Impact of an arthritis self-management programme with an added exercise component for osteoarthritic knee sufferers on improving pain, functional outcomes, and use of health care services: An experimental study

Abstract

Objective

The aim of this study was to assess the effect of an adopted Arthritis Self-Management Programme (ASMP) with an added exercise component among osteoarthritic knee sufferers in Hong Kong.

Methods

An experimental study with 88 participants assigned to an intervention group and 94 participants to a control group. One hundred and forty-nine participants (81.9%) completed the 1 week and 120 participants (65.6%) the 16 week post-intervention assessments. Participants in the intervention group received a 6-week ASMP with an added exercise component. Outcome measures included arthritic pain and fatigue rating, practice of light exercise routines, functional status, and number of unplanned arthritis-related medical consultations. To assess the programme's effect on outcome measures, the between-groups and within-group mean changes were compared using Mann–Whitney U-test and Friedman test.

Results

At 16 weeks, there were significant mean changes between groups in four outcome measures: reduction in arthritis pain (p = 0.0001) and fatigue (p = 0.008), and increased duration of weekly light exercise practice (p = 0.0001) and knee flexion (p = 0.004). The ability to perform daily activities and the number of unplanned arthritis-related medical consultations show statistically significant improvements between three time-points within the intervention group only (p = 0.0001 and p = 0.005, respectively), but not between-groups (p = 0.14 and p = 0.86, respectively). Both groups apparently had no changes in muscle strength.

Conclusion

Our findings suggest that the intervention had a positive effect in reducing pain, fatigue, knee range of motion, the practice of exercise routines, the number of medical consultations and in improving functional status and over a 16-week period.

Practice implications

The self-management programme we applied took into account the local context and the ethnicity of the group. This process is worth further exploration and testing in different groups.

Introduction

Osteoarthritis is one of the most prevalent activity-limiting conditions among older people in developed countries [1]. A local general household survey [2] reported that about 30% of Hong Kong people aged over 65 had been diagnosed with osteoarthritis and about 11% of the interviewed population with arthritis required long-term follow-up [3]. Arthritis of the knee is particularly common among Hong Kong Chinese and is responsible for most of the disablement of the elderly in Hong Kong [4]. Another local survey reported that of people aged 50 and over, 13% of women and 7% of men were diagnosed with osteoarthritis of the knee [5] and that 24% of women and 17% of men had persistent knee pain.

Because of its common and chronic nature amongst the local population, effective management lies heavily on those with osteoarthritic knee problems to self-manage their own symptoms on a day-to-day basis. Patient education needs to focus on preventing exacerbation of the condition, inspiring in them the confidence to learn and empowering them to manage their every day lives within the culture [6], [7].

Self-efficacy, developed by Bandura [8] as part of social learning theory, can be enhanced through four sources of information: performance accomplishments, vicarious learning, verbal persuasion, and physiological information. By adopting this self-efficacy theory, self-management programmes enhance the participants’ perception of control of their illness and enable them to apply more effective self-management strategies on a day-to-day basis. It empowers participants and moves away from the traditional passive patient role. Experimental studies of the Arthritis Self-Management Programme (ASMP) originally developed by Lorig and Gonzalev [7] suggest that activating effective self-management of arthritis is important in achieving good outcomes, such as decreased levels of patient's arthritis pain [9], [10], [11], [12]. However, other research indicates conflicting results [15], [16].

Most studies of arthritis education programmes have been conducted in Western countries [10], [12], [13], [14], [16], [17]. Despite the steep increase of osteoarthritis prevalence with age [18], there is a paucity of self-management education programmes for older adults with osteoarthritis in Asian countries. Evidence-based health education programmes are needed to develop, implement and test the effectiveness of programmes with different cultures [9]. A pilot study carried out by us previously [19] showed that a self-management programme was effective in reducing arthritic pain among old aged residents in long-term care settings. As in a similar study on rheumatoid arthritis [20], we found that most local Chinese participants wished to emphasize learning exercise routines rather than learning coping strategies. Talbot et al. [21] found that participants in self-management programmes may independently follow exercise regimes but that it varied on an individual basis. Most of the time, osteoarthritic sufferers only exercise if they feel relatively pain-free. Stenstrom [22] further found that rather than letting individuals decide on when to exercise, specific goal increases in a regular goal-directed exercise programme was of benefit for arthritis sufferers. As exercises were found to be an important component of the first line non-pharmacologic treatment of knee osteoarthritis [23], we modified the ASMP used previously to give emphasis to light exercise routines.

The current experimental study evaluates the effectiveness of the adopted ASMP intervention with an added exercise component among Chinese osteoarthritic knee sufferers. This article reports the results of clinical outcome measures on improving pain, function, and on the use of health care services.