Self-management education programmes for osteoarthritis

• Published in: Cochrane database of systematic reviews 2014-01, Vol.2014 (1), p.CD008963-CD008963
• Main Authors: Kroon, Féline P B, van der Burg, Lennart R A, Buchbinder, Rachelle, Osborne, Richard H, Johnston, Renea V, Pitt, Veronica
• Format: Article
• Language: English
• Subjects: Female; Health Literacy; Humans; Male; Osteoarthritis; Osteoarthritis - therapy; Pain Management - methods; Patient Education as Topic - methods; Program Evaluation; Randomized Controlled Trials as Topic; Rheumatology; Self Care - methods
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD008963.pub2

Self-management education programmes are complex interventions specifically targeted at patient education and behaviour modification. They are designed to encourage people with chronic disease to take an active self-management role to supplement medical care and improve outcomes. To assess the effectiveness of self-management education programmes for people with osteoarthritis. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PyscINFO, SCOPUS and the World Health Organization (WHO) International Clinical Trial Registry Platform were searched, without language restriction, on 17 January 2013. We checked references of reviews and included trials to identify additional studies. Randomised controlled trials of self-management education programmes in people with osteoarthritis were included. Studies with participants receiving passive recipients of care and studies comparing one type of programme versus another were excluded. In addition to standard methods we extracted components of the self-management interventions using the eight domains of the Health Education Impact Questionnaire (heiQ), and contextual and participant characteristics using PROGRESS-Plus and the Health Literacy Questionnaire (HLQ). Outcomes included self-management of osteoarthritis, participant's positive and active engagement in life, pain, global symptom score, self-reported function, quality of life and withdrawals (including dropouts and those lost to follow-up). We assessed the quality of the body of evidence for these outcomes using the GRADE approach. We included twenty-nine studies (6,753 participants) that compared self-management education programmes to attention control (five studies), usual care (17 studies), information alone (four studies) or another intervention (seven studies). Although heterogeneous, most interventions included elements of skill and technique acquisition (94%), health-directed activity (85%) and self-monitoring and insight (79%); social integration and support were addressed in only 12%. Most studies did not provide enough information to assess all PROGRESS-Plus items. Eight studies included predominantly Caucasian, educated female participants, and only four provided any information on participants' health literacy. All studies were at high risk of performance and detection bias for self-reported outcomes; 20 studies were at high risk of selection bias, 16 were at high risk of attrition bias, two were at high risk of reportin