Long-term randomized controlled trials of tailored-print and small-group arthritis self-management interventions.

Abstract

OBJECTIVE:

The objective of this study was to test the effectiveness of a mail-delivered, tailored self-management intervention (SMART) and to compare it with the classic Arthritis Self-Management Program (ASMP).

METHODS:

We performed 2 randomized controlled trials: 1) a study of 1090 participants randomized to SMART or USUAL CARE, and 2) a study of 341 participants randomized to SMART or ASMP. Dependent variables included disability, pain, depression, role function, global severity, doctor visits, and self-efficacy. SMART interventions were provided in months 0-18 and not reinforced. Results were assessed at 1, 2, and 3 years using analyses of covariance (ANCOVA).

RESULTS:

Compared with USUAL CARE, SMART participants at 1 year had decreased disability, improved role function, and increased self-efficacy (all P <0.01). At 2 years, decreases in global severity, doctor visits, and increases in self-efficacy (all P <0.01) were noted. At 3 years without reinforcement, no statistically significant effects remained. Compared with ASMP, SMART at 1 year had greater decreases in disability (P = 0.02) and increases in self-efficacy (P = 0.01). There were no differences at 2 years. At 3 years, role function (P = 0.04) and doctor visit (P = 0.03) were improved in ASMP as compared with SMART. Improvements from baseline were seen for nearly all variables in both groups.

CONCLUSIONS:

A mail-delivered arthritis self-management program, SMART, was similarly effective to the classic ASMP, with slightly better results in the first year and a slightly more rapid attenuation over the next 2 years. Results suggest that both programs are effective, and that the addition of a mail-delivered program could improve accessibility to arthritis self-management treatment.

• Authors: Kate R Lorig, Philip L Ritter, Diana D Laurent, James F Fries
• Journal: Medical care (Med Care) Vol. 42 Issue 4 Pg. 346-54 (Apr 2004) ISSN: 0025-7079 [Print] United States
• PMID: 15076811 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, U.S. Gov't, P.H.S.)

Topics

• Activities of Daily Living
• Adult
• Aged
• Aged, 80 and over
• Analysis of Variance
• Arthritis (prevention & control, psychology)
• Female
• Health Status
• Humans
• Longitudinal Studies
• Male
• Middle Aged
• Outcome Assessment, Health Care
• Patient Education as Topic (methods)
• Program Evaluation
• Quality of Life
• Self Care (methods)
• Self Efficacy
• Self-Help Groups (standards)
• Severity of Illness Index
• Surveys and Questionnaires
• Teaching Materials (standards)