title: Self-management in osteoarthritis of hip or knee: a randomized clinical trial in a primary healthcare setting.
abstract: 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 randomized 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 randomized: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rehabilitation Foundation Limburg, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands. P.Heuts@srl.nl
authors.forename: Peter H T G
authors.initials: PH
authors.lastname: Heuts
authors.forename: Rob
authors.initials: R
authors.lastname: de Bie
authors.forename: Marion
authors.initials: M
authors.lastname: Drietelaar
authors.forename: Karin
authors.initials: K
authors.lastname: Aretz
authors.forename: Marijke
authors.initials: M
authors.lastname: Hopman-Rock
authors.forename: Caroline H G
authors.initials: CH
authors.lastname: Bastiaenen
authors.forename: Job F M
authors.initials: JF
authors.lastname: Metsemakers
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Onno
authors.initials: O
authors.lastname: van Schayck
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000628:therapy*; D010147:Pain Measurement; D010353:Patient Education as Topic; D011320:Primary Health Care; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome