title: Does self-management lead to sustainable health benefits in people with arthritis? A 2-year transition study of 452 Australians.
abstract: OBJECTIVE
  To evaluate the Arthritis Self-Management Course (ASMC) when applied in a nationwide context.
  
  
  METHODS
  Four hundred fifty-two people who participated in the ASMC across Australian states took part in a longitudinal followup study. ASMC is a 6 week, 2 h group educational program designed to assist people with chronic illness to better manage their condition. Measures of program effectiveness included health status and service utilization. Data were collected on 3 occasions: before intervention (baseline) and 6 months and 2 years after the program.
  
  
  RESULTS
  Several indicators of health status showed improvement at 6 months following the ASMC. These included reduction in pain (4%; p < 0.001), fatigue (3%; p < 0.01), and health distress (12%; p < 0.001) as well as increase in self-efficacy (6%; p < 0.001). Increased self-efficacy was a significant predictor of positive change in health status. Health-related behaviors such as aerobic exercise also increased, with the proportion of people who did little or no exercise decreasing by up to 8%. These changes were sustained at 2 years. There was an increase in use of analgesics at 6 months and an increase in use of nonsteroidal antiinflammatory drugs at 2 years. No changes in healthcare utilization (physician visits, allied health visits, and hospitalizations) were observed.
  
  
  CONCLUSIONS
  The ASMC is a widely applied program in which participants benefit through a reduction in pain, fatigue, and health distress. Although the absolute changes in health status are small, the low cost and wide application of the intervention suggests the program may have a substantial public health effect.
authors.affiliation: Centre for Rheumatic Diseases, Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, Parkville, Australia. richardo@unimelb.edu.au
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
authors.forename: Tanya
authors.initials: T
authors.lastname: Wilson
authors.forename: Kate R
authors.initials: KR
authors.lastname: Lorig
authors.forename: Geoffrey J
authors.initials: GJ
authors.lastname: McColl
mesh_terms: D000203:Activities of Daily Living; D001168:Arthritis / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D001315:Australia; D019468:Disease Management; D005221:Fatigue / Q000503:physiopathology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010146:Pain / Q000503:physiopathology / Q000517:prevention & control; D010353:Patient Education as Topic; D011788:Quality of Life; D012648:Self Care / Q000379:methods*