Long-term randomized controlled trials of tailored-print and small-group arthritis self-management interventions.
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.
Lorig
Kate R
KR
Department of Medicine, Stanford University School of Medicine, Stanford, California, USA. lorig@stanford.edu
Ritter
Philip L
PL
Laurent
Diana D
DD
Fries
James F
JF
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001168:Arthritis / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000379:methods; D020377:Self Efficacy; D012657:Self-Help Groups / Q000592:standards*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013664:Teaching Materials / Q000592:standards*