Study questions self-help courses for OA

Participation in self-help courses for osteoarthritis may reduce anxiety and improve participant's psychological wellbeing but does not reduce pain or improve physical function, according to a recent large randomised trial.Introducing their paper Dr Marta Buszewicz and colleagues identify that the literature is lacking on the efficacy of self-management approaches for osteoarthritis. The team cites a recent review, which suggests that self management can improve knowledge, performance of self management behaviours, self efficacy, and aspects of health status compared with standard care. However, Buszewicz's group comment that the studies reviewed had small sample sizes, short follow-up, and used non-validated outcome measures.Therefore, to evaluate the clinical effectiveness of a self-management program for osteoarthritis on a larger scale using validated outcome measures the investigators enrolled 812 patients. Participants were aged 50 or more, had been diagnosed with osteoarthritis of the hips or knees (or both) for at least a year, with associated pain or functional disability during the past month.Participants were randomised to six sessions of self-management of arthritis and an education booklet (intervention group, n=406) or the education booklet alone (control group, n=406).At one year's follow-up, no significant differences were reported between the groups for the primary outcome measures. However, for the intervention group the anxiety subscore, of the hospital anxiety and depression scale (HADS), was significantly reduced. Also, a significant difference was observed for the pain subscore of the arthritis self efficacy (ASE) scale after four and 12 months. No significant difference was seen in number of visits to the general practitioner.Reflecting on their findings Buszewicz's team write, "Little doubt exists that such techniques provide some benefit for those with chronic conditions, but the best way to provide the intervention is unclear, and insufficient evidence exists to justify a policy of active recruitment of patients from primary care settings."The team concludes, "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."Reference...