BMJ  2006;333:879 (28 October), doi:10.1136/bmj.38965.375718.80 (published 13 October 2006)

Research

Self management of arthritis in primary care: randomised controlled trial

Marta Buszewicz, senior lecturer1, Greta Rait, senior lecturer2, Mark Griffin, Statistician1, Irwin Nazareth, professor2, Anita Patel, health economist3, Angela Atkinson, project manager4, Julie Barlow, professor of health psychology5, Andy Haines, dean6

1 Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London N19 5LW, 2 Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2NF, 3 Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London, London SE5 8AT, 4 Clinical Research Facility, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, 5 Interdisciplinary Research Centre in Health, Coventry University, Coventry CV1 5FB, 6 London School of Hygiene and Tropical Medicine, London WC1E 7HT

Correspondence to: M Buszewicz m.buszewicz{at}pcps.ucl.ac.uk

Abstract

Objective To evaluate clinical effectiveness of a self management programme for arthritis in patients in primary care with osteoarthritis.

Design Randomised controlled trial.

Setting 74 general practices 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 randomised 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 ISRCTN79115352 [controlled-trials.com] .


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Rapid Responses:

Read all Rapid Responses

Gain Not Pain True Measure
Kitty FitzHerbert
bmj.com, 17 Oct 2006 [Full text]
Erratum - apologies for not acknowledging the contribution of the Trial Steering Committee members to this trial
Marta J Buszewicz
bmj.com, 27 Oct 2006 [Full text]
Challenges in the management of osteoarthritis
Surya P Rajeev, et al.
bmj.com, 30 Oct 2006 [Full text]
Dilemmas surrounding implementation of expert patient programmes.
Suresh Kumar Chhetri
bmj.com, 1 Nov 2006 [Full text]
Impact on utilisation is likely to require a more integrated approach to self management
Anne Rogers
bmj.com, 3 Nov 2006 [Full text]
Self care and quality of life in the elderly
Angel J. Romero Cabrera, et al.
bmj.com, 3 Nov 2006 [Full text]
Educational programes must be effective and benefit equally
Rozhia Salih
bmj.com, 6 Nov 2006 [Full text]
Educational programes must be effective and benefit equally
Rozhia Salih
bmj.com, 6 Nov 2006 [Full text]
Another trial on self management of arthritis in primary care
Peter HTG Heuts, et al.
bmj.com, 1 Dec 2006 [Full text]
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