Self-management and peer support among people with arthritis on a hospital joint replacement waiting list: a randomised controlled trial

Introduction: To evaluate the efficacy of a self-management support program including a 6 week self-management course, indvidualised phone support and goal setting in osteoarthritis patients on a waiting list for arthroplasty surgery. Method. Randomised controlled trial of 152 public hospital outpatients awaiting hip or knee replacement surgery who were not classified as requiring urgent surgery. Participants were randomised to a self-management program or to usual care. The primary outcome was change in the Health Education Intervention Questionnaire (HeiQ) from randomisation to 6 month follow-up. Quality of life and depressive symptoms were also measured. Changes in pain and function were assessed using the Western Ontario and McMaster Universities (WOMAC) Arthritis Index. Results: At 6 month follow-up, health-directed behaviour was significantly greater in the intervention [mean 4.29, 95% confidence interval (CI) 3.99-4.58] than the control (mean 3.81, 95% Cl 3.52-4.09; P= 0.017). There was also a significant effect on skill and technique acquisition for the intervention (mean 4.37, 95% Cl 4.19-4.55) in comparison to control (mean 4.11, 95% Cl 3.93-4.29; P= 0.036). There was no significant effect of the intervention on the remaining HeiQ subscales, WOMAC pain or disability, quality of life or depressive symptoms. Discussion: The arthritis self-management program improved health-directed behaviours, skill acquisition and stiffness in patients on a joint replacement waiting list, although the observed effects were of modest size (Cohen's d between 0.36 and 0.42). There was no significant effect on pain, function or quality of life in the short term. Self-management programs can assist in maintaining health behaviours (particularly walking) in this patient group. Further research is needed to assess their impact on quality of life and over longer periods. (C) 2009 Osteoarthritis Research Society International. Published-by Elsevier Ltd. All rights reserved.