Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. Family practice nurses supporting self-management in older patients with mild osteoarthritis: a randomized trial The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews Self-management and peer support among people with arthritis on a hospital joint replacement waiting list: a randomised controlled trial. Behavior change following a self-management intervention for housebound older adults with arthritis: an experimental study Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee. Non-pharmacological care for patients with generalized osteoarthritis: design of a randomized clinical trial Effect of an education programme for patients with osteoarthritis in primary care - a randomized controlled trial Effects of activity strategy training on pain and physical activity in older adults with knee or hip osteoarthritis: a pilot study. Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network. Can a disease-specific education program augment self-management skills and improve Health-Related Quality of Life in people with hip or knee osteoarthritis? Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Effects of a tailored activity pacing intervention on pain and fatigue for adults with osteoarthritis. Osteoarthritis of the knee: isokinetic quadriceps exercise versus an educational intervention. Impact of the fit and strong intervention on older adults with osteoarthritis. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee Coping self-efficacy as a mediator between catastrophizing and physical functioning: treatment target selection in an osteoarthritis sample Health outcomes of two telephone interventions for patients with rheumatoid arthritis or osteoarthritis. Economic evaluation of arthritis self management in primary care A pilot study of health education via a nurse-run telephone self-management programme for elderly people with osteoarthritis A Phase II Multicentered, Single-Blind, Randomized, Controlled Trial of the Stroke Self-Management Program Patient and provider interventions for managing osteoarthritis in primary care: protocols for two randomized controlled trials A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals Self-management for osteoarthritis of the knee: Does mode of delivery influence outcome? A randomized controlled study of the Arthritis Self-Management Programme in the UK. Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: A cluster randomized trial A physiotherapist-delivered integrated exercise and pain coping skills training intervention for individuals with knee osteoarthritis: a randomised controlled trial protocol Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial Outcomes of self-help education for patients with arthritis. Feasibility of a dyadic intervention for management of osteoarthritis: A pilot study with older patients and their spousal caregivers Group interventions for co-morbid insomnia and osteoarthritis pain in primary care: the lifestyles cluster randomized trial design. Can a Nurse-Directed Intervention Reduce the Exposure of Patients With Knee Osteoarthritis to Nonsteroidal Antiinflammatory Drugs? A reexamination of the effectiveness of self-care education for persons with arthritis. A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST). Spouse-assisted coping skills training in the management of osteoarthritic knee pain. Challenges in Evaluating an Arthritis Self-management Program for People with Hip and Knee Osteoarthritis in Real-world Clinical Settings Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. Exercise, self-efficacy, and mobility performance in overweight and obese older adults with knee osteoarthritis. The internet-based arthritis self-management program: a one-year randomized trial for patients with arthritis or fibromyalgia. Reduced utilization and cost of primary care clinic visits resulting from self-care education for patients with osteoarthritis of the knee. Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. Building equity in chronic disease management in Thailand: a whole-system provincial trial of systematic, pro-active chronic illness care Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study Self-management in osteoarthritis of hip or knee: a randomized clinical trial in a primary healthcare setting. Bias effects in three common self-report pain assessment measures. Self management of arthritis in primary care: randomised controlled trial Gender differences in participation and responsiveness to a health intervention for older Americans. Long-term impact of Fit and Strong! on older adults with osteoarthritis. The Self-Management of OsteoArthritis in Veterans (SeMOA) Study: design and methodology. The effects of social support and education on health care costs after three years. The effects of social support and education interventions on health care costs. Efficacy of patient education and supervised exercise vs patient education alone in patients with hip osteoarthritis: a single blind randomized clinical trial. The effectiveness of self‐management educational interventions for osteoarthritis of the knee 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 A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients. Improving Physical Activity and Function in Overweight and Obese Older Adults with Osteoarthritis of the Knee: A Feasibility Study A Cost Analysis of Self-Management Programs for People with Chronic Illness Community-based Spanish language arthritis education program: a randomized trial. The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. A controlled evaluation of arthritis education. Long-term clinical benefits and costs of an integrated rehabilitation programme compared with outpatient physiotherapy for chronic knee pain. The effect of an educational program to improve health-related quality of life in patients with osteoarthritis on waiting list for total knee replacement: a randomized study. The effect of a group education programme on pain and function through knowledge acquisition and home-based exercise among patients with knee osteoarthritis: a parallel randomised single-blind clinical trial. One-year evaluation of cognitive-behavioral intervention in osteoarthritis. Telephone-Based Self-management of Osteoarthritis The effectiveness of a self-management program on quality of life for knee osteoarthritis (OA) patients. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: A randomized controlled study
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 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 Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged INTRODUCTION To evaluate the efficacy of a self-management support program including a 6 week self-management course , individualised phone support and goal setting in osteoarthritis patients on a waiting list for arthroplasty surgery . METHOD R and omised controlled trial of 152 public hospital out patients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery . Participants were r and omised to a self-management program or to usual care .  The primary outcome was change in the Health Education Intervention Question naire ( HeiQ ) from r and omisation to 6 month follow-up . Quality of life and depressive symptoms were also measured . Changes in pain and function were assessed using the Western Ontario and McMaster Universities ( WOMAC ) Arthritis Index . RESULTS At 6 month follow-up , health-directed behaviour was significantly greater in the intervention [ mean 4.29 , 95 % confidence interval ( CI ) 3.99 - 4.58 ] than the control ( mean 3.81 , 95 % CI 3.52 - 4.09 ; P=0.017 ) . There was also a significant effect on skill and technique acquisition for the intervention ( mean 4.37 , 95 % CI 4.19 - 4.55 ) in comparison to control ( mean 4.11 , 95 % CI 3.93 - 4.29 ; P=0.036 ) . There was no significant effect of the intervention on the remaining HeiQ subscales , WOMAC pain or disability , quality of life or depressive symptoms . DISCUSSION The arthritis self-management program improved health-directed behaviours , skill acquisition and stiffness in patients on a joint replacement waiting list , although the observed effects were of modest size ( Cohen 's d between 0.36 and 0.42 ) . There was no significant effect on pain , function or quality of life in the short term . Self-management programs can assist in maintaining health behaviours ( particularly walking ) in this patient group . Further research is needed to assess their impact on quality of life and over longer periods Background This study examined the impact of a home-based self-management intervention for housebound older adults with arthritis on the adoption of health behaviors . The moderating role of socio-demographic , psychological , and physical characteristics in the process of behavior change was also investigated . Methods Participants were 113 older adult women ( n = 102 ) and men ( n = 11 ) with osteoarthritis ( OA ) or rheumatoid arthritis ( RA ) who were r and omly assigned to experimental ( n = 68 ) or wait list control ( n = 45 ) groups . Participants were interviewed using st and ardized question naires at baseline , pre-intervention , and post-intervention . Results Adjusted multilevel modeling analyses indicated that from pre to post intervention , experimental participants significantly increased their weekly frequency of exercise and relaxation activities . Socioeconomic status and depression played a moderating role in this change for exercise with larger effects occurring among more privileged , non-depressed participants . Conclusion We conclude that a self-management intervention can successfully improve involvement in exercise and relaxation among housebound older adults with arthritis Osteoarthritis ( OA ) is a common and often disabling condition that predominately affects older adults . It is the commonest cause of locomotor disability and forms a major element of the workload in primary care . Previous studies suggest that there are both deficits in the knowledge patients have about their disease and extensive ' unmet ' information needs . This paper explores the patients ' perspective on the meaning and significance of living with arthritis , identified through quantitative and qualitative approaches undertaken during a trial that evaluated the effectiveness of a primary care-based patient education programme . This paper draws on qualitative and quantitative data from : the baseline interview ( knowledge of arthritis , satisfaction with services and support received in primary care ) ; patient diaries ( individual goals and reflections on treatment ) ; and group teaching sessions ( themes describing the patient 's experience ) . The different data sources were interrogated for common and divergent themes . One hundred and ninety-four participants were identified and 170 completed baseline interviews . Participants were predominantly female ( 73 % ) , with a mean age of 63 and arthritis of long-st and ing ; 55 % reported that they had had it for 5 years or more .  Use of primary care services was high , with 41 % consulting their GP in the 2 weeks before interview . Levels of information were low , with less than 25 % receiving support/advice about the disease , pain management or its impact upon daily life . Set against negative perceptions of the quality of services , patients ' personal priorities were for improved pain management and enhanced mobility/functional ability . The combined quantitative and qualitative data provide insight into the patients ' perspective on the causes and impact of knee OA , individual goals desired from treatment and the quality of care . There is consistent evidence of unmet needs for information and support and the priority placed by patients on finding strategies to cope with OA and maintaining independence . Even within a tightly defined study sample participating in the intervention , a diversity of experience and goals were revealed , which highlights the importance of taking account of context ual factors and individual differences when evaluating complex interventions Background Non-pharmacological treatment ( NPT ) is a useful treatment option in the management of hip or knee osteoarthritis . To our knowledge however , no studies have investigated the effect of NPT in patients with generalized osteoarthritis ( GOA ) . The primary aim of this study is to compare the effectiveness of two currently existing health care programs with different intensity and mode of delivery on daily functioning in patients with GOA . The secondary objective is to compare the cost-effectiveness of both interventions . Methods / Design In this r and omized , single blind , clinical trial with active controls , we aim to include 170 patients with GOA . The experimental intervention consist of six self-management group sessions provided by a multi-disciplinary team ( occupational therapist , physiotherapist , dietician and specialized nurse ) . The active control group consists of two group sessions and four sessions by telephone , provided by a specialized nurse and physiotherapist . Both therapies last six weeks . Main study outcome is daily functioning during the first year after the treatment , assessed on the Health Assessment Question naire . Secondary outcomes are health related quality of life , specific complaints , fatigue , and costs . Illness cognitions , global perceived effect and self-efficacy , will also be assessed for a responder analysis . Outcome assessment s are performed directly after the intervention , after 26 weeks and after 52 weeks . Discussion This article describes the design of a r and omized , single blind , clinical trial with a one year follow up to compare the costs and effectiveness of two non-pharmacological interventions with different modes of delivery for patients with GOA.Trial registration Dutch Trial Register Background Osteoarthritis ( OA ) is a degenerative disease , considered to be one of the major public health problems . Research suggests that patient education is feasible and valuable for achieving improvements in quality of life , in function , well-being and improved coping . Since 1994 , Primary Health Care in Malmö has used a patient education programme directed towards OA . The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy , function and self-perceived health . Method The study was a single-blind , r and omized controlled trial ( RCT ) in which the  EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity . Results We found differences between the intervention group and the control group , comparing the results at baseline and after 6 months in EuroQol-5D ( p < 0.001 ) and in st and ing one leg eyes closed ( p = 0.02 ) in favour of the intervention group . No other differences between the groups were found . Conclusion This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree , but not self-efficacy . Further research to investigate the effect of exercise performance on function , as well as self-efficacy is warranted . Trial registration The trial is registered with Clinical Trials.gov . Registration number : OBJECTIVE To examine effects of activity strategy training ( AST ) , a structured rehabilitation program taught by occupational therapists and design ed to teach adaptive strategies for symptom control and engagement in physical activity ( PA ) . METHODS A r and omized controlled pilot trial was conducted at 4 sites ( 3 senior housing facilities and 1 senior center ) in southeastern , lower Michigan . Fifty-four older adults with hip or knee osteoarthritis ( mean + /- SD age 75.3+/-7.1 years ) participated . At each site , older adults were r and omly assigned to 1 of 2 programs : exercise plus AST ( Ex + AST ) or exercise plus health education ( Ex + Ed ) . The programs involved 8 sessions over 4 weeks with 2 followup sessions over a 6-month period , and were conducted concurrently within each site . Pain , total PA and PA intensity ( measured objective ly by actigraphy and subjectively by the Community Healthy Activities Model Program for Seniors question naire ) , arthritis self-efficacy , and physical function were assessed at baseline and posttest . RESULTS At posttest , participants who received Ex + AST had significantly higher levels of objective peak PA ( P=0.02 ) compared with participants who received Ex + Ed . Although not statistically significant , participants in Ex + AST tended to have larger pain decreases , increased total objective and subjective PA , and increased physical function . No effects were found for arthritis self-efficacy . CONCLUSION Although participants were involved in identical exercise programs , participants who received AST tended to have larger increases in PA at posttest compared with participants who received health education . Future studies will be needed to examine larger sample s and long-term effects of AST OBJECTIVE Studies have suggested that the Arthritis Self-Management Program ( ASMP ) course is effective at reducing arthritis pain and health care costs  in volunteer participants . There have been no reports of trials of the ASMP in the context of primary care physicians ' practice s , where the potential for spreading the program may be greatest . We conducted a r and omized controlled trial of the ASMP course in a large primary care physician network . METHODS Patients with osteoarthritis , rheumatoid arthritis , or fibromyalgia were recruited for the study . Subjects in the intervention practice s received the 6 week course and those in the control practice s received only the ASMP book , without course .  Disability , pain , self-efficacy , mental health , and satisfaction were measured using vali date d instruments at baseline and at 4 months . RESULTS One hundred thirteen patients were recruited for the ASMP course  ( intervention ) and completed baseline and 4 month followup question naires . Eighty-four percent completed at least 4 of 6 classes . Seventy-four patients received the ASMP manual ( controls ) and completed both question naires . Patients in the intervention and control groups had similar baseline pain ( p = 0.94 ) , self-efficacy to control pain ( p = 0.90 ) , mental health ( p = 0.10 ) , and vitality scores ( p = 0.21 ) , but those in the intervention arm had slightly less disability ( p = 0.04 ) . At 4 months , there was no significant improvement from baseline in any endpoint and no difference between patients in the intervention and control groups ( all p > 0.2 ) . Patient satisfaction with arthritis care and outcomes was no different for intervention and control patients ( all p > 0.3 ) . All types of health care re source use were similar at baseline and followup for both intervention and control groups ( all p > 0.2 ) . CONCLUSION While the ASMP course has been found to be effective in other patient groups , there were no significant clinical benefits noted at 4 months in patients recruited from primary care practice 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 OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects .  Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis .  Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization OBJECTIVE We examined whether tailored activity pacing intervention was more effective at reducing pain and fatigue than general activity pacing intervention . METHOD Adults with knee or hip osteoarthritis ( N = 32 ) stratified by age and gender were r and omized to receive either tailored or general pacing intervention . Participants wore an accelerometer for 5 days that measured physical activity and allowed for repeated symptom assessment . Physical activity and symptom data were used to tailor activity pacing instruction . Outcomes at 10-week follow-up were pain ( Western Ontario and McMaster Universities Osteoarthritis Index ) and fatigue ( Brief Fatigue Inventory ) . RESULTS Compared with general intervention , the tailored group had less fatigue interference ( p = .02 ) and trended toward decreased fatigue severity ( p = .09 ) at 10-wk follow-up . No group differences were found in pain reduction . CONCLUSION Tailoring instruction on the basis of recent symptoms and physical activity may be a more effective symptom management approach than general instruction given the positive effects on fatigue OBJECTIVE To evaluate the effects of isokinetic exercise versus a program of patient education on pain and function in older persons with knee osteoarthritis . DESIGN A r and omized , comparative clinical trial , with interventions lasting 8 weeks and evaluations of 12 weeks . SETTING An outpatient Veterans Affairs Medical Center clinic and an affiliated university hospital . PATIENTS One hundred thirteen men and women between 50 and 80 years old with diagnosed osteoarthritis of the knee ; 98 completed the entire assigned treatment . INTERVENTION Patients received either a regimen of isokinetic exercise of the quadriceps muscle three times weekly over 8 weeks or a series of 4 discussion s and lectures led by health care professionals . MAIN OUTCOME MEASURES Variables studied for change were isokinetic and isometric quadriceps strength , pain and function determined by categorical and visual analog scales , and overall status using physician and patient global evaluations by the Arthritis Impact Scale , version 2 , Western Ontario McMaster 's Arthritis Index , and Medical Outcome Study Short Form 36 . RESULTS Both treatment groups showed significant strength gains ( p < .05 ) , which occurred over a wider velocity spectrum for the exercise group . Exercised patients also had improved pain scores for more of the variables measured than those receiving education . Both groups had positive functional outcomes and slightly improved measures of overall status . CONCLUSIONS Isokinetic exercise is an effective and well-tolerated treatment for knee osteoarthritis , but a much less costly education program also showed some benefits PURPOSE This study assessed the impact of a low cost , multicomponent physical activity intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of a facility-based multiple-component training program followed by home-based adherence  ( n = 80 ) to a  wait list control group ( n = 70 ) . Assessment s were conducted at baseline and at 2 and 6 months following r and omization . The training program consisted of range of motion , resistance training , aerobic walking , and education-group problem solving regarding self-efficacy for exercise and exercise adherence . All training group participants developed individualized plans for posttraining adherence . RESULTS Relative to the persons in the control group , individuals who participated in the exercise program experienced a statistically significant improvement in exercise efficacy , a 48.5 % increase in exercise adherence , and a 13.3 % increase in 6-min distance walk that were accompanied by significant decreases in lower extremity stiffness at 2 and 6 months . Program participants also experienced a significant decrease in lower extremity pain and a borderline significant improvement in efficacy to adhere to exercise over time at 6 months ( p = .052 ) . In contrast , persons in the control group deteriorated over time on the efficacy and adherence measures and showed no change on the other measures . No adverse health effects were encountered . IMPLICATION S These benefits indicate that this low-cost intervention may hold great promise as one of a growing number of public health intervention strategies for older adults in the United States with osteoarthritis Context Previous studies of acupuncture for osteoarthritis have had conflicting results . This may have occurred because most studies have included small sample s , a limited number of treatment sessions , or other limitations . Contribution This r and omized , controlled trial compared 24 acupuncture sessions over 26 weeks with sham acupuncture or arthritis education in 570 patients with osteoarthritis of the knee .  Acupuncture led to greater improvements in function but not pain after 8 weeks and in both pain and function after 26 weeks . No adverse effects were associated with acupuncture . Caution s Many participants dropped out of the study , so readers should interpret the findings at 26 weeks with caution . The Editors Osteoarthritis is the most common form of arthritis and is a major cause of morbidity , limitation of activity , and health care utilization , especially in elderly patients ( 1 , 2 ) . Pain and functional limitation are the primary clinical manifestations of osteoarthritis of the knee . Current recommendations for managing osteoarthritis , including guidelines published by the American College of Rheumatology ( 3 ) and European League of Associations of Rheumatology ( 4 ) , focus on relieving pain and stiffness and maintaining or improving physical function as important goals of therapy . No curative therapies exist for osteoarthritis ; thus , both pharmacologic and nonpharmacologic management focus on controlling pain and reducing functional limitation ( 5 ) . Nonpharmacologic therapy , which includes patient education , social support , physical and occupational therapy , aerobic and resistive exercises , and weight loss , is the cornerstone of a multidisciplinary approach to osteoarthritis patient management ( 3 ) . Pharmacologic therapies include nonopioid analgesics ( such as acetaminophen ) , nonsteroidal anti-inflammatory drugs ( NSAIDs ) ( including cyclooxygenase-2 [ COX-2 ] enzyme selective inhibitors ) , topical analgesics ( capsaicin cream ) , opioid analgesics , and intra-articular steroid and hyaluronate injections . Often , these agents are used in combination for additive analgesic efficacy ( 6 ) . Pharmacologic management of osteoarthritis is often ineffective , and agents such as NSAIDs may cause unwanted and dangerous side effects ( 7 , 8) . Complementary and alternative medicine is another approach to treating osteoarthritis ( 9 - 12 ) , particularly in Asian societies ( 13 ) . Many U.S. patients with osteoarthritis also use complementary and alternative medical therapies ( 14 ) . A systematic review of acupuncture and knee osteoarthritis ( 15 ) identified 7 small r and omized , controlled trials published in English . Within the method ologic limitations of the studies , the evidence suggested that acupuncture seemed to alleviate knee pain and function compared with sham acupuncture controls , although 2 trials comparing acupuncture with an active , nonpharmacologic treatment ( physical therapy ) did not indicate such an effect ( 16 , 17 ) . Before conducting our large-scale trial , we completed both a pilot study ( 18 ) and a r and omized , single-blind trial ( 19 ) of the effect of acupuncture on osteoarthritis of the knee . Participants in the uncontrolled pilot study ( n= 12 ) showed statistically significant improvement in both self-reported pain and physical function , as well as performance measures of physical function after 8 weeks of acupuncture treatment and at 12-week follow-up as compared with their baseline ( 18 ) . In our larger r and omized , single-blind trial ( n= 73 ) , which examined the benefit of acupuncture added to st and ard management with NSAIDs , the acupuncture  treatment group experienced statistically significant improvements in self-reported pain and disability scores compared with a st and ard-care control group as late as 4 weeks after the end of treatment ( 19 ) . However , this effect diminished within 18 weeks ( 26 weeks after the beginning of the trial ) after the final acupuncture treatment . Together , however , the previously conducted trials ( both our preliminary studies [ 18 , 19 ] and those referenced in the systematic review [ 15 ] ) have 3 method ologic limitations : lack of credible controls for the placebo effect , inadequate assessment of long-term treatment benefits , and insufficient sample sizes . We tested the hypothesis that an 8-week intensive acupuncture treatment regimen , followed by an 18-week tapering regimen , reduces pain and improves function among patients with knee osteoarthritis as compared with both sham acupuncture and education control groups . Methods Patient Recruitment We recruited patients for this multisite , placebo-controlled trial from March 2000 through December 2003 , primarily through print and radio advertisements . The 3 sites were the Integrative Medicine Clinic of the University of Maryl and School of Medicine , Baltimore , Maryl and ; the Innovative Medical Research Center ( a private research firm ) , Towson , Maryl and ; and the Hospital for Special Surgery , New York City , New York . The institutional review boards of the 3 sites approved the study . We determined the sample size ( n= 570 ) by a power analysis based on our r and omized pilot study ( 19 ) , adjusted by the estimated decrease in effect size result ing from the inclusion of a sham acupuncture group design ed to control for placebo effects . Patients met the following inclusion criteria : age 50 years or older , a diagnosis of osteoarthritis of the knee , radiographic evidence of at least 1 osteophyte at the tibiofemoral joint ( KellgrenLawrence grade 2 ) , moderate or greater clinical ly significant knee pain on most days during the past month , and willingness to be r and omly assigned . Exclusion criteria were the presence of serious medical conditions that precluded participation in study , bleeding disorders that might contraindicate acupuncture , intra-articular corticosteroid or hyaluronate injections ( as well as any knee surgeries or concomitant use of topical capsaicin cream ) during the past 6 months , previous experience with acupuncture , or any planned events ( including total knee replacement ) that would interfere with participation in the study during the following 26 weeks . After a brief telephone screening , patients were scheduled to visit 1 of the 3 participating sites to sign an informed consent statement and undergo a brief rheumatologic examination ( including radiographic examination of affected knees ) by a physician or a nurse practitioner . Because the education course was a group activity , patients were recruited until a cohort of 12 to 21 patients was formed , at which point each cohort at each site was r and omly assigned to 1 of 3 groups by a computer-generated process using r and omly selected blocks of 3 , 6 , and 9 . We assured allocation concealment by using disguised letter codes that were generated and sent to the site coordinators by a central statistical core . We used this procedure to ensure that approximately equal numbers of participants were in each treatment group across the course of the study , to ensure that each cohort would have participants assigned to all 3 treatment groups , and to make the breaking of the group assignment process more difficult . The research assistants who collected assessment s from participants , the participants themselves ( in the true acupuncture and sham acupuncture groups ) , and the statistician were blinded to group assignment . Assessment s were conducted at baseline and 4 , 8 , 14 , and 26 weeks after r and omization . Study Interventions We developed and modified the acupuncture treatment and sham control protocol s from previously reported and vali date d procedures ( 18 - 21 ) . During the trial , 7 acupuncturists were used : 3 at the Integrative Medicine Clinic , 3 at the Innovative Medical Research Center , and 1 at the Hospital for Special Surgery . In general , acupuncturists were assigned to the same participants throughout the 26-week treatment schedule , except for vacation conflicts and staff turnover , and provided approximately the same proportions of true versus sham procedures . All acupuncturists were state-licensed and had at least 2 years of clinical experience . The study 's principal acupuncturist trained and supervised the acupuncturists in performing true or sham procedures and avoiding interactions that could inadvertently communicate group assignment . True Acupuncture The true acupuncture  ( experimental ) group underwent 26 weeks of gradually tapering treatment according to the following schedule : 8 weeks of 2 treatments per week followed by 2 weeks of 1 treatment per week , 4 weeks of 1 treatment every other week , and 12 weeks of 1 treatment per month . We based the acupuncture point selection s on Traditional Chinese Medicine meridian theory to treat knee joint pain , known as the Bi syndrome . These points consisted of 5 local points ( Yanglinquan [ gall bladder meridian point 34 ] , Yinlinquan [ spleen meridian point 9 ] , Zhusanli [ stomach meridian point 36 ] , Dubi [ stomach meridian point 35 ] , and extra point Xiyan ) and 4 distal points ( Kunlun [ urinarybladder , meridian point 60 ] , Xuanzhong [ gall bladder meridian point 39 ] , Sanyinjiao [ spleen meridian point 6 ] , and Taixi [ kidney meridian point 3 ] ) on meridians that traverse the area of pain ( 22 , 23 ) . The same points were treated for each affected leg . If both knees were affected , 9 needles were inserted in each leg . ( The outcome measures were not specifically targeted to whether the patient had osteoarthritis in 1 or both knees , and we observed no differential effects on the basis of the number of knees treated . ) The acupuncturists inserted 1.5-inch ( for local points ) and 1-inch ( for distal points ) 32-gauge ( 0.25-mm diameter ) acupuncture needles to a conventional depth of approximately 0.3 to 1.0 inch , depending on point location . All participants in the treatment group achieved the De-Qi sensation , a local sensation of heaviness , numbness , soreness , or paresthesia that accompanies the insertion and manipulation of needles during acupuncture , at these 9 points . Acupuncturists applied electrical The purpose of this study was to assess the relative effects of coping self-efficacy and  catastrophizing  on physical functioning . Over a 9-month period , study ing changes in self-efficacy as possible mediator between catastrophizing changes and physical functioning changes might provide evidence for the most promising treatment target . Data came from a r and omized , longitudinal controlled trial comparing exercise , self-management and the two combined to treat 254 individuals with early knee osteoarthritis . A secondary analysis using a bootstrapped linear mixed-effects mediational model produced estimates of both the direct and indirect effects . Results indicated that self-efficacy partially mediated the effect between catastrophizing and physical functioning suggesting that self-efficacy was the more direct treatment target compared to catastrophizing . Treatments targeting both  self-efficacy and catastrophizing  may have greater impact on physical functioning compared to treatments that focus on only one OBJECTIVE The effects of treatment counseling or symptom monitoring telephone intervention strategies on the health outcomes of patients with rheumatoid arthritis ( RA ) or osteoarthritis ( OA ) , compared with usual care , were assessed . METHODS A 3-group , r and omized , controlled 9-month trial was conducted incorporating 405 patients with RA or OA and using the Arthritis Impact Measurement Scales ( AIMS 2 ) as the outcome measure . RESULTS Analyses of covariance showed that the AIMS 2 total health status of the treatment counseling group ( effect size = 33 , P < 0.01 ) , but not the symptom monitoring group ( effect size = 0.21 , P = 0.10 ) , was significantly improved , compared with usual care , for both RA and OA patients . The specific types of benefits differed significantly between RA and OA patients . The mean number of medical visits by OA patients in the treatment counseling group was also significantly reduced ( P < 0.01 ) . CONCLUSION Telephone contact using the treatment counseling strategy produced significant , but different , health status benefits for RA and OA patients . The symptom monitoring strategy produced modest benefits Objective To assess the cost effectiveness of a self management programme plus education booklet for arthritis in primary care . Design Cost effectiveness and cost utility analysis from health and social care and societal perspectives alongside a r and omised controlled trial . Setting 74 general practice s in the United Kingdom . Participants 812 patients aged 50 or more with osteoarthritis of the hips or knees , or both , and pain or disability , or both . Interventions R and omisation to either six sessions of an arthritis self management programme plus an education booklet ( intervention group ) or the education booklet alone ( st and ard care control group ) . Main outcome measures Total health and social care costs and total societal costs at 12 months ; cost effectiveness ( incremental cost effectiveness ratios and cost effectiveness acceptability curves ) on basis of quality of life ( SF-36 , primary outcome measure ) , EuroQol visual analogue scale , and quality adjusted life years ( QALYs ) . Results At 12 months health and social care costs in the intervention group were £ 101 higher ( 95 % confidence interval £ 3 to £ 176 ) than those in the control group because the additional costs of the arthritis self management programme did not seem to be fully offset by savings elsewhere . There were no significant differences in societal costs ( which were up to 13 times the size of health and social care costs ) or any of the outcomes . From the health and social care perspective the intervention was dominated by the control on the basis of QALYs ( which were non-significantly lower in the intervention group ) and had incremental cost effectiveness ratios between £ 279 and £ 13 473 for the other outcomes . From the societal perspective the intervention seemed superior to the control owing to non-significantly lower costs and non-significantly better outcomes on all measures except QALYs . Probabilities of the arthritis self management programme ’s cost effectiveness ranged between 12 % and 97 % ( for thresholds ranging £ 0 to £ 1000 ) based on one point improvements in SF-36 outcomes , but the clinical significance of this is debatable . Probabilities of cost effectiveness on the basis of the visual analogue scale and QALYs were low . Conclusions Cost effectiveness of an arthritis self management programme is not suggested on the basis of current National Institute for Health and Clinical Excellence cost perspectives and QALY thresholds . The probability of cost effectiveness is greater when broader costs and other quality of life outcomes are considered . These results suggest that the cost effectiveness of the Department of Health ’s expert patients programme can not be assumed across all clinical conditions and that further rigorous evaluations for other conditions may be needed . Trial registration Current Controlled Trials IS RCT N79115352 We conducted a pilot study of a nurse-run telephone self-management programme for elderly people with osteoarthritis ( OA ) . Thirty-two subjects , aged 60 years or more , with a diagnosis of OA were recruited from two hospital rheumatology clinics and were r and omized to a control or intervention group . The intervention group received six weekly mailings of OA health education modules , a relaxation audio-tape and six weekly 45 min follow-up telephone self-management sessions . There was a 100 % compliance rate in the intervention group , and all subjects completed baseline and three-month interviews ; one subject in each group was lost to six-month follow-up . There were no significant differences in self-management between the control and intervention groups . However , at three months there were improvements in the intervention group ( relative to baseline ) on some outcome measures . The results suggest that the telephone may be a useful tool for reinforcing health-promoting activities for patients Background and Purpose — The benefits of chronic disease self-management programs for stroke survivors are uncertain because individuals with severe impairments have been excluded from previous research . We undertook a phase II r and omized controlled trial to determine whether a self-management program design ed for survivors ( SSMP ; 8 weeks ) was safe and feasible compared to st and ard care ( control ) or a generic self-management program ( generic ; 6 weeks ) . Methods — Stroke survivors were recruited from 7 South Australian hospitals via a letter or indirectly ( eg , newspapers ) . Eligible participants were r and omized at a 1:1:1 ratio of 50 per group . Primary outcomes were recruitment , participation , and participant safety . Secondary outcomes were positive and active engagement in life using the Health Education Impact Question naire and characteristics of quality of life and mood at 6 months from program completion . Results — Of 315 people screened , 149 were eligible and 143 were r and omized ( 48 SSMP , 47 generic , 48 control ) ; mean age was 69 years ( SD , 11 ) and 59 % were female . Demographic features were similar between groups and 41 % had severe cognitive impairment ; 57 % accessed the interventions , with 52 % SSMP and 38 % generic completing > 50 % of sessions ( P=0.18 ) . Thirty-two participants reported adverse events ( 7 control , 12 generic , 13 SSMP ; P=0.3 ; 34 % severe ) ; however , none was attributable to the interventions . Potential benefits for improved mood were found . Conclusions — SSMP was safe and feasible . Benefits of the stroke-specific program over the generic program included greater participation and completion rates . An efficacy trial is warranted given the forecast growth in the stroke population and improved survival trends Background Osteoarthritis ( OA ) of the hip and knee are among the most common chronic conditions , result ing in substantial pain and functional limitations . Adequate management of OA requires a combination of medical and behavioral strategies . However , some recommended therapies are under-utilized in clinical setting s , and the majority of patients with hip and knee OA are overweight and physically inactive . Consequently , interventions at the provider-level and patient-level both have potential for improving outcomes . This manuscript describes two ongoing r and omized clinical trials being conducted in two different health care systems , examining patient-based and provider-based interventions for managing hip and knee OA in primary care . Methods / Design One study is being conducted within the Department of Veterans Affairs ( VA ) health care system and will compare a Combined Patient and Provider intervention relative to usual care  among n = 300 patients ( 10 from each of 30 primary care providers ) . Another study is being conducted within the Duke Primary Care Research Consortium and will compare Patient Only , Provider Only , and Combined ( Patient + Provider ) interventions relative to usual care  among n = 560 patients across 10 clinics . Participants in these studies have clinical and / or radiographic evidence of hip or knee osteoarthritis , are overweight , and do not meet current physical activity guidelines . The 12-month , telephone-based patient intervention focuses on physical activity , weight management , and cognitive behavioral pain management . The provider intervention involves provision of patient-specific recommendations for care ( e.g. , referral to physical therapy , knee brace , joint injection ) , based on evidence -based guidelines . Outcomes are collected at baseline , 6-months , and 12-months . The primary outcome is the Western Ontario and McMasters Universities Osteoarthritis Index ( self-reported pain , stiffness , and function ) , and secondary outcomes are the Short Physical Performance Test Protocol ( objective physical function ) and the Patient Health Question naire-8 ( depressive symptoms ) . Cost effectiveness of the interventions will also be assessed . Discussion Results of these two studies will further our underst and ing of the most effective strategies for improving hip and knee OA outcomes in primary care setting s . Trial registration NCT01130740 ( VA ) ; NCT 01435109 ( NIH Introduction Our aim in the present study was to determine whether a disease-specific self-management program for primary care patients with osteoarthritis ( OA ) of the knee ( the Osteoarthritis of the Knee Self-Management Program ( OAK ) ) implemented by health care professionals would achieve and maintain clinical ly meaningful improvements in health-related outcomes compared with a control group . Methods Medical practitioners referred 146 primary care patients with OA of the knee . Volunteers with coexistent inflammatory joint disease or serious comorbidities were excluded . R and omisation was to either a control group or the OAK group . The OAK group completed a 6-week self-management program . The control group had a 6-month waiting period before entering the OAK program . Assessment s were taken at baseline , 8 weeks and 6 months . The primary outcomes were the results measured using the Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) Pain and Function subscales on the Short Form 36 version 1 question naire ( SF-36 ) Secondary outcomes were Visual Analogue Scale ( VAS ) pain , Timed Up & Go Test ( TUG ) , knee range of motion and quadriceps and hamstring strength-isometric contraction . Responses to treatment ( responders ) and minimal clinical ly important improvements ( MCIIs ) were determined . Results In the OAK group , VAS pain improved from baseline to week 8 from mean ( SEM ) 5.21 ( 0.30 ) to 3.65 ( 0.29 ) ( P ≤ 0.001 ) . During this period , improvements in the OAK group compared with the control group and responses to treatment were demonstrated according to the following outcomes : WOMAC Pain , Physical Function and Total dimensions , as well as SF-36 Physical Function , Role Physical , Body Pain , Vitality and Social Functioning domains . In addition , from baseline to week 8 , the proportion of MCIIs was greater among the OAK group than the control group for all outcomes . For the period between baseline and month 6 , WOMAC Pain , Physical Function and Total dimensions significantly improved in the OAK group compared to the control group , as did the SF-36 Physical Function , Role Physical , Body Pain , Vitality and Social Functioning domains , as well as hamstring strength in both legs . During the same period , the TUG Test , range of motion extension and left-knee flexion improved compared with the control group , although these improvements had little clinical relevance . Conclusions We recorded statistically significant improvements compared with a control group with regard to pain , quality of life and function for participants in the OAK program on the basis of WOMAC and SF-36 measures taken 8 weeks and 6 months from baseline 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 : The objective of this study was to determine whether the Arthritis Self-Management Programme ( ASMP ) improves perceptions of control , health behaviours and health status , and changes use of health care re sources . The design was a pragmatic r and omized controlled study ; participants were allocated to ASMP ( Intervention Group ) or a 4-month waiting-list Control Group . The Intervention Group completed a 12-month follow-up . In total , 544 people with arthritis were recruited from the community--311 in the Intervention Group and 233 in the Control Group . Main outcome measures included : arthritis self-efficacy , health behaviours ( exercise , cognitive symptom management , diet and relaxation ) and health status ( pain , fatigue , anxiety , depression and positive affect ) . At 4 months follow-up , the ASMP had a significant effect on arthritis self-efficacy for other symptoms and pain subscales . Performance of a range of health behaviours ( cognitive symptom management , communication with physicians , dietary habit , exercise and relaxation ) was significantly greater among the Intervention Group . The Intervention Group were significantly less depressed and had greater positive mood . In addition , trends towards decreases on fatigue and anxiety were noted . Physical functioning , pain and GP visits remained stable at 4 months . A similar pattern of findings was found at 12 months follow-up for the Intervention Group . Furthermore , a significant improvement was found on pain and visits to GPs had decreased . Apart from a small improvement on physical functioning among the Intervention Group participants with osteoarthritis 12 months , all effects were independent of the type of arthritis . The findings suggest that the ASMP is effective in promoting improvements in perception of control , health behaviours and health status , when delivered in UK setting Objective Chronic knee pain is a major cause of disability and health care expenditure , but there are concerns about efficacy , cost , and side effects associated with usual primary care . Conservative rehabilitation may offer a safe , effective , affordable alternative . We compared the effectiveness of a rehabilitation program integrating exercise , self-management , and active coping strategies ( Enabling Self-management and Coping with Arthritic Knee Pain through Exercise [ ESCAPE-knee pain ] ) with usual primary care in improving functioning in persons with chronic knee pain . Methods We conducted a single-blind , pragmatic , cluster r and omized controlled trial . Participants age ≥50 years , reporting knee pain for > 6 months , were recruited from 54 inner-city primary care practice s. Primary care practice s were r and omized to continued usual primary care ( i.e. , whatever intervention a participant 's primary care physician deemed appropriate ) , usual primary care plus the rehabilitation program delivered to individual participants , or usual primary care plus the rehabilitation program delivered to groups of 8 participants . The primary outcome was self-reported functioning ( Western Ontario and McMaster Universities Osteoarthritis Index physical functioning [ WOMAC-func ] ) 6 months after completing rehabilitation . Results A total of 418 participants were recruited ; 76 ( 18 % ) withdrew , only 5 ( 1 % ) due to adverse events . Rehabilitated participants had better functioning than participants continuing usual primary care ( −3.33 difference in WOMAC-func score ; 95 % confidence interval [ 95 % CI ] −5.88 , −0.78 ; P = 0.01 ) . Improvements were similar whether participants received individual rehabilitation ( −3.53 ; 95 % CI −6.52 , −0.55 ) or group rehabilitation ( −3.16 ; 95 % CI −6.55 , −0.12 ) . Conclusion ESCAPE-knee pain provides a safe , relatively brief intervention for chronic knee pain that is equally effective whether delivered to individuals or groups of participants Background Knee osteoarthritis ( OA ) is a prevalent chronic musculoskeletal condition with no cure . Pain is the primary symptom and results from a complex interaction between structural changes , physical impairments and psychological factors . Much evidence supports the use of strengthening exercises to improve pain and physical function in this patient population . There is also a growing body of research examining the effects of psychologist-delivered pain coping skills training ( PCST ) particularly in other chronic pain conditions . Though typically provided separately , there are symptom , re source and personnel advantages of exercise and PCST being delivered together by a single healthcare professional . Physiotherapists are a logical choice to be trained to deliver a PCST intervention as they already have expertise in administering exercise for knee OA and are cognisant of the need for a biopsychosocial approach to management . No studies to date have examined the effects of an integrated exercise and PCST program delivered solely by physiotherapists in this population . The primary aim of this multisite r and omised controlled trial is to investigate whether an integrated 12-week PCST and exercise treatment program delivered by physiotherapists is more efficacious than either program alone in treating pain and physical function in individuals with knee OA . Methods / design This will be an assessor-blinded , 3-arm r and omised controlled trial of a 12-week intervention involving 10 physiotherapy visits together with home practice . Participants with symptomatic and radiographic knee OA will be recruited from the community in two cities in Australia and r and omized into one of three groups : exercise alone , PCST alone , or integrated PCST and exercise .  R and omisation will be stratified by city ( Melbourne or Brisbane ) and gender . Primary outcomes are overall average pain in the past week measured by a Visual Analogue Scale and physical function measured by the Western Ontario and McMaster Universities Osteoarthritis Index subscale . Secondary outcomes include global rating of change , muscle strength , functional performance , physical activity levels , health related quality of life and psychological factors . Measurements will be taken at baseline and immediately following the intervention ( 12 weeks ) as well as at 32 weeks and 52 weeks to examine maintenance of any intervention effects . Specific assessment of adherence to the treatment program will also be made at weeks 22 and 42 . Relative cost-effectiveness will be determined from health service usage and outcome data . Discussion The findings from this r and omised controlled trial will provide evidence for the efficacy of an integrated PCST and exercise program delivered by physiotherapists in the management of painful and functionally limiting knee OA compared to either program alone . Trial registration Australian New Zeal and Clinical Trials Registry reference number : Summary Osteoporosis is an increasing burden on individuals and health re sources . The Osteoporosis Prevention and Self-Management Course ( OPSMC ) was design ed to assist individuals to prevent and manage osteoporosis ; however , it had not been evaluated in an Australian setting . This r and omised controlled trial showed that the course increased osteoporosis knowledge . Introduction and hypothesisOsteoporosis is a major and growing public health concern . An OPSMC was design ed to provide individuals with information and skills to prevent or manage osteoporosis , but its effectiveness has not previously been evaluated . This study aim ed to determine whether OPSMC attendance improved osteoporosis knowledge , self-efficacy , self-management skills or behaviour . Material s and methods Using a wait list r and omised controlled trial design , 198 people ( 92 % female ) recruited from the community and aged over 40 ( mean age = 63 ) were r and omised into control ( n = 95 ) and intervention ( n = 103 ) groups . The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators . The primary outcome were osteoporosis knowledge , health-directed behaviour , self-monitoring and insight and self-efficacy . Results The groups were comparable at baseline . At 6-week follow-up , the intervention group showed a significant increase in osteoporosis knowledge compared with the control group ; mean change 3.5 ( p < 0.001 ) on a measure of 0–20 . The intervention group also demonstrated a larger increase in health-directed behaviour , mean change 0.16 ( p < 0.05 ) , on a measure of 0–6 . Conclusion The results indicate that the OPSMC is an effective intervention for improving underst and ing of osteoporosis and some aspects of behaviour in the short term Behavioral and health status outcomes of an unreinforced , self-help education program for arthritis patients taught by lay persons were examined in 2 ways : a 4-month r and omized experiment and a 20-month longitudinal study . At 4 months , experimental subjects significantly exceeded control subjects in knowledge , recommended behaviors , and in lessened pain . These changes remained significant at 20 months . The course was inexpensive and well-accepted by patients , physicians , and other health professionals This study evaluated a novel intervention for older osteoarthritis ( OA ) patients and their spousal caregivers that consisted of st and ard patient education supplemented by information related to effectively managing arthritis as a couple . Twenty-four female OA patients and their husb and s were r and omly assigned to either an educational intervention that was targeted at both patient and spouse or to a patient education intervention that was targeted at only the patient . Findings revealed that both interventions were evaluated favorably but the couple intervention was better attended than the patient intervention . In addition , patients in the couple intervention experienced greater increased efficacy in managing arthritis pain and other symptoms . The findings of this pilot study point to the utility of a dyadic intervention approach to management of OA in late life Six weekly sessions of group cognitive-behavioral therapy for insomnia and osteoarthritis pain ( CBT-PI ) , and for osteoarthritis pain alone ( CBT-P ) were compared to an education only control ( EOC ) . Basic education about pain and sleep was comparable , so EOC controlled for information and group participation . Active interventions differed from EOC in training pain coping skills ( CBT-P and CBT-PI ) and sleep enhancement techniques ( CBT-PI ) . Persons with osteoarthritis age 60 or older were screened for osteoarthritis pain and insomnia severity via mailed survey . Primary outcomes were pain severity ( pain intensity and interference ratings from the Grade d Chronic Pain Scale ) and insomnia severity ( Insomnia Severity Index ) . Secondary outcomes were arthritis pain ( AIMS -2 symptom scale ) and sleep efficiency assessed by wrist actigraphy . Ancillary outcomes included : cognitive function , depression , and health care use . A clustered r and omized design provided adequate power to identify moderate effects on primary outcomes ( effect size>0.35 ) . Modified intent to treat analyses , including all participants who attended the first session , assessed effects across CBT-PI , CBT-P , and EOC groups . Treatment effects were assessed post-intervention ( 2 months ) and at 9 months , with durability of intervention effects evaluated at 18 months . The trial was executed in 6 primary clinics , r and omizing 367 participants , with 93.2 % of r and omized patients attending at least 4 group sessions .  Response rates for post-intervention and 9 month assessment s were 96.7 % and 92.9 % respectively . This hybrid efficacy-effectiveness trial design evaluates whether interventions yield specific benefits for clinical and behavioral outcomes relative to an education only control when implemented in a primary care setting 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 We examined the effectiveness of 2 models of arthritis self-care intervention , the home study model and the small group model . The effects of disease diagnosis and duration , self-care behavior , perceived helplessness , social support , treatment choice , and formal education level on outcomes among persons with arthritis who participated in these programs were evaluated . A pretest-posttest control group design was utilized in the initial experimental study ; comparison group design s were used in the longitudinal studies . Three hundred seventy-four subjects completed the interventions and 12 months of research followup . We found that the intervention models had a statistically significant positive impact on arthritis knowledge , self-care behavior , perceived helplessness , and pain . These findings did not vary when the effects of education level , disease diagnosis and duration , informal social support , and treatment choice were controlled . The small group intervention was more effective in bringing about initial improvements in pain and depression , whereas the home study intervention was more effective in maintaining improvements in perceived helplessness . Changes in perceived helplessness and self-care behavior appear to explain in part the observed improvement in pain OBJECTIVE To determine the effects of structured exercise programs on  self-reported disability in older adults with knee osteoarthritis . SETTING AND DESIGN A r and omized , single-blind clinical trial lasting 18 months conducted at 2 academic medical centers . PARTICIPANTS A total of 439 community-dwelling adults , aged 60 years or older , with radiographically evident knee osteoarthritis , pain , and self-reported physical disability .  INTERVENTIONS An aerobic exercise program , a resistance exercise program , and a health education program . MAIN OUTCOME MEASURES The primary outcome was self-reported disability score ( range , 1 - 5 ) . The secondary outcomes were knee pain score ( range , 1 - 6 ) , performance measures of physical function , x-ray score , aerobic capacity , and knee muscle strength . RESULTS A total of 365 ( 83 % ) participants completed the trial . Overall compliance with the exercise prescription was 68 % in the aerobic training group and 70 % in the resistance training group . Postr and omization , participants in the aerobic exercise group had a 10 % lower adjusted mean ( + /- SE ) score on the physical disability question naire ( 1.71 + /- 0.03 vs 1.90 + /- 0.04 units ; P<.001 ) , a 12 % lower score on the knee pain question naire ( 2.1 + /- 0.05 vs 2.4 + /- 0.05 units ; P=.001 ) , and performed better ( mean [ + /- SE ] ) on the 6-minute walk test ( 1507 + /- 16 vs 1349 + /- 16 ft ; P<.001 ) , mean ( + /-SE ) time to climb and descend stairs ( 12.7 + /- 0.4 vs 13.9 + /- 0.4 seconds ; P=.05 ) , time to lift and carry 10 pounds ( 9.1 + /- 0.2 vs 10.0 + /- 0.1 seconds ; P<.001 ) , and mean ( + /-SE ) time to get in and out of a car ( 8.7 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P<.001 ) than the health education group . The resistance exercise group had an 8 % lower score on the physical disability question naire ( 1.74 + /- 0.04 vs 1.90 + /- 0.03 units ; P=.003 ) , 8 % lower pain score ( 2.2 + /- 0.06 vs 2.4 + /- 0.05 units ; P=.02 ) , greater distance on the 6-minute walk ( 1406 + /- 17 vs 1349 + /- 16 ft ; P=.02 ) , faster times on the lifting and carrying task ( 9.3 + /- 0.1 vs 10.0 + /- 0.16 seconds ; P=.001 ) , and the car task ( 9.0 + /- 0.3 vs 10.6 + /- 0.3 seconds ; P=.003 ) than the health education group . There were no differences in x-ray scores between either exercise group and the health education group . CONCLUSIONS Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability , physical performance , and pain from participating in either an aerobic or a resistance exercise program . These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis OBJECTIVE To evaluate the effects of a spouse-assisted pain-coping skills training intervention on pain , psychological disability , physical disability , pain-coping , and pain behavior in patients with osteoarthritis ( OA ) of the knees . METHODS Eighty-eight OA patients with persistent knee pain were r and omly assigned to 1 of 3 conditions : 1 ) spouse-assisted pain-coping skills training , ( spouse-assisted CST ) , 2 ) a conventional CST intervention with no spouse involvement ( CST ) , or 3 ) an arthritis education-spousal support ( AE-SS ) control condition . All treatment was carried out in 10 weekly , 2-hour group sessions . RESULTS Data analysis revealed that at the completion of treatment , patients in the spouse-assisted CST condition had significantly lower levels of pain , psychological disability , and pain behavior , and higher scores on measures of coping attempts , marital adjustment , and self-efficacy than patients in the AE-SS control condition . Compared to patients in the AE-SS control condition , patients who received CST without spouse involvement had significantly higher post-treatment levels of self-efficacy and marital adjustment and showed a tendency toward lower levels of pain and psychological disability and higher scores on measures of coping attempts and ratings of the perceived effectiveness of pain-coping strategies . CONCLUSION These findings suggest that spouse-assisted CST has potential as a method for reducing pain and disability in OA patients Objective . To evaluate the influence of a 6-week Arthritis Self-Management Program ( ASMP ) on health-related quality of life ( HRQOL ) and self-management skills in clinical setting s. Methods . Individuals with hip or knee osteoarthritis referred to orthopedic surgeons or rheumatologists at 6 hospitals in Victoria , Australia , were recruited . In a r and omized controlled trial , participants received the Stanford ASMP and self-help book ( intervention ) or book only ( control ) . Assessment s included the Assessment of Quality of Life instrument ( AQoL ; range −0.04 to 1.00 ) and Health Education Impact Question naire ( heiQ ; range 1–6 ) at baseline and up to 12 months . The primary outcome was HRQOL at 12 months ( assessed using the AQoL ) . Results . Recruitment was concluded early due to persistent challenges including infrequent referrals and patient inability or disinterest in participating . Of 1125 individuals screened , only 120 were r and omized ( control , n = 62 ; intervention , n = 58 ) . Seven ASMP were conducted while 18 scheduled ASMP were cancelled . Forty-four of 58 intervention group participants received the intervention as allocated ( 76 % ) ; all control group participants were sent the book ( 100 % ) . Ninety-four participants ( 78 % ) completed 12-month assessment s ( control , 90 % ; intervention , 66 % ) . There was no difference in HRQOL at 12 months ( adjusted mean difference −0.02 , 95 % CI −0.09 to 0.05 ) . At 6 weeks , the intervention group reported higher heiQ skill and technique acquisition scores ( adjusted mean difference 0.29 , 95 % CI 0.04 to 0.55 ) ; however , this dissipated by 3 months . Conclusion . Significant challenges hampered this evaluation of the ASMP . The observed lack of enthusiasm from potential referrers and patients raises doubts about the practicality of this intervention in real-world setting s. ( ANZCTR Clinical Trials Registry no. ACTRN12606000174583 OBJECTIVE To evaluate the long-term effects of a spouse-assisted coping skills intervention in patients with osteoarthritis ( OA ) of the knees , and to evaluate how pre- to posttreatment changes in marital adjustment and self-efficacy relate to long-term improvements in pain , psychological disability , physical disability , pain coping , and pain behavior . METHODS A followup study was conducted with 88 OA patients who had been r and omly assigned to 1 of 3 treatment conditions : 1 ) spouse-assisted coping skills training ( spouse-assisted CST ) , 2 ) a conventional CST intervention with no spouse involvement , and 3 ) an arthritis education-spousal support ( AE-SS ) control condition .  To evaluate long-term outcome , comprehensive measures of self-efficacy , marital adjustment , pain , psychological disability , physical disability , pain coping , and pain behavior were collected from these individuals at 6 and 12 months posttreatment . RESULTS Data analysis revealed that , at 6-month followup , patients in the spouse-assisted CST condition scored higher on measures of coping and self-efficacy than those in the AE-SS control group . At 6-month followup , patients who received CST without spouse involvement showed a significantly higher frequency of coping attempts and reported higher levels of marital adjustment than those in the AE-SS control group . At 12-month followup , patients in the spouse-assisted CST condition had significantly higher overall self-efficacy than those in the AE-SS control condition . In addition , patients in both the spouse-assisted CST and CST only conditions tended to show improvements in physical disability at the 12-month followup . Individual differences in outcome were noted at the 12-month followup . Patients in the spouse-assisted CST condition who reported initial ( pre- to posttreatment ) increases in marital adjustment had lower levels of psychological disability , physical disability , and pain behavior at 12-month followup . However , for patients in the conventional CST and AE-SS control conditions , increases in marital adjustment occurring over the initial phase of treatment were related to increases in pain and decreases in scores on the Pain Control in Rational Thinking factor of the Coping Strategies Question naire . Finally , patients in the spouse-assisted CST condition who showed pre- to posttreatment increases in self-efficacy were more likely to show decreases in pain , psychological disability , and physical disability at 12-month followup . CONCLUSIONS These findings suggest that spouse-assisted CST can enhance self-efficacy and improve the coping abilities of OA patients in the long term . Individual differences in the long-term outcome of spouse-assisted CST were noted , with some patients ( those showing increases in marital satisfaction and self-efficacy ) showing much better outcomes than others 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 OBJECTIVE To determine the efficacy of an Internet-based Arthritis Self-Management Program ( ASMP ) as a re source for arthritis patients unable or unwilling to attend small-group ASMPs , which have proven effective in changing health-related behaviors and improving health status measures . METHODS R and omized intervention participants were compared with usual care controls at 6 months and 1 year using repeated- measures analyses of variance . Patients with rheumatoid arthritis , osteoarthritis , or fibromyalgia and Internet and e-mail access ( n = 855 ) were r and omized to an intervention  ( n = 433 ) or  usual care control ( n = 422 ) group . Measures included 6 health status variables ( pain , fatigue , activity limitation , health distress , disability , and self-reported global health ) , 4 health behaviors ( aerobic exercise , stretching and strengthening exercise , practice of stress management , and communication with physicians ) , 5 utilization variables ( physician visits , emergency room visits , chiropractic visits , physical therapist visits , and nights in hospital ) , and self-efficacy . RESULTS At 1 year , the intervention group significantly improved in 4 of 6 health status measures and self-efficacy . No significant differences in health behaviors or health care utilization were found . CONCLUSION The Internet-based ASMP proved effective in improving health status measures at 1 year and is a viable alternative to the small-group ASMP OBJECTIVE To determine the extent to which the cost of an  effective self-care intervention for primary care patients with knee osteoarthritis ( OA ) was offset by savings result ing from reduced utilization of ambulatory medical services . METHODS In an attention-controlled clinical trial , 211 patients with knee OA from the general medicine clinic of a municipal hospital were assigned arbitrarily to conditions of self-care education ( group E ) or attention control ( group AC ) . Group E ( n = 105 ) received individualized instruction and followup emphasizing nonpharmacologic management of joint pain . Group AC ( n = 106 ) received a st and ard public education presentation and attention-controlling followup . A comprehensive clinical data base provided data concerning utilization and cost of health services during the following year . RESULTS Only 25 subjects ( 12 % ) were lost to followup . The 94 subjects remaining in group E made 528 primary care visits during the year following intervention , compared with 616 visits by the 92 patients remaining in group AC ( median visits 5 versus 6 , respectively ; P < 0.05 ) . Fewer visits translated directly into reduced clinic costs in group E , relative to controls ( median costs [ 1996 dollars ] $ 229 versus $ 305 , respectively ; P < 0.05 ) . However , self-care education had no significant effects on utilization and costs of outpatient pharmacy , laboratory , or radiology services over the ensuing year . The cost per patient to deliver the self-care intervention was estimated to be $ 58.70 . CONCLUSION Eighty percent of the cost of delivering effective self-care education to the knee OA patients in this study was offset within 1 year by the reduced frequency and costs of primary care visits . For > 50 % of patients receiving the intervention , the savings associated with fewer primary care visits exceeded the cost of self-care education Osteoarthritis ( OA ) is the commonest cause of locomotor disability and forms a major element of the workload of the primary care team . There is evidence that patient education may improve quality of life , physical functioning , mental health and coping as well as reducing health service use . The aim of this study was to evaluate the effectiveness of a primary care-based patient education programme ( PEP ) using a r and omised controlled trial . A cluster r and omised controlled trial , involving 22 practice s , was used to determine the efficacy of a nurse-led education programme . The programme consisted of a home visit and four 1-h teaching sessions . Patients were assessed at baseline and then 1 , 3 , 6 and 12 months post intervention using 36-item Short Form ( SF-36 ) , Western Ontario and McMaster Universities Arthritis Index ( WOMAC ) , arthritis helplessness index and a patient knowledge question naire .  Direct interviews were used at baseline and at the 12-month follow-up . There were no differences in depression , OA knowledge , pain or physical ability at either 1 month or 1 year between the two groups .  Control practice s ( 65 patients from 12 practice s ) recruited significantly fewer patients than intervention practice s ( 105 patients from ten practice s , p=0.02 ) . Control practice s had more doctors ( p=0.02 ) , more non-white patients  ( p=0.007 ) , fewer  patients living alone  ( p=0.005 ) and lower levels of disability ( p=0.008 ) . We detected a lack of benefit of PEP for people with OA of the knee . This was thought to be due in part to the short intervention time employed and the heterogeneous nature of the disease and the population studied 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 Thail and has a history of implementing innovative and proactive policies to address the health needs of its population . Since 1962 Thail and has implemented initiatives that led to it having a health system characterized by a primary care focus , de central ization and mechanisms to maximize equity and universal access to basic care at the local level . Thai health structures initially evolved to meet challenges including infectious and developmental diseases and later HIV . Early in the 21st century chronic illness rapidly became the greatest cause of morbidity and mortality and the question has arisen how Thail and can adapt its strong health system to deal with the new epidemics . This article describes an effort to reorient provincial health services to meet the needs of the increasing number of people with diabetes and heart disease . It describes measures taken to build on the equity-promoting elements of the Thai health system . The project included ; a situational analysis , development and implementation of a chronic disease self-management intervention implemented by nurses and alignment of provincial health services . The self-management intervention is currently being evaluated within a clustered r and omized control trial . The evaluation has been developed to fit with the focus on equity in relation to both selection criteria and the outcomes that are being assessed & NA ; This study tested the separate and combined effects of spouse‐assisted pain coping skills training ( SA‐CST ) and exercise training ( ET ) in a sample of patients having persistent osteoarthritic knee pain . Seventy‐two married osteoarthritis ( OA ) patients with persistent knee pain and their spouses were r and omly assigned to : SA‐CST alone , SA‐CST plus ET , ET alone , or st and ard care ( SC ) . Patients in SA‐CST alone , together with their spouses , attended 12 weekly , 2‐h group sessions for training in pain coping and couples skills . Patients in SA‐CST+ET received spouse‐assisted coping skills training and attended 12‐weeks supervised ET . Patients in the ET alone condition received just an exercise program . Data analyses revealed : ( 1 ) physical fitness and strength :  the SA‐CST+ET and ET alone groups had significant improvements in physical fitness compared to SA‐CST alone and patients in SA‐CST+ET and ET alone had significant improvements in leg flexion and extension compared to SA‐CST alone and SC , ( 2 ) pain coping : patients in SA‐CST+ET and SA‐CST alone groups had significant improvements in coping attempts compared to ET alone or SC and spouses in SA‐CST+ET rated their partners as showing significant improvements in coping attempts compared to ET alone or SC , and ( 3 ) self‐efficacy : patients in SA‐CST+ET reported significant improvements in self‐efficacy and their spouses rated them as showing significant improvements in self‐efficacy compared to ET alone or SC . Patients receiving SA‐CST+ET who showed increased self‐efficacy were more likely to have improvements in psychological disability . An intervention that combines spouse‐assisted coping skills training and exercise training  can improve physical fitness , strength , pain coping , and self‐efficacy in patients suffering from pain due to osteoarthritis OBJECTIVE To assess in a primary healthcare setting the efficacy of a self-management program in middle-aged patients with osteoarthritis ( OA ) . METHODS This was a 2-group r and omized controlled trial , with 273 patients aged 40 to 60 years with OA of the hip(s ) and /or knee(s ) . The experimental intervention was compared with care-as-usual . Treatments and followup measurements were performed in a general healthcare setting by general practitioners . Duration of followup was 21 months after start of the intervention . Instruction in self-management techniques was given by physiotherapists . The main outcome measures were pain severity in hips and knees , other significant complaints , and functional limitations . RESULTS To begin , 297 patients were r and omized : 149 as self-management and 148 controls ; before the intervention 24 withdrew for practical reasons ( 17 self-management  , 7 controls ) . At 3-month followup the intervention group was significantly improved on a visual analog scale ( VAS ) for knee pain ( score 0.67 ; SD 2.10 ) and the WOMAC ( score 2.46 ; SD 9.49 ) , while the control group showed stable VAS knee pain ( 0.01 ; SD 2.00 ) and deterioration on WOMAC ( -0.53 ; SD 9.47 ) . At 21-month followup the differences between the groups increased in favor of the intervention group ( VAS pain knee : p values from 0.023 at 3 mo to 0.004 at 21 mo ; WOMAC : p values from 0.030 to 0.022 ) . CONCLUSION The self-management program positively influenced knee pain and self-reported functional level in this sample of patients with OA . Differences between the study groups increased during followup in favor of the intervention group OBJECTIVE Past research has shown response biases to influence the accuracy of results from self-report measures . In pain assessment , where a percentage of patients have financial and other reasons to minimize or exaggerate psychological disturbance , it becomes especially important to identify the influence of response bias in self-report of adjustment . This study investigated the susceptibility of three commonly used self-report pain assessment  measures to response bias . DESIGN This study used a within-subjects ( asymptomatic subjects ) design with two experimental conditions and nonequivalent control group ( chronic pain patients ) . SUBJECTS Experimental group : 40 students enrolled in an occupational therapy program at a major southeastern United States university . CONTROL GROUP 200 subjects referred to a multidisciplinary pain clinic at a major teaching hospital . MEASURES  Coping Strategies Question naire , Multidimensional Pain Inventory , and Pain Beliefs and Perceptions Inventory .  RESULTS With few exceptions , asymptomatic subjects scored significantly differently on these measures while portraying themselves as either coping well or coping poorly . In addition , when using the " coping poorly " response set , asymptomatic subjects reproduced scores similar to those of symptomatic chronic pain patients . CONCLUSION The susceptibility to manipulation appeared constant across the three measures , a finding that highlighted the difficulties clinicians and research ers encounter in accurate interpretation of results from these measures in the absence of validity indicators . This study also emphasizes the ease with which subjects with sufficient motivation can present themselves in an untruthful and manipulative manner and can generate scores that are , on their own , difficult to distinguish from those of a group of typical chronic pain patients 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 ] Women increasingly outnumber men in the US population ( Arber & Ginn , 1993 ) , but most research has been conducted with men ( Stacey & Olesen , 1988 ) . The purpose of this study was to determine whether older men and women differ in their participation rates and in their responsiveness to a health intervention . Three hundred sixty-three health maintenance organization members with osteoarthritis , 60 years of age or older , were r and omly  assigned to a control group or to receive social support , education , or a combination of education and social support , education , or a combination of education and social support . Of the 363 r and omly assigned members , 245 completed all of the follow-up assessment s. Men and women volunteered in proportion to their representation in the osteoarthritis population . Although the genders differed in several ways , the interventions were equally effective for men and women , and the study results applied to both genders PURPOSE We present final outcomes from the multiple-component Fit and Strong ! intervention for older adults with lower extremity osteoarthritis . DESIGN AND METHODS A r and omized controlled trial compared the effects of this exercise and behavior-change program followed by home-based reinforcement  ( n=115 ) with a wait list control  ( n=100 ) at 2 , 6 , and 12 months . Fit and Strong ! combined flexibility , aerobic walking , and resistance training with education and group problem solving to enhance self-efficacy for exercise and maintenance of physical activity . All participants developed individualized plans for long-term maintenance . RESULTS Relative to controls , treatment participants experienced statistically significant improvements in self-efficacy for exercise  ( p=.001 ) , minutes of exercise per week ( p=.000 ) , and lower extremity stiffness ( p=.018 ) at 2 months . These benefits were maintained at 6 months and were accompanied by increased self-efficacy for adherence to exercise over time ( p=.001 ) , reduced pain ( p=.040 ) , and a marginally significant increase in self-efficacy for arthritis pain management ( p=.052 ) . Despite a substantially smaller sample size at 12 months , significant treatment-group effects were maintained on self-efficacy for exercise ( p=.006 ) and minutes of exercise per week ( p=.001 ) , accompanied by marginally significant reductions in lower extremity stiffness ( p=.056 ) and pain ( p=.066 ) . No adverse health effects were seen . Effect sizes for self-efficacy for exercise and for maintenance of physical activity were 0.798 and 0.713 , and 0.905 and 0.669 , respectively , in the treatment group at 6 and 12 months . IMPLICATION S This consistent pattern of benefits indicates that this low-cost intervention is efficacious for older adults with lower extremity osteoarthritis 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 OBJECTIVE To determine whether experimentally developed social support , education about appropriate use of the health care system , and their combination are effective in reducing health care costs for people with osteoarthritis at a 3-year followup assessment . METHOD Three hundred sixty-three health maintenance organization members with osteoarthritis were r and omly assigned to 1 of 3 intervention groups or to a control group .  Two hundred fifty-six participants completed the 3-year assessment .  Health status and health care use were assessed upon entering the study , and after 1 , 2 , and 3 years . RESULTS Health care costs in the combined experimental groups were lower than those in the control group by $ 1,279/participant/year in year 3 . There were no significant changes in health status between participants ' entry into the study and the year 3 assessment . The 3 interventions had nearly equal effects on health status and health care costs . Implementation costs were least for the social support intervention , but the group that combined education and social support had less attrition and greater persistence . CONCLUSION Interventions that target appropriate use of the health care system can be highly cost-effective without adversely affecting health status OBJECTIVE To determine whether experimentally developed social support and education about appropriate use of the health care system decrease health care costs without negatively affecting health status . METHOD Three hundred sixty-three health maintenance organization members with osteoarthritis were r and omly assigned to 1 of 3 intervention groups or to a control group .  Health status and health care use were assessed upon entering the study , and after 1 year and 2 years . RESULTS A savings of $ 1,156/participant/year was obtained when health care costs of the experimental groups were compared with those of the control group . Production or implementation costs were least for the social support intervention . The nearly equal effects of the 3 interventions on health care costs make implementation costs the primary focus when deciding which intervention to use . CONCLUSION We believe that the social support treatment is the most cost-effective intervention OBJECTIVE To compare the efficacy of patient education and supervised exercise with that of patient education alone for the management of pain in patients with hip osteoarthritis ( OA ) . DESIGN Single blind r and omized clinical trial . SETTING Recruitment of patients from hospitals , primary health care and advertisement , Oslo , Norway . PARTICIPANTS 109 patients with radiographic and symptomatic hip OA with mild to moderate symptoms . INTERVENTIONS Patient education ( PE ) . Patient education and supervised exercise ( PE+SE ) . PRIMARY OUTCOME MEASURE The pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC pain ) . RESULTS No significant between group differences were found for WOMAC pain over the 16-month follow-up . Significant improvements were found for the secondary outcome WOMAC physical function ( P=0.011 ) in the group receiving PE+SE compared to the group receiving PE only . No significant differences were found for WOMAC stiffness , the SF-36 subscales or the activity scale . The effect sizes ( 95 % confidence interval ) for WOMAC pain were -0.26 ( 0.11 , -0.64 ) , -0.35 ( 0.07 , -0.77 ) , and -0.30 ( 0.15 , -0.75 ) , and for WOMAC physical function -0.29 ( 0.09 , -0.67 ) , -0.48 ( -0.06 , -0.91 ) , and -0.47 ( -0.02 , -0.93 ) at 4 , 10 and 16 months , respectively , in favor of the group receiving both PE and SE . All patients attended the three-session PE program , and 75 % performed ≥16 sessions of the 12-week SE program . CONCLUSION The study could not demonstrate a significant difference in pain reduction over time between PE+SE vs PE alone . Adding SE to PE may improve physical function , but the magnitude of possible benefit is unknown as the 95 % confidence intervals around the mean difference were wide . TRIAL REGISTRATION Clinical Trials NCT00319423 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 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 OBJECTIVE Both the Arthritis Self-Management Program ( ASMP ) and the generic Chronic Disease Self-Management Program ( CDSMP ) have been shown to be successful in improving conditions in patients with arthritis . This study compared the relative effectiveness of the 2 programs for individuals with arthritis . METHODS Patients whose primary disease was arthritis were r and omized to the ASMP ( n = 239 ) or to the CDSMP ( n = 116 ) . Analyses of covariance were used to compare the outcome measures for the 2 programs at 4 months and 1 year . Measures included quality of life outcomes ( self reported , health distress , disability , activity limitation , global health , pain , and fatigue ) , health behaviors ( practice of mental stress management , stretching and strength exercise , aerobic exercise ) , self efficacy , and health care utilization ( physician visits and hospitalizations ) . RESULTS Both programs showed positive results . The disease-specific ASMP appeared to have advantages over the more generic CDSMP for patients with arthritis at 4 months . These advantages had lessened slightly by 1 year . CONCLUSION The disease-specific ASMP should be considered first where there are sufficient re sources and participants . However , both programs had positive effects , and the CDSMP should be considered a viable alternative & NA ; Osteoarthritis of the knee , a prevalent condition in older adults , can impact physical function and ability to perform physical activity . This r and omized controlled trial examined the effects of a 6‐month self‐efficacy‐based , individually delivered , lower‐extremity exercise and fitness walking intervention with 6‐month follow‐up on physical activity and function . The 26 subjects were mostly older ( M = 63.2 years , SD = 9.8 ) , White ( 83 % ) , obese ( BMI M = 33.3 , SD = 6.0 ) women ( 96 % ) . Physical activity was measured by diaries . Physical function was measured by the 6‐minute walk , Short Physical Performance Battery ( SPPB ) , and WOMAC Physical Function subscale . Exercise self‐efficacy was assessed by a question naire . Results showed significant increases in self‐reported performance of lower‐extremity exercise and participation in fitness walking , distance in the 6‐minute walk , and SPPB scores from baseline to 6‐month follow‐up with a trend for improvement in self‐efficacy . Results suggest that the intervention was feasible , acceptable , and improved physical activity and function The soaring cost of health care is a national problem that needs response at multiple levels , including that of the community . Reducing or limiting health care costs through interventions that emphasize the self-management of health may promote broader health care coverage , better quality of health care , and a sense of control over one 's health . Therefore , it behooves community psychologists to perform cost analyses when testing interventions for people in a community . The present study investigated the effects of social support and education interventions on psychosocial variables , health status , and health care costs in older people with osteoarthritis . Participants were 363 members of a health maintenance organization ( HMO ) , 60 years of age and older , with osteoarthritis . Participants were r and omly assigned to one of three intervention groups ( social support , education , or a combination of both ) or to a control group . The results indicated that feelings of helplessness decreased in the intervention groups but not in the control group . All groups showed increases in self-efficacy and overall health status . In addition , health care costs increased less in the intervention groups than in the control group . Cost analysis was used to demonstrate that the monetary savings of the intervention greatly outweighed the cost of conducting the intervention . It appears that interventions can limit health care costs while improving health and increasing feelings of control for older people with osteoarthritis . Further , this paper demonstrates how a cost-benefit focus can benefit community studies OBJECTIVES To determine 4-month and 1-year health-related outcomes of a 6-week , lay-led , and community-based arthritis self-management program for Spanish-speaking participants and to determine the role of self-efficacy in predicting health status for this population . METHODS Three hundred and thirty one subjects were r and omized to the program or to a 4-month wait list control group . One hundred ninety eight subjects continued in a 1-year longitudinal study . Data were collected via mailed question naires with telephone follow up . RESULTS At 4 months , treatment subjects , compared with controls , demonstrated positive changes in exercise , disability , pain , and self-efficacy ( P < 0.05 ) . At 1 year , compared with baseline , treatment subjects demonstrated improvements in exercise , general health , disability , pain , self-efficacy , and depression ( P < 0.05 ) . Baseline and 4-month changes in self-efficacy predicted health status at 1 year . CONCLUSIONS Spanish-speaking participants of an arthritis self-management program demonstrate short- and long-term benefits ( improved health behaviors , health status , and self-efficacy ) OBJECTIVE Evaluation of a self-management program for patients with osteoarthritis ( OA ) of the hip or knee . The program , which consisted of 6 weekly sessions of 2 hours , included health education by a peer and physical exercises taught by a physical therapist . METHODS R and omized controlled trial . Inclusion criteria were diagnosis of OA of the hip or knee according to ACR clinical and radiographic criteria and age 55 to 75 years . EXCLUSION CRITERIA on waiting list for joint replacement . There were pretest , posttest , and followup ( 6 months ) assessment s. The experimental group consisted of 56 patients , the control group 49 . Outcome variables were pain , quality of life , activity restrictions , knowledge about OA , self-efficacy , body mass index ( BMI ) , and mobility measures . Attention was also paid to effects on health care utilization and lifestyle behavior . RESULTS Significant MANOVA group x time effects ( p < 0.05 , one-sided ) were found for pain , quality of life , strength of the left M. quadriceps , knowledge , self-efficacy , BMI , physically active lifestyle , and visits to the physical therapist . Most effects were moderate at posttest assessment and smaller at followup . No effects were found for range of motion and functional tasks . CONCLUSION The program was reasonably effective , but more attention should be paid to proactive followup interventions and to the selection of participants The benefits of patient education for those with chronic arthritis are well documented . Informed patients should practice self care more often , and may show reduced disability from their disease . An important question relates to maintenance of the knowledge and skills acquired in educational programmes . This prospect i ve study evaluated an education programme for people with rheumatoid arthritis ( RA ) and osteoarthritis ( OA ) . The intervention group participated in a comprehensively planned six session behaviourally based programme . A question naire was given to 100 patients and 95 matched but non-r and om controls before the programme , 1 month later , and at 3 and 12 months . The intervention group demonstrated improvements in knowledge , self-reported health behaviour and disability scores at 12 months , compared to the controls . No differences were reported in symptoms , compliance with therapy , pain perception , and locus of control BACKGROUND Chronic knee pain is a major cause of disability in the elderly . Management guidelines recommend exercise and self-management interventions as effective treatments . The authors previously described a rehabilitation programme integrating exercise and self-management [ Enabling Self-management and Coping with Arthritic knee Pain through Exercise ( ESCAPE-knee pain ) ] that produced short-term improvements in pain and physical function , but sustaining these improvements is difficult . Moreover , the programme is untried in clinical environments , where it would ultimately be delivered . OBJECTIVES To establish the feasibility of ESCAPE-knee pain and compare its clinical effectiveness and costs with outpatient physiotherapy . DESIGN Pragmatic , r and omised controlled trial . SETTING Outpatient physiotherapy department and community centre . PARTICIPANTS Sixty-four people with chronic knee pain . INTERVENTIONS Outpatient physiotherapy compared with ESCAPE-knee pain . OUTCOMES The primary outcome was physical function assessed using the Western Ontario and McMaster Universities Osteoarthritis Index . Secondary outcomes included pain , objective functional performance , anxiety , depression , exercise-related health beliefs and healthcare utilisation . All outcomes were assessed at baseline and 12 months after completing the interventions ( primary endpoint ) . ANCOVA investigated between-group differences . RESULTS Both groups demonstrated similar improvements in clinical outcomes . Outpatient physiotherapy cost pound 130 per person and the healthcare utilisation costs of participants over 1 year were pound 583 . The ESCAPE-knee pain  programme cost pound 64 per person and the healthcare utilisation costs of participants over 1 year were pound 320 . CONCLUSIONS ESCAPE-knee pain can be delivered as a community-based integrated rehabilitation programme for people with chronic knee pain . Both ESCAPE-knee pain and outpatient physiotherapy produced sustained physical and psychosocial benefits , but ESCAPE-knee pain cost less and was more cost-effective OBJECTIVE To evaluate the effect of therapeutic education and functional readaptation ( TEFR ) on health-related quality of life ( HRQL ) in patients diagnosed with osteoarthritis on a waiting list for total knee replacement ( TKR ) . METHODS R and omized controlled trial of 9 months duration was conducted . One hundred consecutive out patients ( 71 females , mean age 71 years ( range 50 - 86 ) , mean disease duration 11.84+/-10.52 months ) were included . Patients were r and omized in two groups . The intervention group received TEFR added to conventional ( pharmacological ) treatment ( n=51 ) . The control group received conventional ( pharmacological ) treatment only ( n=49 ) . The main outcome variable was self-reported HRQL measured by the Spanish version of Western Ontario and McMaster Universities Osteoarthritis Index ( WOMAC ) . Secondary outcomes were general HRQL measured by Short Form Health Survey general question naire ( SF-36 ) , number of visits to general physicians and their cost . Assessment s were done at baseline and at 9 months . MAIN RESULTS Eighty patients completed the study . Significant improvement in the WOMAC function was found at 9 months in the TERF group with respect to the control group ( P=0.035 ) . Consumption of analgesics increased significantly in the TERF group compared with controls ( P=0.036 ) . Significant improvements in pain ( P=0.027 ) measured by WOMAC and in bodily pain ( P=0.043 ) and physical function ( P=0.031 ) , measured by SF-36 , were observed in the intervention group with respect to baseline . CONCLUSIONS The function dimension measured by WOMAC of patients who received both pharmacological treatment and TERF improved with respect to the control group receiving only pharmacological treatment . This suggests that a program of TEFR during the period on the waiting list for TKR may reduce the negative impact of this situation OBJECTIVES To assess the effect of a group education programme on pain and function through knowledge acquisition and a home-based exercise programme . DESIGN A parallel r and omised single-blind clinical trial . PARTICIPANTS Fifty patients aged 65 years or over with knee osteoarthritis . INTERVENTIONS The study group ( n=25 ) was given a group education programme once a week for 4 weeks , followed by a self-executed home-based exercise programme . The controls ( n=25 ) were given a brief course in short-wave diathermy treatment . MAIN OUTCOME MEASURES Patients were assessed before the intervention , after the intervention ( 4 weeks ) and again 8 weeks later ( follow-up ) using the Western Ontario McMaster Osteoarthritis Index ( WOMAC ) , the repeated sit-to-st and test and the get-up- and -go test . RESULTS At 4 weeks , there was a significant improvement in both groups in all outcome variables except the WOMAC stiffness score ; for example , the WOMAC total score was reduced by a mean of 9.5 points [ 95 % confidence interval ( CI ) -12.3 to -6.7 ] . However , at follow-up , patients in the study group demonstrated continued improvement in the get-up- and -go test and the WOMAC total , pain and disability scores , but no such improvement was noted among the controls . This difference was significant ; for example , the difference in mean WOMAC total score between the groups was -9.0 points ( 95%CI -14.5 to -3.4 ) . CONCLUSION A simple group education programme for patients with knee osteoarthritis is associated with improved functional abilities and pain reduction . Further study is required to determine if this positive effect can be maintained over a longer period We compared a cognitive-behavior modification and a traditional education intervention for adults with osteoarthritis ( OA ) . Forty OA patients were r and omly assigned to one of two groups : cognitive-behavior modification or didactic lectures . During ten weekly sessions , the cognitive-behavior group learned methods for coping with pain and the disabilities associated with OA . The traditional education group experienced a series of lectures from health care professionals . Prior to the interventions and following 2 , 6 , and 12 months , patients in both groups were evaluated with a general Quality of Well-being ( QWB ) scale , the Arthritis Impact Measurement Scales ( AIMS ) , the Beck Depression Inventory ( BDI ) , and other measures . Although there were some differences between the two groups at 2-month follow-up , by the end of 1 year , physical and psychological functioning did not differ significantly between the two groups . In comparison to baseline , both groups demonstrated initial changes on QWB , depression , and the pain component of the AIMS . Improvements in depression remained through the 1-year follow-up . Multiple regression analysis demonstrated that the mobility and physical activity aspects of the AIMS were significant long-term predictors of outcome ( 1 year ) for general quality -of-life measures . One-year outcomes for depression were significantly predicted from scores on social support and mobility measures from the AIMS . We conclude that cognitive-behavior modification and education produce similar effects on long-term physical and psychological functioning in OA patients 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 To evaluate the effectiveness of the Taipei Osteoarthritis Program ( TOAP ) for community elderly persons who suffer from knee OA . METHODS A quasi-experimental study was conducted between January 2008 and December 2008 . Two hundred and five community-dwelling individuals aged 67±10 years with knee OA were recruited from four districts in Taipei City and r and omized . By a clustered r and omization according to the districts , 114 participants were in the intervention group ( IG ) with a 4-week TOAP program and 91 participants were in the control group ( CG ) with routine care . The main outcome measures included health-related quality of life ( HRQOL ) and disability level , which were assessed by the Short Form-36 Taiwan Version ( T-SF36 ) and the Western Ontario McMaster Universities Arthritis Index Taiwan Version ( T-WOMAC ) , respectively , and were repeatedly measured at the baseline , post invention ( 4 weeks after baseline ) , and follow-up ( 8 weeks after baseline ) . RESULTS Subjects in the IG increased their changes of GH scores from baseline to post-intervention and follow-up , which were significantly more than those of subjects in the CG ( p=0.011 and 0.005 , respectively ) . Significant difference of changes was also found at follow-up for the mental component scale between the groups ( p=0.013 ) . There was no change in disability level . CONCLUSIONS The arthritis self-management program improved the psychological outcomes among the participants , but it had no significant effect on a self-reported disability level 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
BACKGROUND Self-management education programmes are complex interventions specifically targeted at patient education and behaviour modification .
They are design ed to encourage people with chronic disease to take an active self-management role to supplement medical care and improve outcomes .
OBJECTIVES To assess the effectiveness of self-management education programmes for people with osteoarthritis .