise and dietary weight loss interventions in overweight and obese older adults with knee osteoarthritis ( OA ) , and to determine if self efficacy and pain mediate the effects of the interventions on mobility task performance . METHODS The Arthritis , Diet , and Activity Promotion Trial was an 18-month , single-blind , r and omized , controlled trial comparing the effects of exercise alone , dietary weight loss alone , a combination of exercise plus dietary weight loss , and a healthy lifestyle control intervention in the treatment of 316 overweight or obese older adults with symptomatic knee OA . Participants completed measures of stair-climb time and 6-minute walk distance , self efficacy for completing each mobility task , and self-reported pain at baseline , 6 months , and 18 months during the trial . RESULTS Mixed model analyses of covariance of baseline adjusted change in the outcomes demonstrated that the exercise + dietary weight loss intervention produced greater improvements in mobility-related self efficacy ( P = 0.0035 ) , stair climb ( P = 0.0249 ) and 6-minute walk performance ( P = 0.00031 ) , and pain ( P = 0.09 ) when compared with the healthy lifestyle control intervention . Mediation analyses revealed that self efficacy and pain served as partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb time . CONCLUSION Exercise + dietary weight loss results in improved mobility-related self efficacy ; changes in these task-specific control beliefs and self-reported pain serve as independent partial mediators of the beneficial effect of exercise + dietary weight loss on stair-climb performance Background and aims : Physical exercise is associated with a lower risk of disability . The impact of comorbidity on the benefits from physical exercise has not been clearly investigated . Elders with comorbidity may benefit from physical exercise to preserve physical function . Methods : Data are from 435 participants with knee osteoarthritis aged ≥60 years enrolled in the Fitness and Arthritis in Seniors Trial ( FAST ) , who were r and omly assigned to 18-month health educational ( HE ) , weight training ( WT ) , or aerobic exercise ( AE ) interventions .  Comorbidity was defined as the presence of osteoarthritis and ≥2 clinical conditions . Percent changes in the 6-minute walk test , self-reported disability and knee pain from baseline to 3- , 9- , and 18-month follow-up visits were analyzed according to comorbidity , using analysis of variance . Significance s were adjusted using the Bonferroni method . Results : Mean age of the sample was 68.7 years . In participants with comorbidity ( n=197 ) , those in the AE intervention showed significant improvement in walking speed , compared to WT and HE groups , since the beginning of follow-up . Subjects with comorbidity in AE and WT groups showed improvement of the disability score at the 3-month follow-up visit compared to those in the HE group . This improvement was maintained at the end of the follow-up by the only AE group compared to the HE one ( p=0.06 ) . In participants with comorbidity  , the pain score was improved by the AE intervention . Conclusions : AE and WT interventions improve physical function in individuals with comorbidity . AE improves physical function and knee pain independently of the presence of comorbidity OBJECTIVE The Arthritis , Diet , and Activity Promotion Trial ( ADAPT ) was a r and omized , single-blind clinical trial lasting 18 months that was design ed to determine whether long-term exercise and dietary weight loss are more effective , either separately or in combination , than usual care in improving physical function , pain , and mobility in older overweight and obese adults with knee osteoarthritis ( OA ) . METHODS Three hundred sixteen community-dwelling overweight and obese adults ages 60 years and older , with a body mass index of > or = 28 kg/m(2 ) , knee pain , radiographic evidence of knee OA , and self-reported physical disability , were r and omized into healthy lifestyle ( control ) , diet only , exercise only , and diet plus exercise groups . The primary outcome was self-reported physical function as measured with the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes included weight loss , 6-minute walk distance , stair-climb time , WOMAC pain and stiffness scores , and joint space width . RESULTS Of the 316 r and omized participants , 252 ( 80 % ) completed the study .  Adherence was as follows : for healthy lifestyle , 73 % ; for diet only , 72 % ; for exercise only , 60 % ; and for diet plus exercise , 64 % . In the diet plus exercise group , significant improvements in self-reported physical function ( P < 0.05 ) , 6-minute walk distance ( P < 0.05 ) , stair-climb time ( P < 0.05 ) , and knee pain ( P < 0.05 ) relative to the healthy lifestyle group were observed . In the exercise group , a significant improvement in the 6-minute walk distance ( P < 0.05 ) was observed . The diet-only group was not significantly different from the healthy lifestyle group for any of the functional or mobility measures . The weight-loss groups lost significantly ( P < 0.05 ) more body weight ( for diet , 4.9 % ; for diet plus exercise , 5.7 % ) than did the healthy lifestyle group ( 1.2 % ) . Finally , changes in joint space width were not different between the groups . CONCLUSION The combination of modest weight loss plus moderate exercise provides better overall improvements in self-reported measures of function and pain and in performance measures of mobility in older overweight and obese adults with knee OA compared with either intervention alone OBJECTIVE To examine the effect of a targeted balance training program on dynamic balance and self-reported physical function in people with medial tibiofemoral osteoarthritis ( OA ) . DESIGN Single-blind r and omized controlled trial . SETTING Exercise gymnasium and community dwellings . PARTICIPANTS Individuals with medial compartment knee OA ( N=40 ) . INTERVENTIONS Ten weeks of partially supervised exercises targeting dynamic balance and strength performed 4 times per week or no intervention ( nonintervention group ) . MAIN OUTCOME MEASURES Dynamic balance was measured using the Community Balance and Mobility Scale ( CB&M ) , and self-reported physical function was measured using the Western Ontario and McMaster Universities Arthritis Index physical function subscale . Secondary outcomes included knee pain , fear of movement , knee joint proprioception , and muscle strength . RESULTS Forty individuals underwent baseline testing , with 36 participants completing follow-up testing .  Adherence to exercise in the training group was high , with 82.2 % of all home-based exercise sessions completed . No significant changes were observed in any outcome in the nonintervention group at follow-up . Significant improvements in self-reported pain , physical function , and fear of movement were observed in the training group when compared with the nonintervention group . No other within- or between-group differences were observed . CONCLUSIONS A 10-week dynamic balance training program for people with knee OA significantly improved self-reported knee pain , physical function , and fear of movement ; however , there was no change in dynamic balance as quantified by the CB&M. Further research is needed to investigate how exercise may result in improvement on objective measures of dynamic balance Summary Combined training in pain and weight management in overweight and obese OA patients result ed in improved pain and other outcomes compared to either training alone . ABSTRACT Overweight and obese patients with osteoarthritis ( OA ) experience more OA pain and disability than patients who are not overweight . This study examined the long‐term efficacy of a combined pain coping skills training ( PCST ) and lifestyle behavioral weight management ( BWM ) intervention in overweight and obese OA patients . Patients ( n = 232 ) were r and omized to a 6‐month program of : 1 ) PCST + BWM ;  2 ) PCST‐only ;  3 ) BWM‐only ; or 4 ) st and ard care control . Assessment s of pain , physical disability ( Arthritis Impact Measurement Scales [ AIMS ] physical disability , stiffness , activity , and gait ) , psychological disability ( AIMS psychological disability , pain catastrophizing , arthritis self‐efficacy , weight self‐efficacy ) , and body weight were collected at 4 time points ( pretreatment , posttreatment , and 6 months and 12 months after the completion of treatment ) . Patients r and omized to PCST + BWM demonstrated significantly better treatment outcomes ( average of all 3 posttreatment values ) in terms of pain , physical disability , stiffness , activity , weight self‐efficacy , and weight when compared to the other 3 conditions ( Ps < 0.05 ) . PCST + BWM also did significantly better than at least one of the other conditions ( ie , PCST‐only , BWM‐only , or st and ard care ) in terms of psychological disability , pain catastrophizing , and arthritis self‐efficacy . Interventions teaching overweight and obese OA patients pain coping skills and weight management simultaneously may provide the more comprehensive long‐term benefits PURPOSE S 1 ) To evaluate the effects of a 12-wk high-intensity knee extensor and flexor resistance training program on strength , pain , and adherence in patients with advanced knee osteoarthritis and varus malalignment and 2 ) to generate pilot data for change in dynamic knee joint load , patent-reported outcomes , and self-efficacy after training . METHODS Fourteen patients ( 48.35 + /- 6.51 yr ) with radiographically confirmed medial compartment knee osteoarthritis and varus malalignment of the lower limb were recruited from a surgical waiting list for high tibial osteotomy . Participants completed a high-intensity isokinetic resistance training program three times per week for 12 wk . Knee extensor and flexor strength  were assessed every third week , whereas  pain and adherence  were recorded at every training session . The external knee adduction moment during the gait , the 6-min-walk test , the Knee Injury and Osteoarthritis Outcome Score ( KOOS ) , and the Arthritis Self-Efficacy Scale ( ASES ) were also evaluated before and after training . RESULTS Significant improvements in knee extensor and flexor strength were observed without increases in pain during or after training . Adherence to the high-intensity program was high . No significant changes were observed for dynamic knee joint load or the KOOS . There was a significant increase in the function subscale of the ASES only . CONCLUSIONS These findings suggest that patients with advanced knee osteoarthritis and malalignment can experience substantial gains in strength after a high-intensity resistance training program without concomitant increases in pain , adverse events , or compromised adherence . These findings provide support for future clinical trials with longer-term outcomes
Small to moderate effect sizes were observed regardless of whether the intervention included exercise .
OBJECTIVE To evaluate studies that used arthritis self-management education alone or with exercise to improve Arthritis Self-Efficacy Scale scores of patients with knee osteoarthritis .
BACKGROUND Increasing self-efficacy may improve patient knee osteoarthritis symptom management and function .