2031 - Self-Management for Osteoarthritis of the Knee; Health Professionals or Lay Leaders?

Wednesday, October 21, 2009: 10:00 AM
106 A (Pennsylvania Convention Center)
Sophie Coleman1, Jessica Rose2, Jean McQuade2, Graeme Carroll3, Charles Inderjeeth4 and N. Kathy Briffa1, 1Curtin Health Innovation Research Institute Curtin University of Technology, Bentley, Australia, 2Arthritis WA, Wembley, Australia, 3Arthrocare, Mt Lawley, Australia, 4SCGH, Nedlands, Australia
Presentation Number: 2031

Purpose: To compare two 6 week self-management (SM) programs for people with OA knee. We have developed a disease specific self-management education program (OAK), for people with OA of the knee1. OAK includes specific education and exercise advice- designed for delivery by health professionals (HP's) utilising their knowledge and expertise. We compared this program with the Arthritis Self-Management Program (ASMP)2. ASMP is scripted for delivery by lay leaders and is generic in content. There is little evidence to support one approach in preference to the other. We hypothesised that the disease specific OAK would lead to better outcomes than ASMP. Method: In a registered RCT (ACTRN 12607000031460), 190 people (59 male) of mean age 67 years with OA knee were randomised to either OAK or ASMP. Groups were assessed pre- and post-intervention, and 6 &12 months later. Outcomes measured were health status (WOMAC), quality of life (SF36), balance, mobility, self-efficacy (S-E), and patient global health (PGH). VAS pain was measured each week of the intervention. Differences between groups were examined using an intention to treat analysis with repeated measures ANOVA. P-values are single tail. Results: Both groups improved over time (p<0.01) in WOMAC, balance, mobility, S-E, and SF36 PCS. Improvements were maintained to12mths. There were no between group differences in improvement (group x time p≥0.06) although OAK participants tended to have better improvements in physical outcomes. During the intervention VAS pain decreased more in the OAK group; mean (SE) OAK: 5.5 (0.3) to 4.4 (0.3); ASMP: 5.1 (0.3) to 4.7 (0.3) (group x time p=0.02). Neither SF36 MCS or PGH changed significantly (time p≥0.08) Conclusion: Improvements in health status, function and QOL were comparable between both groups. This information is relevant when planning SM models for use in OA considering the additional costs incurred employing HP's. 1Coleman S, Briffa K, Conroy H, Prince R, Carroll G, McQuade J: BMC Musc Dis 2008 9:117 2Lorig K, Gonzalez V: Hlth Educ & Bhvr 1992 19:355
Table: Mean (SE) health status and quality of life pre- and post-intervention and 6 &12 months
 

Pre-

 

Post-

 

  6month

 

12month

  Group x Time
 

  OAK

 ASMP 

  OAK

 ASMP

  OAK 

 ASMP 

  OAK

 ASMP  p-value

WOMAC Pain

 7.3(0.37) 7.1(0.37) 6.2(0.37) 6.6 (0.37) 5.8 (0.4) 6.1(0.4) 5.2(0.4) 6.0(0.4) 0.13
Stiffness 3.5(0.2) 3.5(0.2) 3.2(0.2) 3.1(0.2) 3.2(0.2) 3.0(0.2) 2.8(0.2) 3.0(0.2) 0.16
Phys Fn 24.6(1.3) 23.6(1.3) 20.2(1.3) 20.8(1.3) 21.1 (1.5) 20.0(1.5) 18.4(1.4) 20.2(1.4) 0.06
 Total 35.5(1.8) 34.1(1.8) 29.6(1.7) 30.5(1.7) 30.2(2.0) 29.0(2.0) 26.8(1.9) 29.2(1.9) 0.07
SF36 PCS 34.3(1.1) 36.6(1.1) 38.6(1.1) 37.9(1.1) 38.7(1.2) 38.5(1.2) 39.0(1.2) 38.7(1.3) 0.08

MCS

 50.8(1.3) 51.6(1.4) 52.5(1.2) 53.6(1.3) 51.2(1.4) 53.2(1.4) 51.4(1.3) 54.3(1.3) 0.32

Keywords: education, patient, osteoarthritis and self-management

Disclosure: S. Coleman, None; J. Rose, None; J. McQuade, None; G. Carroll, None; C. Inderjeeth, None; N. K. Briffa, None.