title: Challenges in evaluating an Arthritis Self-Management Program for people with hip and knee osteoarthritis in real-world clinical settings.
abstract: OBJECTIVE
  To evaluate the influence of a 6-week Arthritis Self-Management Program (ASMP) on health-related quality of life (HRQOL) and self-management skills in clinical settings.
  
  
  METHODS
  Individuals with hip or knee osteoarthritis referred to orthopedic surgeons or rheumatologists at 6 hospitals in Victoria, Australia, were recruited. In a randomized controlled trial, participants received the Stanford ASMP and self-help book (intervention) or book only (control). Assessments included the Assessment of Quality of Life instrument (AQoL; range -0.04 to 1.00) and Health Education Impact Questionnaire (heiQ; range 1-6) at baseline and up to 12 months. The primary outcome was HRQOL at 12 months (assessed using the AQoL).
  
  
  RESULTS
  Recruitment was concluded early due to persistent challenges including infrequent referrals and patient inability or disinterest in participating. Of 1125 individuals screened, only 120 were randomized (control, n = 62; intervention, n = 58). Seven ASMP were conducted while 18 scheduled ASMP were cancelled. Forty-four of 58 intervention group participants received the intervention as allocated (76%); all control group participants were sent the book (100%). Ninety-four participants (78%) completed 12-month assessments (control, 90%; intervention, 66%). There was no difference in HRQOL at 12 months (adjusted mean difference -0.02, 95% CI -0.09 to 0.05). At 6 weeks, the intervention group reported higher heiQ skill and technique acquisition scores (adjusted mean difference 0.29, 95% CI 0.04 to 0.55); however, this dissipated by 3 months.
  
  
  CONCLUSIONS
  Significant challenges hampered this evaluation of the ASMP. The observed lack of enthusiasm from potential referrers and patients raises doubts about the practicality of this intervention in real-world settings. (ANZCTR Clinical Trials Registry no. ACTRN12606000174583).
authors.affiliation: Melbourne EpiCentre, Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Melbourne, Australia.
authors.forename: Ilana N
authors.initials: IN
authors.lastname: Ackerman
authors.forename: Rachelle
authors.initials: R
authors.lastname: Buchbinder
authors.forename: Richard H
authors.initials: RH
authors.lastname: Osborne
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D020370:Osteoarthritis, Knee / Q000523:psychology / Q000601:surgery / Q000628:therapy*; D017060:Patient Satisfaction; D015397:Program Evaluation; D011788:Quality of Life; D012648:Self Care / Q000379:methods* / Q000523:psychology; D016896:Treatment Outcome