Arthritis Self-management Does Not Reduce Pain Levels Or GP Visits, UK
Main Category: Arthritis / RheumatologyAlso Included In: Pain / Anesthetics; Primary Care / General Practice; Clinical Trials / Drug Trials
Article Date: 17 Oct 2006 - 9:00 PDT
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Self-management programmes for people with osteoarthritis do not reduce pain, or the number of visits patients make to their GP, a new study reveals today.
Osteoarthritis affects around five million people in the UK (8% of the population). Patient-centred arthritis self-management programmes tested on volunteers in the USA indicated a beneficial effect on pain, depression, exercise taken, communication with doctors and participants' self-perception about their capacity to manage their condition
Researchers from London undertook one of the largest trials to measure the effects of arthritis self-management programmes on patients. The findings showed that whilst these programmes helped to reduce levels of anxiety for arthritis patients, they did little to reduce physical pain. The authors say their findings suggest that more research needs to be done to support the roll-out of the government's Expert Patient Programme - a generic self-management programme for arthritis and other chronic diseases.
The study involved 812 participants with osteoarthritis in their hips and/or knees. They were divided into two groups. The first were placed on a six-session arthritis self-management programme and education booklet, the second received the education booklet alone. The participants were asked to complete a questionnaire at the start of the trial, then after four months, and again after a year. Those on the self-management programme experienced a reduction in anxiety levels and improved confidence in managing their symptoms. Neither group experienced a significant reduction in pain, improved physical functioning, or made fewer visits to their GP.
The authors conclude that there is "little doubt that self-management techniques provide some benefit for those with chronic or long-term conditions" but add that in terms of arthritis self-management programmes "there is currently insufficient evidence to justify a policy of active recruitment of patients from primary care settings."
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Contact: Emma Dickinson
BMJ-British Medical Journal
Visit our arthritis / rheumatology section for the latest news on this subject.
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16 Feb. 2012. <http://www.medicalnewstoday.com/releases/54140.php>
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http://www.medicalnewstoday.com/releases/54140.php.
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Gain Not Pain True Measure
posted by Kitty FitzHerbert Training Services Development Manager Arth on 18 Oct 2006 at 3:11 amFrom Arthritis Care, Provider of the UK courses:
Arthritis Care always welcomes research into the efficacy of self-management but warns against the over-simplification of the complexities of this issue.
There are many reasons why this piece of research, already criticised in the United States for lacking sufficient detail, might not reflect actual outcomes. There might, for example, be a spike in GP contacts as people who have been through the programme assume greater control of their condition; GP visits might increase because they have learned to manage better, and need less contact with secondary care; there might be no net reduction in pain because their joint mobility and feelings of well-being have improved, leading to increased exercise but potentially more pain.
Nevertheless, the research still concluded that Challenging Arthritis does reduce anxiety about living with arthritis, and increases self-efficacy, with participants being more confident about managing pain and other arthritis symptoms.
The key issue, for Arthritis Care, is that the many graduates of the programme report that Challenging Arthritis has been life-changing for them. As the new NHS is intended to be patient-focused, it is imperative that planners of future care consider not just what research says but what patients themselves say.
The point of the Challenging Arthritis programme was never to reduce pain, but to enable participants living with arthritis to acquire new skills, giving them greater control of their lives and greater ability to surmount the obstacles of living with this debilitating condition. The programme is based on clinical research and has a broad range of positive outcomes, including the empowerment, new confidence and self-assurance that participants report.
Arguably, one of the chief measurements taken in this study – whether attendance on the programme reduced GP visits – was not an appropriate measurement since the Challenging Arthritis programme specifically aims to give participants the skills to gain more from their essential GP visits, rather than to replace them.
Furthermore, this study is based on programmes that took place some years ago, and it does not appear to take into account the medical treatment that participants were receiving at the time, nor does it seem to measure important results from the programme, such as improved communication with doctors, or improved health behaviours like dietary changes or taking increased exercise, an important aspect of managing arthritis.
Most significantly, it was reported by the researchers that not every participant actually attended all of the educational sessions, and therefore the purported measurement of the impact of the programme as a whole could be significantly flawed.
Arthritis Care agrees with the researchers’ conclusion that there is a case for further study to identify predictive factors such as motivation levels in participants that could influence the long-term benefits of arthritis self-management.
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