Does self-management education benefit all populations with arthritis? A randomized controlled trial in a primary care physician network.
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' practices, where the potential for spreading the program may be greatest. We conducted a randomized 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 practices received the 6 week course and those in the control practices received only the ASMP book, without course. Disability, pain, self-efficacy, mental health, and satisfaction were measured using validated 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 questionnaires. Eighty-four percent completed at least 4 of 6 classes. Seventy-four patients received the ASMP manual (controls) and completed both questionnaires. 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 resource use were similar at baseline and followup for both intervention and control groups (all p > 0.2).


CONCLUSIONS
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 practices.
Solomon
Daniel H
DH
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. dhsolomon@partners.org
Warsi
Asra
A
Brown-Stevenson
Tina
T
Farrell
Maureen
M
Gauthier
Suzanne
S
Mikels
Debra
D
Lee
Thomas H
TH
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D005356:Fibromyalgia / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*; D012216:Rheumatic Diseases / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome