Self management of arthritis in primary care: randomised controlled trialBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38965.375718.80 (Published 26 October 2006) Cite this as: BMJ 2006;333:879
- Marta Buszewicz, senior lecturer ()1,
- 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
- Accepted 24 August 2006
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.
Figures A and B, figure legends, and boxes 1 and 2 are on bmj.com
Thanks to Jennifer Beecham, Angela Coulter, and Melissa Pickering for help in conducting this trial; Peter Croft, Paul Dieppe, and Andrew Nunn for comments on an earlier draft; and Mike Kenward for statistical advice. Many thanks also to the MRC general practice framework nurses and general practices involved and all the patients who took part.
Contributors MB, GR, MG, AP, JB, and AH helped conceive, design, and run the trial. IN and AA helped with the ongoing management of the trial and AA supervised data collection. MG had full access to all data and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors helped draft the paper and revise it critically and approved the final version. MB is guarantor.
Conflict of interest None declared.
Funding Medical Research Council (reference G9900306).
Ethical approval Multicentre research ethics committee approval from the London office (reference MREC/99/2/87). Local research ethics committee approval was obtained in all areas where patients were recruited to the trial.