Self-management programs refer to formalized training and education programs that are taught by both healthcare professionals and trained layperson instructors. They typically include several sessions over several weeks. These programs train people in several elements of self-management for osteoarthritis including medication compliance, pain management and pain coping strategies, joint protection strategies during physical activity, exercise advice, problem-solving approaches and stress management techniques.
Four high quality studies (Saffari 2018, Somers 2012, Hurley 2007, Omidi 2018) and one moderate quality study (Coleman 2012) compared self-management to usual care or no treatment. These studies reported greater improvements in pain, function, or both compared to the control groups. In addition, some of these studies reported greater improvements in quality of life, pain catastrophizing, and self-efficacy in the self-management groups (Saffari 2018, Somers 2012).
One high quality (Marconcin 2018) and three moderate quality studies examined the combined use of self-management and exercise to either groups that received self-management or exercise alone (Bennell 2016) or usual care (Yip 2007, Kao 2012). Yip et al. reported greater improvements in pain, time spent in leisure activities, and self-efficacy, compared to usual care. (Yip 2007) reported greater improvements in pain and function compared to the control groups. Bennell, et al, reported improvements in pain and function in all groups. There were no differences between groups on pain measures but the combined use of self-management (i.e., pain coping skills training) and exercise had greater improvements in function compared to those receiving only self-management or exercise (Bennell 2016).
An attempt was made to examine the literature on cognitive behavioral therapy (CBT) in the management of people with knee osteoarthritis. One high quality (Helminen 2015) and 4 moderate quality (Focht 2012, Focht 2017, Smith 2015, Lerman 2017) studies were reviewed. Control groups consisted of usual care (Helminen 2015), traditional exercise approaches for knee osteoarthritis, (Focht 2012, Focht 2017) or behavioral desensitization (Smith 2015, Lerman 2017). Inconsistency in outcome results across studies made it difficult to provide a recommendation for this intervention approach at this time.
Benefits/Harms of Implementation
Patients may expect improvements in pain and function, problem-solving abilities, and self-efficacy from participating in these programs. Engagement in exercise recommendations could result in some temporary increased knee pain or muscle soreness.
Outcome Importance
Pain, function, self-efficacy in managing osteoarthritis.
Feasibility
Self-management programs are feasible for patients provided they have appropriate access. Some patients may have limited access for participation, making the programs less feasible.
Future Research
Future research should examine delivery methods designed to increase access for patients (e.g., online delivered programs). Given that some patients with severe symptoms and disability may not be able to respond to self-management programs, future research should assess whether the outcomes of self-management programs vary with disease severity. This research should determine if there is a threshold of disease or disability severity that discriminates between responders and non-responders of this treatment approach.
- (45) Yip YB, Sit JW, Fung KK et al. Effects of a self-management arthritis programme with an added exercise component for osteoarthritic knee: randomized controlled trial. J Adv Nurs 2007;59(1):20-28. PM:17559610
- Bennell, K. L., Ahamed, Y., Jull, G., Bryant, C., Hunt, M. A., Forbes, A. B., Kasza, J., Akram, M., Metcalf, B., Harris, A., Egerton, T., Kenardy, J. A., Nicholas, M. K., Keefe, F. J. Physical Therapist-Delivered Pain Coping Skills Training and Exercise for Knee Osteoarthritis: Randomized Controlled Trial. Arthritis care & research 2016; 5: 590-602
- Coleman, S., Briffa, N. K., Carroll, G., Inderjeeth, C., Cook, N., McQuade, J. A randomised controlled trial of a self-management education program for osteoarthritis of the knee delivered by health care professionals. Arthritis Research & Therapy 2012; 1: R21
- Focht, B. C., Garver, M. J., Lucas, A. R., Devor, S. T., Emery, C. F., Hackshaw, K. V., Fairman, C. M., Bowman, J., Rejeski, W. J. A group-mediated physical activity intervention in older knee osteoarthritis patients: effects on social cognitive outcomes. Journal of Behavioral Medicine 2017; 3: 530-537
- Hurley, M. V., Walsh, N. E., Mitchell, H. L., Pimm, T. J., Patel, A., Williamson, E., Jones, R. H., Dieppe, P. A., Reeves, B. C. Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: a cluster randomized trial. Arthritis & Rheumatism 2007; 7: 1211-9
- Kao, M. J., Wu, M. P., Tsai, M. W., Chang, W. W., Wu, S. F. The effectiveness of a self-management program on quality of life for knee osteoarthritis (OA) patients. Archives of Gerontology & Geriatrics 2012; 2: 317-24
- Lerman, S. F., Finan, P. H., Smith, M. T., Haythornthwaite, J. A. Psychological interventions that target sleep reduce pain catastrophizing in knee osteoarthritis. Pain 2017; 11: 2189-2195
- Marconcin, P., Espanha, M., Teles, J., Bento, P., Campos, P., Andre, R., Yazigi, F. A randomized controlled trial of a combined self-management and exercise intervention for elderly people with osteoarthritis of the knee: the PLE2NO program. Clinical Rehabilitation 2018; 2: 223-232
- Omidi, A., Zanganeh, M. J., Khodaveisi, M., Mohammadi, Y. The effect of self-management training on pain intensity in patients with knee osteoarthritis referring to orthopedic clinic of Imam Hossein Hospital in Malayer. National Journal of Physiology, Pharmacy and Pharmacology 2018; 7: 1035-1040
- Saffari, M., Emami Meybodi, M. K., Sanaeinasab, H., Karami, A., Pakpour, A. H., Koenig, H. G. A theory of planned behavior-based intervention to improve quality of life in patients with knee/hip osteoarthritis: a randomized controlled trial. Clinical Rheumatology 2018; 0: 10
- Smith, M. T., Finan, P. H., Buenaver, L. F., Robinson, M., Haque, U., Quain, A., McInrue, E., Han, D., Leoutsakis, J., Haythornthwaite, J. A. Cognitive-behavioral therapy for insomnia in knee osteoarthritis: A randomized, double-blind, active placebo-controlled clinical trial. Arthritis and Rheumatology 2015; 5: 1221-1233
- Somers, T. J., Blumenthal, J. A., Guilak, F., Kraus, V. B., Schmitt, D. O., Babyak, M. A., Craighead, L. W., Caldwell, D. S., Rice, J. R., McKee, D. C., Shelby, R. A., Campbell, L. C., Pells, J. J., Sims, E. L., Queen, R., Carson, J. W., Connelly, M., Dixon, K. E., Lacaille, L. J., Huebner, J. L., Rejeski, W. J., Keefe, F. J. Pain coping skills training and lifestyle behavioral weight management in patients with knee osteoarthritis: a randomized controlled study. Pain 2012; 6: 1199-209
- Omidi, A., Zanganeh, M. J., Khodaveisi, M., Mohammadi, Y. The effect of self-management training on pain intensity in patients with knee osteoarthritis referring to orthopedic clinic of Imam Hossein Hospital in Malayer. National Journal of Physiology, Pharmacy and Pharmacology 2018; 7: 1035-1040
- Helminen, E. E., Sinikallio, S. H., Valjakka, A. L., Vaisanen-Rouvali, R. H., Arokoski, J. P. Effectiveness of a cognitive-behavioural group intervention for knee osteoarthritis pain: a randomized controlled trial. Clinical Rehabilitation 2015; 9: 868-81
- Focht, B. C., Garver, M. J., Lucas, A. R., Devor, S. T., Emery, C. F., Hackshaw, K. V., Fairman, C. M., Bowman, J., Rejeski, W. J. A group-mediated physical activity intervention in older knee osteoarthritis patients: effects on social cognitive outcomes. Journal of Behavioral Medicine 2017; 3: 530-537