Arthritis self-management program variations: three studies.

OBJECTIVES: 1) Determine strengths and weaknesses of the Arthritis Self-Management Program (ASMP). 2) Compare 3- and 6-week ASMP. 3) Evaluate 1.5-hour arthritis program. METHODS: Study 1: Qualitative methods incorporating incomplete block design. Study 2: Comparison of 3- and 6-week outcomes. Study 3: Pretest/posttest comparison. RESULTS: Study 1: Pain management, exercise, and sharing ranked as the most useful aspects of the ASMP. Nutrition, medications, and making decisions about nontraditional treatments ranked least useful. Study 2: Six-week ASMP subjects improved pain, health distress, illness impact, exercise, cognitive pain management, self-efficacy, and reduced visits to physicians (P < 0.05). Three-week subjects improved health distress, cognitive pain management, and self-efficacy (P < 0.05). Study 3: Improved knowledge, self-efficacy, and pain (P < 0.05). CONCLUSIONS: The traditional 6-week ASMP is more effective than a 3-week version. A 1.5-hour community program is effective in increasing knowledge, self-efficacy, and contact with the Arthritis Foundation.

Arthritis patient education studies, 1987-1991: a review of the literature.

Arthritis is a chronic disease that is estimated to affect 14.5% of the American population and is the leading cause of functional dependency in the activities of daily living (ADLs) and the instrumental activities of daily living (IADLs) in all persons over the age of 65 years. Clinical studies have shown that medical care, including the use of medications, can offer a 20-50% improvement in reported arthritis symptoms. Data from patient education studies suggest that a further improvement of 15-30% is attainable through patient education interventions. This literature review has been completed to update the reviews of patient education studies by Lorig and Riggs in 1983 and Lorig, Konkol, and Gonzalez in 1987. More specifically, the objectives of this review are: (1) to provide a summary of arthritis patient education studies published or presented since 1987; (2) to summarize the findings concerning the effectiveness of arthritis patient education studies which attempt to change knowledge, behavior, psychosocial status, and health status; (3) to discuss shifting trends in observed outcomes of arthritis patient education studies; and (4) to discuss implications for the future.

Pilot randomized trial of education to improve self-management skills of men with symptomatic HIV/AIDS.

OBJECTIVE: To evaluate the acceptability, practicality, and short-term efficacy of a health education program to improve disease self-management in patients with symptomatic HIV/AIDS. DESIGN: Randomized controlled trial, baseline and 3-month follow-up questionnaire assessments. SETTING: San Francisco Bay communities. PARTICIPANTS: Seventy-one men with symptomatic HIV or AIDS were randomly assigned to a seven-session group educational intervention (N=34) or a usual-care control group (N=37). INTERVENTION: Interactive health education groups were used to teach wide-ranging disease self-management skills and information: symptom assessment and management, medication use, physical exercise, relaxation, doctor-patient communication, and nutrition. Each group was led by two trained peer-leaders (one of whom was HIV-positive) recruited from the community. MAIN OUTCOME MEASURES: The primary outcome of interest was symptom status. Secondary outcomes were self-efficacy and health behaviors. Analysis of covariance was used to compare experimental and control group mean outcomes, adjusting for baseline value differences. RESULTS: The symptom severity index (number of symptoms moderate or greater severity) decreased in the experimental, and increased in the control group (-0.9 versus +0.5; p < .03). Pain, fatigue, and psychological symptoms were not significantly different between groups. Self-efficacy for controlling symptoms improved in the experimental, and decreased in the control group (+4 versus -7; p < .02). Changes in stress/relaxation exercises and HIV/AIDS knowledge were not different between groups. A trend was shown toward more frequent physical exercise in the experimental group compared with less in the control group (+1.3 versus -0.5 times/week; p=.06). CONCLUSIONS: Health education emphasizing self-management skills for HIV/AIDS patients can be implemented and evaluated and was accepted by patients, peer-leaders, and health care providers. Whether this educational program can lead to prolonged improvement in HIV symptoms and behaviors can be adequately addressed only by a larger trial of longer duration.

Chronic disease self-management program: 2-year health status and health care utilization outcomes.

OBJECTIVES: To assess the 1- and 2-year health status, health care utilization and self-efficacy outcomes for the Chronic Disease Self-Management Program (CDSMP). The major hypothesis is that during the 2-year period CDSMP participants will experience improvements or less deterioration than expected in health status and reductions in health care utilization. DESIGN: Longitudinal design as follow-up to a randomized trial. SETTING: Community. PARTICIPANTS: Eight hundred thirty-one participants 40 years and older with heart disease, lung disease, stroke, or arthritis participated in the CDSMP. At 1- and 2-year intervals respectively 82% and 76% of eligible participants completed data. MAIN OUTCOME MEASURES: Health status (self-rated health, disability, social/role activities limitations, energy/fatigue, and health distress), health care utilization (ER/outpatient visits, times hospitalized, and days in hospital), and perceived self-efficacy were measured. MAIN RESULTS: Compared with baseline for each of the 2 years, ER/outpatient visits and health distress were reduced (P <0.05). Self-efficacy improved (P <0.05). The rate of increase is that which is expected in 1 year. There were no other significant changes. CONCLUSIONS: A low-cost program for promoting health self-management can improve elements of health status while reducing health care costs in populations with diverse chronic diseases.

Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.

OBJECTIVES: This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. METHODS: The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service utilization, as determined by mailed, self-administered questionnaires, were measured. RESULTS: Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being. CONCLUSIONS: An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.